Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction.

PubMed

Macri, Erin M; Culvenor, Adam G; Morris, Hayden G; Whitehead, Timothy S; Russell, Trevor G; Khan, Karim M; Crossley, Kay M

2017-05-09

Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. IV.

A combined procedure with Bereiter-type trochleoplasty leads to a stable patellofemoral joint at 5-year follow-up.

PubMed

Wind, Rutger J P; Heesterbeek, Petra J C; Wymenga, Ate B

2018-06-11

Trochlear dysplasia is a major risk factor predisposing to patellar instability and has been reported to occur in up to 85% of patients with recurrent patellar dislocation. Different operative techniques have been described to correct trochlear dysplasia, including the Bereiter technique, in which subchondral bone is removed and the cartilage can be compressed into a U-shaped groove. The hypothesis was that after a Bereiter-type trochleoplasty combined with medialisation of the tibial tubercle and MPFL reconstruction, patellar pain and instability decreased and anatomic reconstruction can be seen radiographically after 5-year follow-up. Between 2004 and 2011, a combined procedure including Bereiter-type trochleoplasty was performed on 21 consecutively included patients (22 knees) with objective patellar instability and severe trochlear dysplasia. Instability and pain were assessed preoperatively and 3, 6, 12, 24 and 60 months postoperatively with the visual analogue scale (VAS) for pain and instability, Kujala, International Knee Documentation Committee Subjective Knee Evaluation (IKDC SKE) and Short Form Health Survey (SF-36). Pre- and postoperatively, a true lateral radiograph was made to investigate the presence of the crossing sign and to measure the trochlear bump and trochlear depth, as well as a sunrise patella view to measure the sulcus angle. VAS pain and instability, Kujala and IKDC SKE improved significantly 5 years after trochleoplasty (p < 0.05). SF-36 showed no significant improvement. None of the patients reported patellar dislocations postoperatively. Sport activities remained limited. Postoperative radiographs showed no crossing sign. There was a significant increase in trochlear depth (p < 0.0001) and also a significant decrease in trochlear bump and sulcus angle (both p < 0.0001). A combined procedure consisting of Bereiter-type trochleoplasty, medialisation of the tibial tubercle and MPFL reconstruction in patients with objective patellar instability and severe trochlear dysplasia resulted in a clear decrease of pain and instability. Radiological assessment showed anatomical reconstruction. Nevertheless, residual symptoms remain and the possibility of future cartilage damage is uncertain. IV.

Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects.

PubMed

Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Dovi-Akue, David; Südkamp, Norbert P; Niemeyer, Philipp

2016-03-01

To compare the geometry of the patellofemoral joint on magnetic resonance images (MRI) between patients with isolated cartilage defects of the patella and a gender- and age-matched control group of patients without patellar cartilage defects. A total of 43 patients (17 female, 26 male) with arthroscopically verified grade III and IV patellar cartilage defects (defect group) were compared with a matched-pair control group of patients with isolated traumatic rupture of the anterior cruciate ligament without cartilage defects of the patellofemoral joint. Preoperative MRI images were analysed retrospectively with regard to patellar geometry (width, thickness, facet angle), trochlear geometry (dysplasia according to Dejour, sulcus angle, sulcus depth, lateral condyle index, trochlea facet asymmetry, lateral trochlea inclination) and patellofemoral alignment (tibial tuberosity-trochlear groove distance, patella height, lateral patella displacement, lateral patellofemoral angle, patella tilt, congruence angle). In addition to the comparison of group values, the measured values were compared to normal values reported in the literature, and the frequency of patients with pathologic findings was compared between both groups. The defect group demonstrated a significantly higher proximal chondral sulcus angle (p < 0.001), a significantly higher distal osseal sulcus angle (p = 0.004), a significantly lower distal sulcus depth (p = 0.047), a significantly lower lateral condyle index (p = 0.045), a significantly lower Caton-Deschamps index (p = 0.020) and a significantly higher Insall-Salvati index (p = 0.010). A major trochlear dysplasia (grade B-D) was significantly more common in the defect group (54 vs. 19%; p < 0.001). Eighty-eight per cent of patients in the defect group demonstrated at least one pathologic finding, compared to 63% in the control group (p = 0.006). Two or more pathologic findings were observed in 42% of the defect group and in 19% of the control group (p = 0.019). There was no significant correlation between the localization of the chondral defects and the results of the measured parameters. Cartilage defects of the patella are associated with the geometry of the patellofemoral joint. In particular, a flat and shallow trochlea, trochlea dysplasia and patella alta seem to contribute to the development of patellar cartilage defects, which must be taken into consideration when planning to do surgical cartilage repair at the patella. III.

Effects of surgical intervention on trochlear remodeling in pediatric patients with recurrent patella dislocation cases.

PubMed

Sugimoto, Dai; Christino, Melissa A; Micheli, Lyle J

2016-07-01

Patella instability is often encountered among physically active pediatric athletes, and surgical intervention is useful in cases with recurrent patella dislocations, chronic instability, and abnormal alignment. Several surgical procedures have been used for patella-realignment and stabilization, but the effects of surgical intervention on bony trochlear remodeling in skeletally immature patients have not been well studied. We thus present two cases of pediatric recurrent patella dislocations that showed trochlear remodeling following patella-realignment surgery. The first case describes an 11-year-old female treated with a Roux-Golthwait procedure and the second case highlights a 12-year-old male treated with lateral release and medial capsular reefing. The Merchant technique, a radiographic criterion that was designed to evaluate patella alignment in relation to the femoral trochlea groove, including sulcus and congruence angles was used to measure postoperative bony development. Both pediatric patients showed successful outcomes following surgical interventions for chronic patella instability. Using the Merchant technique, both patients showed improved congruence and sulcus angles postoperatively. Patella realignment in skeletally immature patients may be beneficial for promoting trochlear remodeling and deepening of the trochlear groove, which may help protect against future dislocation or subluxation events. Level IV, case report.

Does severity of femoral trochlear dysplasia affect outcome in patellofemoral instability treated by medial patellofemoral ligament reconstruction and anterior tibial tuberosity transfer?

PubMed

Moitrel, G; Roumazeille, T; Arnould, A; Migaud, H; Putman, S; Ramdane, N; Pasquier, G

2015-10-01

Medial patellofemoral ligament (MPFL) reconstruction associated to anterior tibial tuberosity transfer (ATTT) is recommended in objective patellofemoral instability (PFI). Efficacy, however, has not been precisely determined in trochlear dysplasia with spur. A case-control study was performed in a PFI population, comparing groups with trochlear dysplasia with and without spur (S+ vs. S-) to assess the impact of trochlear dysplasia on (1) patellofemoral stability, (2) functional results and complications, and (3) patellofemoral cartilage status on MRI. Trochlear spur does not affect outcome in PFI managed by MPFL reconstruction and ATTT. Twenty-eight knees (26 patients) with PFI were analyzed retrospectively and divided into 2 groups of 14 knees each according to presence of trochlear spur (S+ vs. S-). All 28 knees had undergone ATTT and MPFL reconstruction by semitendinosus autograft. Results were assessed on Lille and IKDC functional scores, and cartilage status was determined on MRI at last follow-up. At a mean 24 months' follow-up (range, 12-52 months), there was no recurrence of dislocation. IKDC and Lille scores tended to improve in both groups, although the only significant improvement was in IKDC score (S- gain, 21.3±16; S+ gain, 18.1±14) (P=0.01). IKDC scores at last follow-up were better in the S+ than S- group (79±19 [range, 21-92] vs. 68±13 [range, 35-84], respectively; P=0.012). Lille scores showed no significant inter-group differences in mean gain (P=0.492) or mean value (P=0.381). The S+ group showed more cartilage lesions (n=14/14 knees, including 12/14 with grade≥2 lesions) than the S- group (n=9/14 knees, all grade≤2). MPFL reconstruction with ATTT provided good short-term patellofemoral stability independently of the severity of trochlear dysplasia. Functional results and gain on IKDC, however, were poorer in case of dysplasia with trochlear spur. This is probably due to cartilage lesions, observed more frequently pre- and post-operatively in the spur group, especially as there was no significant difference in Lille Score, which highlights stability. III, retrospective case-control study. Copyright © 2015. Published by Elsevier Masson SAS.

Transventricular Transvelar Approach to Trochlear Nerve Schwannoma: Novel Technique to Lesions of Inferior Pineal Region.

PubMed

Farrokhi, Majid Reza; Ghaffarpasand, Fariborz; Taghipour, Mousa; Derakhshan, Nima

2018-06-01

The schwannoma of the trochlear nerve is rare and originates mostly from the distal parts in the interpeduncular cistern. A lesion on the proximal segment in the inferior pineal region is extremely rare. Because of the rarity of the disease, the surgical approach to this region for the resection of trochlear nerve schwannoma has not been well documented in the literature. We herein describe a novel approach to successfully resect the trochlear nerve schwannoma. A 12-year-old boy presented with occipital headache, abnormal gait, and disturbed conjoined eye movement. He was diagnosed with a lesion in the inferior pineal region compressing the superior medullary velum into the roof of the fourth ventricle. A bilateral midline suboccipital craniotomy was performed, and the fourth ventricle was exposed. The lesion was approached through the fourth ventricle superior medullary velum (transventricular transvelar approach). The lesion was totally resected, and his histopathology examination revealed trochlear schwannoma. The patient's symptoms resolved, and he had no recurrence at 12-year follow-up with normal eye movement and vision. The transventricular transvelar approach is feasible and safe to treat a lesion of the lower part of the pineal region being pushed through the superior medullary velum. Copyright © 2018 Elsevier Inc. All rights reserved.

Evaluation of a modified knee rotation angle in MRI scans with and without trochlear dysplasia: a parameter independent of knee size and trochlear morphology.

PubMed

Dornacher, Daniel; Trubrich, Angela; Guelke, Joachim; Reichel, Heiko; Kappe, Thomas

2017-08-01

Regarding TT-TG in knee realignment surgery, two aspects have to be considered: first, there might be flaws in using absolute values for TT-TG, ignoring the knee size of the individual. Second, in high-grade trochlear dysplasia with a dome-shaped trochlea, measurement of TT-TG has proven to lack precision and reliability. The purpose of this examination was to establish a knee rotation angle, independent of the size of the individual knee and unaffected by a dysplastic trochlea. A total of 114 consecutive MRI scans of knee joints were analysed by two observers, retrospectively. Of these, 59 were obtained from patients with trochlear dysplasia, and another 55 were obtained from patients presenting with a different pathology of the knee joint. Trochlear dysplasia was classified into low grade and high grade. TT-TG was measured according to the method described by Schoettle et al. In addition, a modified knee rotation angle was assessed. Interobserver reliability of the knee rotation angle and its correlation with TT-TG was calculated. The knee rotation angle showed good correlation with TT-TG in the readings of observer 1 and observer 2. Interobserver correlation of the parameter showed excellent values for the scans with normal trochlea, low-grade and high-grade trochlear dysplasia, respectively. All calculations were statistically significant (p < 0.05). The knee rotation angle might meet the requirements for precise diagnostics in knee realignment surgery. Unlike TT-TG, this parameter seems not to be affected by a dysplastic trochlea. In addition, the dimensionless parameter is independent of the knee size of the individual. II.

Microsurgical anatomy of the trochlear nerve.

PubMed

Joo, Wonil; Rhoton, Albert L

2015-10-01

The trochlear nerve is the cranial nerve with the longest intracranial course, but also the thinnest. It is the only nerve that arises from the dorsal surface of the brainstem and decussates in the superior medullary velum. After leaving the dorsal surface of the brainstem, it courses anterolaterally around the lateral surface of the brainstem and then passes anteriorly just beneath the free edge of the tentorium. It passes forward to enter the cavernous sinus, traverses the superior orbital fissure and terminates in the superior oblique muscle in the orbit. Because of its small diameter and its long course, the trochlear nerve can easily be injured during surgical procedures. Therefore, precise knowledge of its surgical anatomy and its neurovascular relationships is essential for approaching and removing complex lesions of the orbit and the middle and posterior fossae safely. This review describes the microsurgical anatomy of the trochlear nerve and is illustrated with pictures involving the nerve and its surrounding connective and neurovascular structures. © 2015 Wiley Periodicals, Inc.

A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up.

PubMed

Tigchelaar, S; van Sambeeck, J; Koeter, S; van Kampen, A

2018-04-01

Trochlear osteotomy is a rarely performed procedure, only indicated in selected cases. Due to its nature, it can potentially lead to cartilage damage and subsequent early osteoarthritis. Satisfactory short-term results from lateral condyle-elevating osteotomy have previously been reported. The long-term effects of this procedure on clinical outcomes, patellar stability and radiological osteoarthritis are reported here. Sixteen patients (19 knees) with patellar instability due to trochlear dysplasia were included. An isolated lateral condyle-elevating trochlear osteotomy was performed between 1995 and 2002. All patients were re-examined at a minimum of 12-year follow-up. Three patients were lost to follow-up, and one patient underwent a patellofemoral arthroplasty 3 years post-operatively due to progressive osteoarthritis. Complete follow-up was therefore available in 12 patients (15 knees). Recurrent instability, VAS pain, WOMAC, Lysholm and Kujala scores were used as outcome measures. Radiological osteoarthritis was recorded using the Iwano and the Kellgren-Lawrence classifications. A repeated-measures ANOVA was used to test for repeated measures (pre-operative, 2-year and final follow-up), and Spearman's correlation coefficient for relationships between osteoarthritis and functional scores. At final follow-up, VAS pain showed a non-significant improvement from 52 to 25, and the median Kujala score was 78. Median Lysholm (54-71, p = 0.021) and WOMAC (78-96, p = 0.021) scores improved from the pre-operative assessment to final follow-up. There was no significant difference observed between clinical scores at the 2-year and final follow-up. Residual patellar instability was reported in four out of 15 knees. Three knees showed no patellofemoral osteoarthritis, eight knees had grade 1 and four knees grade 2. No correlation between VAS pain, Lysholm, WOMAC or Kujala scores and osteoarthritis could be identified (n.s.). A stand-alone lateral condyle-elevating trochleoplasty results in the significant improvement of most clinical scores; however, when performed as a stand-alone procedure, it leads to a high percentage of residual instability. In contrast to general belief, the development of patellofemoral osteoarthritis at 12-year follow-up did not exceed the findings from other trochleoplasty case series. Case series with no comparison group, Level IV.

[Usefulness of magnetic resonance imaging in the evaluation of patellar malalignment].

PubMed

Figueroa, D; Novoa, F; Meleán, P; Calvo, R; Vaisman, A; Figueroa, F; Delgado, G

2014-01-01

The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) at 20° of knee flexion in patients with patellofemoral pain syndrome (PFPS) caused by suspected patellofemoral malalignment (PFM). Fifty MRIs were performed on 25 patients with PFPS secondary to suspected PFM based on clinical examination, and on 25 patients without PFPS (control group). Measurements were made of tibial tuberosity-trochlear groove distance (TTTG) and modified Laurin, Merchant and trochlear angles. The results were analyzed with ANOVA and Fischer tests. Pearson correlation coefficients were used to analyze differences between PFPS and control cases. Specificity, sensitivity, positive predictive value and negative predictive value for knee pain were documented. Significant differences were observed between PFPS and control groups in TTTG (11.79 mm vs. 9.35 mm; P=.002), Laurin angle (12.17° vs. 15.56°; P=.05), and trochlear angle (139° vs. 130.02°; P=.049). No differences were found between groups as regards the Merchant angle (P=.5). TTTG was 70% predictive of PFPS; however, it was only 53.33% specific, with a sensitivity of 51.61% for PFPS. Laurin angle was 77.78% predictive of PFPS, with a specificity of 92% and a sensitivity of 28%. Trochlear angle was 85.71% predictive of PFPS, with a specificity of 96% and a sensitivity of 24%. MRI can confirm clinically suspected PFPS secondary to malalignment. MRI determination of TTTG, patellar tilt, and trochlear angle correlates positively with clinical diagnosis of PFPS, suggesting that PFPS is caused by subtle malalignment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Analysis of failed surgery for patellar instability in children with open growth plates.

PubMed

Nelitz, Manfred; Theile, Michael; Dornacher, Daniel; Wölfle, Julia; Reichel, Heiko; Lippacher, Sabine

2012-05-01

Many surgical procedures have been proposed to treat recurrent patellar dislocation in children. In recent years, a more tailored approach considering the underlying pathology has been advocated. The aim of the study was to analyze a group of patients with recurrent patellofemoral instability after unsuccessful operative stabilization (Roux-Goldthwait procedure, lateral release, medial reefing or in combination) in childhood and adolescence. A total of 37 children and adolescents with recurrent patellofemoral instability despite previous surgery were analyzed retrospectively. Radiographic examination included AP and lateral views to assess patella alta and limb alignment. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TTTG) distance. As a control group, 23 age- and sex-matched adolescents that were treated with a favorable outcome after medial reefing alone or combined with a Roux-Goldthwait procedure were analyzed. Severe trochlear dysplasia (type B-D according to Dejour) as detected on MRI scans was found significantly more often in the study group (89%) than in the control group (21%). No statistical difference of patellar height ratio (Insall-Salvati index) and TTTG distance between the two groups could be found. Of the measured parameters, only the incidence of trochlear dysplasia was increased. Trochlear dysplasia therefore seems to be a major risk factor for failure of operative stabilization of recurrent patellofemoral instability in children and adolescents. The results in children are in consensus with the literature in adults that a more tailored operative therapy including reconstruction of the MPFL and trochleaplasty has to be considered. Retrospective study, Level III.

Application of an artificial neural network and morphing techniques in the redesign of dysplastic trochlea.

PubMed

Cho, Kyung Jin; Müller, Jacobus H; Erasmus, Pieter J; DeJour, David; Scheffer, Cornie

2014-01-01

Segmentation and computer assisted design tools have the potential to test the validity of simulated surgical procedures, e.g., trochleoplasty. A repeatable measurement method for three dimensional femur models that enables quantification of knee parameters of the distal femur is presented. Fifteen healthy knees are analysed using the method to provide a training set for an artificial neural network. The aim is to use this artificial neural network for the prediction of parameter values that describe the shape of a normal trochlear groove geometry. This is achieved by feeding the artificial neural network with the unaffected parameters of a dysplastic knee. Four dysplastic knees (Type A through D) are virtually redesigned by way of morphing the groove geometries based on the suggested shape from the artificial neural network. Each of the four resulting shapes is analysed and compared to its initial dysplastic shape in terms of three anteroposterior dimensions: lateral, central and medial. For the four knees the trochlear depth is increased, the ventral trochlear prominence reduced and the sulcus angle corrected to within published normal ranges. The results show a lateral facet elevation inadequate, with a sulcus deepening or a depression trochleoplasty more beneficial to correct trochlear dysplasia.

Chondromalacia of the trochlear notch in athletes who throw.

PubMed

Robla, J; Hechtman, K S; Uribe, J W; Phillipon, M S

1996-01-01

Six athletes who throw and one shot-putter who underwent elbow arthroscopy were found to have an area of chondromalacia involving the posterolateral aspect of the olecranon. Preoperative symptoms were pain and tenderness to palpation over the lateral edge of the olecranon. On physical examination, range of motion was full or only slightly decreased (< 5 degrees) in five patients; coexistent loose bodies were also noted in two patients having a 20 degrees loss of extension. None of the patients exhibited ligamentous laxity to valgus stress testing of the elbow. During arthroscopy, the involved area was distinct from the bare area of the olecranon. This area was found as an isolated lesion in only one of seven patients; localized synovitis was noted in five patients, olecranon osteophytes in three, and loose bodies in two. A reciprocal lesion on the articular surface of the humerus was not identified in any patient. During arthroscopy, the lesion was debrided to a stable margin, and all associated pathologic conditions were addressed. Six of the seven athletes were able to return to their sport at premorbidity levels with this approach. This area of trochlear chondromalacia has not been previously described and, in our study, occurred in individuals whose elbows were subjected to repetitive valgus stress with lateral compression.

Longitudinal change in patellofemoral cartilage thickness, cartilage T2 relaxation times, and subchondral bone plate area in adolescent vs mature athletes.

PubMed

Culvenor, Adam G; Wirth, Wolfgang; Maschek, Susanne; Boeth, Heide; Diederichs, Gerd; Duda, Georg; Eckstein, Felix

2017-07-01

Patellofemoral cartilage changes have been evaluated in knee trauma and osteoarthritis; however, little is known about changes in patellar and trochlear cartilage thickness, T2 relaxation-time and subchondral bone plate area (tAB) during growth. Our prospective study aimed to explore longitudinal change in patellofemoral cartilage thickness, T2 and tAB in adolescent athletes, and to compare these data with those of mature (i.e., adult) athletes. 20 adolescent (age 16±1years) and 20 mature (46±5years) volleyball players were studied over 2-years (10 men and 10 women each group). 1.5T MRI 3D-VIBE and multi-echo spin-echo sequences were acquired at baseline and 2-year follow-up. Using manual segmentation and 3D reconstruction, longitudinal changes in patellar and trochlear cartilage thickness, patellar cartilage T2 (mono-exponential decay curve with five echoes [9.7-67.9ms]), and patellar and trochlear tAB were determined. The annual increase in both patellar and trochlear cartilage thickness was 0.8% (95% confidence interval [CI] 0.6, 1.0) and 0.6% (0.3, 0.9), for adolescent males and females respectively; the longitudinal gain in patellar and trochlear tAB was 1.3% (1.1, 1.5) and 0.5% (0.2, 0.8), and 1.6% (1.1, 2.2) and 0.8% (0.3, 0.7) for adolescent males and females, respectively (no significant between-sex differences). Mature athletes showed smaller gains in tAB, and loss of <1% of cartilage thickness annually. While no significant sex-differences existed in adolescent patellar T2 changes, mature males gained significantly greater T2 than mature females (p=0.002-0.013). Patellar and trochlear cartilage thickness and tAB were observed to increase in young athletes in late adolescence, without significant differences between sexes. Mature athletes displayed patellar cartilage loss (and T2 increases in mature males), potentially reflecting degenerative changes. Copyright © 2017 Elsevier B.V. All rights reserved.

Superolateral Hoffa's Fat Pad Edema in Collegiate Volleyball Players.

PubMed

Mehta, Kaushal; Wissman, Robert; England, Eric; Dʼheurle, Albert; Newton, Keith; Kenter, Keith

2015-01-01

Superolateral Hoffa's fat pad (SHFP) edema is a previously described magnetic resonance (MR) finding located between the patellar tendon and the lateral femoral condyle. The purpose of our study was to determine the prevalence and clinical significance of SHFP edema in female collegiate volleyball players. Sixteen female collegiate volleyball players were consented for bilateral knee evaluations which consisted of history, physical examination and MR imaging. Each MR study was reviewed for the presence of SHFP edema, and 6 patellar maltracking measurements were done. These were tibial tuberosity-trochlear groove distance, patellar translation, lateral patellofemoral angle, trochlear depth, trochlear sulcus angle, and lateral trochlear inclination angle. A total of 16 athletes, 32 knees (16 girls; age range, 18-22 years; mean, 19.9) were enrolled in the study. Sixteen knees (50%) in 8 athletes had SHFP edema, with 100% bilaterality; 16 knees in 8 athletes had no evidence of SHFP edema (50%). Functional outcomes and physical examination findings were within normal limits for all athletes with no difference noted between SHFP edema-positive and -negative individuals. There was a statistically significant difference in the tibial tuberosity-trochlear groove distance, patellar translation, and patellofemoral angle (P value of < 0.001, 0.03 and 0.01, respectively) between the SHFP edema-positive and -negative individuals. Elite female volleyball athletes have a very high prevalence of SHFP edema, which is always bilateral. Although the exact etiology of SHFP edema remains inconclusive, it could potentially be a sensitive indicator of subtle patellar maltracking which cannot be distinguished by history and physical examination findings. Given the very high prevalence of SHFP edema and this being an asymptomatic finding, there is likely little clinical significance of this in majority of high-performance athletes.

Femoral rotational asymmetry is a common anatomical variant.

PubMed

Newman, Christopher R; Walter, William L; Talbot, Simon

2018-05-01

The sulcus line (SL) is a three-dimensional landmark that corrects for individual variation in the coronal alignment of the trochlear groove in contrast to the traditional Whiteside's line (WL). Femoral rotational asymmetry (FRA) is an anatomical variation in which the posterior condyles and trochlear groove are not perpendicular to each other. This study aims to measure the SL and assess its reliability relative to WL, in addition to measuring and classifying the FRA. A retrospective analysis of a series of 191 CT scans of nonarthritic knees was performed. Measurements were taken of rotational landmarks in three-dimensional reconstructions. The variability and outlier rate of SL was less than WL (P < 0.05), however, it was also greater than the posterior condylar line (PC) (P < 0.05). Averaging the PC + 3° and the SL did not change the rate of femoral malrotation relative to the surgical epicondylar axis (SEA) (P > 0.05), however it decreased the rate of change of the rotational alignment of the trochlear groove between the native knee and the prosthetic knee from 31% to 5% (P < 0.05). FRA was classified and was >5° in 56/191 (29%) of cases. The SL technique is more accurate than WL for determining the rotational alignment of the trochlear groove. Nonarthritic femora have a high rate of rotational asymmetry. Identifying and classifying FRA in individual cases allows the femoral component to be inserted in a position which gives the best possible match to both the native posterior condyles and trochlear groove. Clin. Anat. 31:551-559, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Combined Brown syndrome and superior oblique palsy without a trochlear nerve: case report.

PubMed

Yang, Hee Kyung; Kim, Jae Hyoung; Kim, Ji-Soo; Hwang, Jeong-Min

2017-08-25

Congenital Brown syndrome is characterized by limited elevation particularly during adduction. The pathogenesis of congenital Brown syndrome is still controversial. A 6-year-old boy had been tilting his head to the left since infancy. He showed right hypertropia (RHT) of 2 prism diopters (Δ) in the primary position. He showed RHT 6Δ in right gaze, RHT 2Δ in left gaze, RHT 12Δ in right head tilt, and orthotropia in left head tilt. The right eye showed limitation of elevation and depression on adduction, and the left eye showed overdepression on adduction. MR images showed an absent right trochlear nerve with a hypoplastic ipsilateral superior oblique muscle. Congenital Brown syndrome may be associated with an absent trochlear nerve and hypoplastic superior oblique muscle suggesting an etiologic mechanism of congenital cranial dysinnervation disorder.

Editorial Commentary: Which Came First, the Patella or the Trochlea? Morphological Relationships in Patients With Patellar Instability.

PubMed

Tanaka, Miho J

2018-06-01

Trochlear dysplasia and patella alta are known risk factors for patellar instability, yet the relation between the two has not been well understood. Morphologic abnormalities such as trochlear dysplasia and patella alta are known to alter patellofemoral kinematics, whereas altered contact pressures, in turn, have been associated with the development of trochlear dysplasia. As our current treatments aim to correct these deformities through increasingly complex procedures such as trochleoplasty and tuberosity distalization, we should consider this relation and the potential for changing the course of developing such morphologic abnormalities earlier in life. Further studies on the developmental cause of this disorder may help guide future treatments in the management of patellar instability. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Molecular and Culture-Based Assessment of the Microbial Diversity of Diabetic Chronic Foot Wounds and Contralateral Skin Sites

PubMed Central

Oates, Angela; Bowling, Frank L.; Boulton, Andrew J. M.

2012-01-01

Wound debridement samples and contralateral (healthy) skin swabs acquired from 26 patients attending a specialist foot clinic were analyzed by differential isolation and eubacterium-specific PCR-denaturing gradient gel electrophoresis (DGGE) in conjunction with DNA sequencing. Thirteen of 26 wounds harbored pathogens according to culture analyses, with Staphylococcus aureus being the most common (13/13). Candida (1/13), pseudomonas (1/13), and streptococcus (7/13) were less prevalent. Contralateral skin was associated with comparatively low densities of bacteria, and overt pathogens were not detected. According to DGGE analyses, all wounds contained significantly greater eubacterial diversity than contralateral skin (P < 0.05), although no significant difference in total eubacterial diversity was detected between wounds from which known pathogens had been isolated and those that were putatively uninfected. DGGE amplicons with homology to Staphylococcus sp. (8/13) and S. aureus (2/13) were detected in putatively infected wound samples, while Staphylococcus sp. amplicons were detected in 11/13 noninfected wounds; S. aureus was not detected in these samples. While a majority of skin-derived DGGE consortial fingerprints could be differentiated from wound profiles through principal component analysis (PCA), a large minority could not. Furthermore, wounds from which pathogens had been isolated could not be distinguished from putatively uninfected wounds on this basis. In conclusion, while chronic wounds generally harbored greater eubacterial diversity than healthy skin, the isolation of known pathogens was not associated with qualitatively distinct consortial profiles or otherwise altered diversity. The data generated support the utility of both culture and DGGE for the microbial characterization of chronic wounds. PMID:22553231

Trochleoplasty: Indications and Technique.

PubMed

Nolan, John E; Schottel, Patrick C; Endres, Nathan K

2018-05-09

Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

Contralateral Superior Cerebellar Artery Syndrome: A Consequence of Brain Herniation

PubMed Central

Mohseni, Meysam; Habibi, Zohreh; Nejat, Farideh

2017-01-01

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon. PMID:28490164

The patellofemoral joint: do age and gender affect skeletal maturation of the osseous morphology in children?

PubMed

Kim, Hee Kyung; Shiraj, Sahar; Anton, Christopher; Horn, Paul S

2014-02-01

The osseous morphology of the patellofemoral joint is an independent factor that affects the biomechanics of patellofemoral instability. The purpose of this study is to determine age- and gender-related differences in the osseous morphology of the patellofemoral joint in children during skeletal maturation. This study was approved by the institutional review board and was HIPAA-compliant. We included 97 children and young adults (age range 5-22 years; 51 girls and 46 boys, mean ages 14.3 years and 13.7 years, respectively). We studied 1.5-T knee MR exams, measuring the osseous morphology of the patellofemoral joint (lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, patellar height ratio, tibial tubercle-trochlear groove distance, and lateral patellofemoral angle) for each MR exam. We compared measurements to published values for patellofemoral instability. Physeal patency (open or closing/closed) was determined on MR. We assessed the associations between MR osseous measurements and gender, age and physeal patency using Wilcoxon rank sum test and least square means regression models. The osseous patellofemoral joint morphology measurements were all within a normal range. There were no significant correlations between MR osseous measurements and age, gender or physeal patency. During skeletal maturation, age and gender do not affect the osseous morphology or congruency of the patellofemoral joint.

Comparison of radiography and ultrasonography for the diagnosis of osteochondritis dissecans in the equine femoropatellar joint.

PubMed

Bourzac, C; Alexander, K; Rossier, Y; Laverty, S

2009-09-01

Osteochondritis dissecans (OCD) lesions of the femoropatellar (FP) joint are diagnosed routinely by radiography, but lesions located in the trochlear groove or without accompanying subchondral bone changes can be difficult to visualise. Ultrasonography allows evaluation of articular cartilage and subchondral bone in the FPjoint. To document the radiographic and ultrasonographic appearance of OCD lesions in the equine FP joint, grade ultrasonographic lesions and compare their accuracy in the diagnosis of these lesions. The medical records of all horses diagnosed with FP OCD between 1995 and 2006 were assessed. Inclusion criteria included availability of both radiographic and ultrasonographic images. Lesion characteristics were evaluated in each trochlear ridge and trochlear groove. For assessment of the accuracy (sensitivity and specificity) of both imaging techniques in the diagnosis of OCD, only cases with an arthroscopic or necropsy examination were studied. Twenty-one horses were included. OCD lesions were diagnosed by radiography (30/32 joints) and ultrasound (32/32 joints). The lateral trochlear ridge (LTR, 91%) and the medial trochlear ridge (MTR, 17%) were involved on radiography. The localisation on ultrasound examination was similar (97% LTR, 25% MTR). All but one lesion seen on radiography were also detected with ultrasound; 2 LTR and 3 MTR lesions, not seen on radiography were diagnosed by ultrasound and confirmed at arthroscopy or necropsy. The specificity was 100% regardless of the site and imaging procedure except for the distal third of the MTR (94% for ultrasound). The sensitivity varied, depending on lesion site. Ultrasonography is a valuable diagnostic tool to diagnose OCD lesions in the FP joint and more sensitive than radiography for lesions affecting the MTR of the distal femur. Ultrasound should be considered as a useful adjunct to radiography for diagnosing equine FP OCD, especially in cases of high clinical suspicion but equivocal radiographic findings. Images can be generated immediately when digital radiography is not available, permitting an immediate on-site diagnosis.

Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced.

PubMed

Vandenneucker, Hilde; Labey, Luc; Vander Sloten, Jos; Desloovere, Kaat; Bellemans, Johan

2016-11-01

The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles. The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.

Effects of Intracranial Trochlear Neurectomy on the Structure of the Primate Superior Oblique Muscle

PubMed Central

Poukens, Vadims; Ying, Howard; Shan, Xiaoyan; Tian, Jing; Zee, David S.

2010-01-01

Purpose. Although cyclovertical strabismus in humans is frequently attributed to superior oblique (SO) palsy, anatomic effects of SO denervation have not been studied. Magnetic resonance imaging (MRI) and orbital histology was used to study the effects of acute trochlear (CN4) denervation on the monkey SO. Methods. Five juvenile macaque monkeys were perfused with formalin for 5 weeks: 15 months after unilateral or bilateral 10-mm intracranial trochlear neurectomy. Denervated and fellow orbits were imaged by MRI, embedded whole in paraffin, serially sectioned at 10-μm thickness, and stained with Masson trichrome. Whole muscle and individual fiber cross sections were quantified in SO muscles throughout the orbit and traced larger fibers in one specimen where they were present. Results. MRI demonstrated marked reduction in midorbital cross section in denervated SO muscles, with anterior shift of SO mass preserving overall volume. Muscle fibers exhibited variable atrophy along their lengths. Denervated orbital layer (OL) fiber cross sections were slightly but significantly reduced from control at most anteroposterior locations, but this reduction was much more profound in global layer (GL) fibers. Intraorbital and intramuscular CN4 were uniformly fibrotic. In one animal, there were scattered clusters of markedly hypertrophic GL fibers that exhibited only sparse myomyous junctions only anteriorly. Conclusions. CN4 denervation produces predominantly SO GL atrophy with relative OL sparing. Overall midorbital SO atrophy was evident by MRI as early as 5 weeks after denervation, as denervated SO volume shifted anteriorly. Occasional GL fiber hypertrophy suggests that at least some SO fibers extend essentially the full muscle length after trochlear neurectomy. PMID:20164458

Magnetic resonance imaging of the femoral trochlea: evaluation of anatomical landmarks and grading articular cartilage in cadaveric knees.

PubMed

Muhle, Claus; Ahn, Joong Mo; Trudell, Debra; Resnick, Donald

2008-06-01

The purpose of the study was to define magnetic resonance imaging (MRI) findings before and after contrast medium opacification of the knee joint in cadaveric specimens to demonstrate anatomical landmarks of the trochlear surface in relation to the neighboring structures, and to evaluate different MRI sequences in the detection of cartilage defects of the trochlear and patellar surface of the knee. The morphology and relationship of the proximal trochlear surface to the prefemoral fat of the distal femur were investigated by use of different MR sequences before and after intra-articular gadolinium administration into the knee joint in ten cadaveric knees. Anatomic sections were subsequently obtained. In addition, evaluation of the articular surface of the trochlea was performed by two independent observers. The cartilage surfaces were graded using a 2-point system, and results were compared with macroscopic findings. Of 40 cartilage surfaces evaluated, histopathologic findings showed 9 normal surfaces, 20 containing partial-thickness defects, and 11 containing full-thickness defects. Compared with macroscopic data, sensitivity of MR sequences for the two reviewers was between 17 and 90%; specificity, 75 and 100%; positive predictive value, 75 and 100%; negative predictive value, 20 and 100%, depending on patellar or trochlea lesions. Interobserver variability for the presence of disease, which was measured using the kappa statistic, was dependent on the MR sequence used between 0.243 and 0.851. Magnetic resonance imaging sequences can be used to evaluate the cartilage of the trochlear surface with less accuracy when compared with the results of grading the articular cartilage of the patella.

Neandertal talus bones from El Sidrón site (Asturias, Spain): A 3D geometric morphometrics analysis.

PubMed

Rosas, Antonio; Ferrando, Anabel; Bastir, Markus; García-Tabernero, Antonio; Estalrrich, Almudena; Huguet, Rosa; García-Martínez, Daniel; Pastor, Juan Francisco; de la Rasilla, Marco

2017-10-01

The El Sidrón tali sample is assessed in an evolutionary framework. We aim to explore the relationship between Neandertal talus morphology and body size/shape. We test the hypothesis 1: talar Neandertal traits are influenced by body size, and the hypothesis 2: shape variables independent of body size correspond to inherited primitive features. We quantify 35 landmarks through 3D geometric morphometrics techniques to describe H. neanderthalensis-H. sapiens shape variation, by Mean Shape Comparisons, Principal Component, Phenetic Clusters, Minimum spanning tree analyses and partial least square and regression of talus shape on body variables. Shape variation correlated to body size is compared to Neandertals-Modern Humans (MH) evolutionary shape variation. The Neandertal sample is compared to early hominins. Neandertal talus presents trochlear hypertrophy, a larger equality of trochlear rims, a shorter neck, a more expanded head, curvature and an anterior location of the medial malleolar facet, an expanded and projected lateral malleolar facet and laterally expanded posterior calcaneal facet compared to MH. The Neandertal talocrural joint morphology is influenced by body size. The other Neandertal talus traits do not co-vary with it or not follow the same co-variation pattern as MH. Besides, the trochlear hypertrophy, the trochlear rims equality and the short neck could be inherited primitive features; the medial malleolar facet morphology could be an inherited primitive feature or a secondarily primitive trait; and the calcaneal posterior facet would be an autapomorphic feature of the Neandertal lineage. © 2017 Wiley Periodicals, Inc.

Correction of Patellofemoral Malalignment With Patellofemoral Arthroplasty.

PubMed

Valoroso, Marco; Saffarini, Mo; La Barbera, Giuseppe; Toanen, Cécile; Hannink, Gerjon; Nover, Luca; Dejour, David H

2017-12-01

The goal of patellofemoral arthroplasty (PFA) is to replace damaged cartilage and correct underlying deformities to reduce pain and prevent maltracking. We aimed to determine how PFA modifies patellar height, tilt, and tibial tuberosity-trochlear groove (TT-TG) distance. The hypothesis was that PFA would correct trochlear dysplasia or extensor mechanism malalignment. The authors prospectively studied a series of 16 patients (13 women and 3 men) aged 64.9 ± 16.3 years (range 41-86 years) who received PFA. All knees were assessed preoperatively and 6 months postoperatively using frontal, lateral, and "skyline" x-rays, and computed tomography scans to calculate patellar tilt, patellar height, and TT-TG distance. The interobserver agreement was excellent for all parameters (intraclass correlation coefficient >0.95). Preoperatively, the median patellar tilt without quadriceps contraction (QC) was 17.5° (range 5.3°-33.4°) and with QC was 19.8° (range 0°-52.0°). The median Caton-Deschamps index was 0.91 (range 0.80-1.22) and TT-TG distance was 14.5 mm (range 4.0-22.0 mm). Postoperatively, the median patellar tilt without QC was 0.3° (range -15.3° to 9.5°) and with QC was 6.1° (range -11.5° to 13.3°). The median Caton-Deschamps index was 1.11 (range 0.81-1.20) and TT-TG distance was 10.1 mm (range 1.8-13.8 mm). The present study demonstrates that beyond replacing arthritic cartilage, trochlear-cutting PFA improves patellofemoral congruence by correcting trochlear dysplasia and standardizing radiological measurements as patellar tilt and TT-TG. The association of lateral patellar facetectomy improves patellar tracking by reducing the patellar tilt. Copyright © 2017 Elsevier Inc. All rights reserved.

Robotic simulation of identical athletic-task kinematics on cadaveric limbs exhibits a lack of differences in knee mechanics between contralateral pairs

PubMed Central

Bates, Nathaniel A.; McPherson, April L.; Nesbitt, Rebecca J.; Shearn, Jason T.; Myer, Gregory D.; Hewett, Timothy E.

2017-01-01

Limb asymmetry is a known factor for increased ACL injury risk. These asymmetries are normally observed during in vivo testing. Prior studies have developed in vitro testing methodologies driven by in vivo kinematics to investigate knee mechanics relative to ACL injury. The objective of this study was to determine if mechanical side-to-side asymmetries persist in contralateral pairs during in vitro simulation testing. In vivo kinematics were recorded for male and female drop vertical jump and sidestep cutting tasks. The recorded kinematics were used to robotically simulate the motions on 7 contralateral pairs of cadaveric lower extremities specimens. ACL and MCL force, torque, and strains were recorded and analyzed for differences between contralateral pairs. There was a general lack of mechanical differences between limb sides. Adduction peak torque for the male sidestep cut movement was significantly different between limb sides (p = 0.04). However, this is consistent with ACL injury mechanics in that movement in the frontal plane (abduction/adduction) increases injury risk and it is possible loading differences in this plane may have resulted from tolerances within the setup process. The findings of this study indicate that contralateral knee joints were representative of each other during biomechanical in vitro tests. In future cadaveric robotic simulations, contralateral limbs can be used interchangeably. In addition, direct comparisons of the structural behaviors of isolated conditions for contralateral knee joints can be performed. PMID:28062120

Inter-Rater Reliability of Cyclotorsion Measurements Using Fundus Photography.

PubMed

Dysli, Muriel; Kanku, Madeleine; Traber, Ghislaine L

2018-04-01

The foveo-papillary angle (FPA) on fundus photographs is the accepted standard for the measurement of ocular cyclotorsion. We assessed the inter-rater reliability of this method in healthy subjects and in patients with trochlear nerve palsies. In this methodological study, fundus photographs of healthy subjects and of patients with trochlear nerve palsies were made with a fundus camera (Zeiss Fundus Camera FF 450 plus, Jena, Germany). Three independent observers measured the FPA on the fundus photographs of all subjects in synedra View (synedra View 16, Version 16.0.0.11, Innsbruck, Austria). One hundred and four eyes of 52 subjects (26 healthy controls and 26 patients) were assessed. The mean FPA of the healthy controls was 5.80 degrees (°) [± 0.44 standard error of the mean (SEM)] compared to 11.55° (± 0.80 SEM) for patients with trochlear nerve palsies. The inter-rater reliability of all measured FPAs showed an intraclass correlation coefficient (ICC) of 0.98 (95% CI 0.97 - 0.98). The inter-rater reliability of objective cyclotorsion measurements using fundus photographs was very high. Georg Thieme Verlag KG Stuttgart · New York.

Principles of ipsilateral and contralateral cortico-cortical connectivity in the mouse.

PubMed

Goulas, Alexandros; Uylings, Harry B M; Hilgetag, Claus C

2017-04-01

Structural connectivity among cortical areas provides the substrate for information exchange in the cerebral cortex and is characterized by systematic patterns of presence or absence of connections. What principles govern this cortical wiring diagram? Here, we investigate the relation of physical distance and cytoarchitecture with the connectional architecture of the mouse cortex. Moreover, we examine the relation between patterns of ipsilateral and contralateral connections. Our analysis reveals a mirrored and attenuated organization of contralateral connections when compared with ipsilateral connections. Both physical distance and cytoarchitectonic similarity of cortical areas are related to the presence or absence of connections. Notably, our analysis demonstrates that the combination of these factors relates better to cortico-cortical connectivity than each factor in isolation and that the two factors relate differently to ipsilateral and contralateral connectivity. Physical distance is more tightly related to the presence or absence of ipsilateral connections, but its relevance greatly diminishes for contralateral connections, while the contribution of cytoarchitectonic similarity remains relatively stable. Our results, together with similar findings in the cat and macaque cortex, suggest that a common set of principles underlies the macroscale wiring of the mammalian cerebral cortex.

Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative.

PubMed

Haj-Mirzaian, Arya; Guermazi, Ali; Hakky, Michael; Sereni, Christopher; Zikria, Bashir; Roemer, Frank W; Tanaka, Miho J; Cosgarea, Andrew J; Demehri, Shadpour

2018-04-30

To determine whether the tibial tuberosity-to-trochlear groove (TT-TG) distance is associated with concurrent patellofemoral joint osteoarthritis (OA)-related structural damage and its worsening on 24-month follow-up magnetic resonance imaging (MRI) in participants in the Osteoarthritis Initiative (OAI). Six hundred subjects (one index knee per participant) were assessed. To evaluate patellofemoral OA-related structural damage, baseline and 24-month semiquantitative MRI Osteoarthritis Knee Score (MOAKS) variables for cartilage defects, bone marrow lesions (BMLs), osteophytes, effusion, and synovitis were extracted from available readings. The TT-TG distance was measured in all subjects using baseline MRIs by two musculoskeletal radiologists. The associations between baseline TT-TG distance and concurrent baseline MOAKS variables and their worsening in follow-up MRI were investigated using regression analysis adjusted for variables associated with tibiofemoral and patellofemoral OA. At baseline, increased TT-TG distance was associated with concurrent lateral patellar and trochlear cartilage damages, BML, osteophytes, and knee joint effusion [cross-sectional evaluations; overall odds ratio 95% confidence interval (OR 95% CI): 1.098 (1.045-1.154), p < 0.001]. In the longitudinal analysis, increased TT-TG distance was significantly related to lateral patellar and trochlear cartilage, BML, and joint effusion worsening (overall OR 95% CI: 1.111 (1.056-1.170), p < 0.001). TT-TG distance was associated with simultaneous lateral patellofemoral OA-related structural damage and its worsening over 24 months. Abnormally lateralized tibial tuberosity may be considered as a risk factor for future patellofemoral OA worsening. • Excessive TT-TG distance on MRI is an indicator/predictor of lateral-patellofemoral-OA. • TT-TG is associated with simultaneous lateral-patellofemoral-OA (6-17% chance-increase for each millimeter increase). • TT-TG is associated with longitudinal (24-months) lateral-patellofemoral-OA (5-15% chance-increase for each millimeter).

T2 Relaxation Values of the Talar Trochlear Articular Cartilage: Comparison Between Patients With Lateral Instability of the Ankle Joint and Healthy Volunteers.

PubMed

Park, So Yoon; Yoon, Young Cheol; Cha, Jang Gyu; Sung, Ki Sun

2016-01-01

The purpose of this study was to evaluate the difference between the T2 relaxation values of the talar trochlear cartilage in patients with lateral instability of the ankle joint and the values in healthy volunteers. A retrospective assessment was conducted of images from 13 MRI examinations of the ankles of 12 patients who underwent lateral ankle ligament repair with an arthroscopically proven normal talar trochlear cartilage. Thirteen ankle MRI examinations of 12 healthy age- and sex-matched volunteers were prospectively performed. Two radiologists independently measured the T2 relaxation values of the talar trochlear cartilage in two layers (superficial and deep) in the following six compartments: medial anterior (M1), medial middle (M2), medial posterior (M3), lateral anterior (L1), lateral middle (L2), and lateral posterior (L3). The T2 relaxation values of patients were compared with those of healthy volunteers. Both readers found that the mean T2 relaxation values of all six compartments of the superficial layer were significantly higher in patients than in control subjects. For reader 1, the M1 findings were 46.2 for patients and 39.6 for healthy volunteers; M2, 50.4 and 41.1; M3, 52.1 and 46.2; L1, 43.1 and 37.9; L2, 47.8 and 41.8; and L3, 53.8 and 49.8. For reader 2, the M1 findings were 45.0 and 40.2; M2, 48.8 and 41.1; M3, 53.2 and 45.6; L1, 42.8 and 38.5; L2, 48.0 and 42.1; and L3, 55.0 and 49.0 (p < 0.05). For the deep layer, the mean T2 relaxation values of M2 (patients, 32.6; volunteers, 27.8 [p = 0.004]) and M3 (patients, 38.3; volunteers, 35.0 [p = 0.046]) for reader 1 and M2 (patients, 31.6; volunteers, 28.7 [p = 0.041]) for reader 2 were significantly higher in patients than in control subjects. Intraobserver and interobserver variability were excellent, except for interobserver variability for M1 deep (0.79) and L1 deep (0.75). The T2 relaxation values of arthroscopically proven normal talar trochlear cartilage of patients with lateral instability were higher than those of healthy volunteers, especially in the superficial layer and the M2 deep layer.

Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis.

PubMed

Calliess, Tilman; Schado, Ssuheib; Richter, Berna I; Becher, Christoph; Ezechieli, Marco; Ostermeier, Sven

2014-02-01

Previous biomechanical studies have shown that bi-cruciate retaining knee replacement does not significantly alter normal knee kinematics, however, there are no data on the influence of a combined medial and patellofemoral bi-compartimental arthroplasty. The purpose of this in vitro study was to evaluate the effect of different replacement scenarios with a modular partial knee replacement system on the amount of quadriceps force required to extend the knee during an isokinetic extension cycle. Ten human knee specimens were tested in a kinematic knee simulator under (1) physiologic condition and after subsequent implantation of (2) a medial unicondylar and (3) a trochlear replacement. An isokinetic extension cycle of the knee with a constant extension moment of 31 Nm was simulated. The resulting quadriceps extension force was measured from 120° to full knee extension. The quadriceps force curve described a typically sinusoidal characteristic before and after each replacement scenario. The isolated medial replacement resulted in a slightly, but significantly higher maximum quadriceps force (1510 N vs. 1585 N, P = 0.006) as well as the subsequent trochlear replacement showed an additional increase (1801 N, P = 0.008). However, for both replacements no significant difference to the untreated condition could be detected in mid-flexion (10-50°). When considering a bi-compartimental replacement an increase of required maximum quadriceps force needed to extend the knee has to keep in mind. However, the close to physiological movement in mid-flexion suggests that patients with a bi-crutiate retaining arthroplasty might have an advantage in knee stability compared to total knee arthroplasty. Copyright © 2013 Elsevier Ltd. All rights reserved.

The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis.

PubMed

Tuna, Burcu Kaya; Semiz-Oysu, Aslıhan; Pekar, Bilhan; Bukte, Yasar; Hayirlioglu, Alper

2014-01-01

The relationship of patellofemoral congruency with chondromalacia patellae (CP) was retrospectively evaluated. Lateral patellar tilt angle (LPTA), sulcus angle (SA), trochlear depth (TD), and patella angle (PA) were measured at 301 knee magnetic resonance images and compared between groups with and without CP. In the CP group, LPTA and TD were significantly low (P<.01), SA was high (P<.01), while PA showed no difference (P>.05). The parameters were also compared between groups with mild and severe CP, and no significant difference was found (P>.05). Our results demonstrate that patellar tilt and trochlear dysplasia are related to the presence but not the degree of CP. Copyright © 2014 Elsevier Inc. All rights reserved.

Subchondral bone density distribution of the talus in clinically normal Labrador Retrievers.

PubMed

Dingemanse, W; Müller-Gerbl, M; Jonkers, I; Vander Sloten, J; van Bree, H; Gielen, I

2016-03-15

Bones continually adapt their morphology to their load bearing function. At the level of the subchondral bone, the density distribution is highly correlated with the loading distribution of the joint. Therefore, subchondral bone density distribution can be used to study joint biomechanics non-invasively. In addition physiological and pathological joint loading is an important aspect of orthopaedic disease, and research focusing on joint biomechanics will benefit veterinary orthopaedics. This study was conducted to evaluate density distribution in the subchondral bone of the canine talus, as a parameter reflecting the long-term joint loading in the tarsocrural joint. Two main density maxima were found, one proximally on the medial trochlear ridge and one distally on the lateral trochlear ridge. All joints showed very similar density distribution patterns and no significant differences were found in the localisation of the density maxima between left and right limbs and between dogs. Based on the density distribution the lateral trochlear ridge is most likely subjected to highest loads within the tarsocrural joint. The joint loading distribution is very similar between dogs of the same breed. In addition, the joint loading distribution supports previous suggestions of the important role of biomechanics in the development of OC lesions in the tarsus. Important benefits of computed tomographic osteoabsorptiometry (CTOAM), i.e. the possibility of in vivo imaging and temporal evaluation, make this technique a valuable addition to the field of veterinary orthopaedic research.

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

PubMed

Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Clinics in diagnostic imaging (163). Transient lateral patellar dislocation with trochlear dysplasia

PubMed Central

Zhang, Junwei; Lee, Chin Hwee

2015-01-01

A 14-year-old girl presented with left knee pain and swelling after an injury. Magnetic resonance (MR) imaging showed a transient lateral patellar dislocation with patellar osteochondral fracture, medial patellofemoral ligament tear and underlying femoral trochlear dysplasia. Open reduction and internal fixation of the osteochondral fracture, plication of the medial patellar retinaculum and lateral release were performed. As lateral patellar dislocation is often clinically unsuspected, an understanding of its characteristic imaging features is important in making the diagnosis. Knowledge of the various predisposing factors for patellar instability may also influence the choice of surgical management. We also discuss signs of acute injury and chronic instability observed on MR imaging, and the imaging features of anatomical variants that predispose an individual to lateral patellar dislocation. Treatment options and postsurgical imaging appearances are also briefly described. PMID:26512145

Rabbit Trochlear Model of Osteochondral Allograft Transplantation

PubMed Central

To, Nhat; Curtiss, Shane; Neu, Corey P; Salgado, Christopher J; Jamali, Amir A

2011-01-01

Allografting and autografting of osteochondral tissues is a promising strategy to treat articular cartilage lesions in damaged joints. We developed a new model of fresh osteochondral allografting using the entire rabbit trochlea. The objective of the current study was to demonstrate that this model would achieve reproducible graft–host healing and maintain normal articular cartilage histologic, immunolocalization, and biochemical characteristics after transplantation under diverse storage and transplantation conditions. New Zealand white (n = 8) and Dutch belted (n = 8) rabbits underwent a 2-stage transplantation operation using osteochondral grafts that had been stored for 2 or 4 wk. Trochlear grafts harvested from the left knee were transplanted to the right knee as either autografts or allografts. Grafts were fixed with 22-gauge steel wire or 3-0 nylon suture. Rabbits were euthanized for evaluation at 1, 2, 4, 6, and 12 wk after transplantation. All grafts that remained in vivo for at least 4 wk demonstrated 100% interface healing by microCT. Trabecular bridging was present at the host–graft interface starting at 2 wk after transplantation, with no significant difference in cartilage histology between the various groups. The combined histology scores indicated minimal evidence of osteoarthritis. Immunostaining revealed that superficial zone protein was localized at the surface of all transplants. The rabbit trochlear model met our criteria for a successful model in regard to the ease of the procedure, low rate of surgical complications, relatively large articular cartilage surface area, and amount of host–graft bone interface available for analysis. PMID:22330350

Avoiding Complications with MPFL Reconstruction.

PubMed

Smith, Marvin K; Werner, Brian C; Diduch, David R

2018-05-12

To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.

MRI quantitative morphologic analysis of patellofemoral region: lack of correlation with chondromalacia patellae at surgery.

PubMed

Endo, Yoshimi; Schweitzer, Mark E; Bordalo-Rodrigues, Marcelo; Rokito, Andrew S; Babb, James S

2007-11-01

In numerous studies, the morphologic features of the patellofemoral joint have been analyzed on radiographs. The objective of this study was to assess patellofemoral measurements on MR images and to correlate the measurements with the presence or absence of chondromalacia patellae confirmed at surgery. Axial and sagittal MR images of 98 knees (97 patients) were evaluated. Lateral and medial patellar facet lengths, lateral-to-medial facet length ratio, and interfacet angle were measured at three levels through the patella. Trochlear depth was measured on an axial slice. Patella and patellar tendon lengths, patellar tendon-to-patella ratio, and overlap of the patellar and trochlear articular cartilages were measured on sagittal slices. These measurements in knees with chondromalacia patellae were compared with those in knees without chondromalacia patellae. For assessment of reproducibility, axial measurements were repeated by a second observer. There was no statistically significant difference in any of the axial and sagittal slice measurements between knees with and those without chondromalacia patellae. Interobserver reliability was excellent for measurements of trochlear depth and measurements in the superior and middle aspects of the patella. Measurements through the inferior patella were slightly less reproducible. The results of our study with MRI confirmed many previous radiographic findings. Although we did not find correlation between the presence of chondromalacia patellae and the patellofemoral indexes we analyzed, it is possible that the results of further investigations incorporating different grades of chondromalacia and different locations along the patellar articular surface may lead to further insight regarding the morphologic risk factors for chondromalacia patellae.

Arthroscopic approach and intra-articular anatomy of the dorsal and plantar synovial compartments of the bovine tarsocrural joint.

PubMed

Lardé, Hélène; Nichols, Sylvain; Babkine, Marie; Desrochers, André

2017-01-01

To determine arthroscopic approaches to the dorsal and plantar synovial compartments of the tarsocrural joint in adult cattle, and to describe the arthroscopic intra-articular anatomy from each approach. Ex vivo study. Fresh adult bovine cadavers (n = 7). Two tarsocrural joint were injected with latex to determine arthroscopic portal locations and arthroscopy of the tarsocrural joint of 12 tarsi was performed. The dorsolateral approach was made through the large pouch located between the long digital extensor and peroneus longus tendons. The dorsomedial approach was made just medial to the common synovial sheath of the tibialis cranialis, peroneus tertius, and long digital extensor tendons. The plantarolateral and plantaromedial approaches were made lateral and medial to the tarsal tendon sheath, respectively. Each approach allowed visualization of the distal tibia articulating with the proximal trochlea of the talus. Consistently observed structures included the distal intermediate ridge of the tibia, and the medial and lateral trochlear ridges and trochlear groove of the talus. Lateral and medial malleoli were best assessed from dorsal approaches. From the lateral approaches evaluation of the abaxial surface of the lateral trochlear ridge allowed visualization of the fibulocalcaneal joint. From the plantar approaches additional observed structures included the coracoid process of the calcaneus, plantar trochlea of the talus, and plantar talotibial and talofibular ligaments. In cattle, the dorsolateral and plantarolateral approaches allowed for the best evaluation of the dorsal and plantar aspects of the tarsocrural joint, respectively. © 2017 The American College of Veterinary Surgeons.

Unilateral Radiotherapy for the Treatment of Tonsil Cancer

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

Chronowski, Gregory M., E-mail: gchronowski@mdanderson.org; Garden, Adam S.; Morrison, William H.

2012-05-01

Purpose: To assess, through a retrospective review, clinical outcomes of patients with squamous cell carcinoma of the tonsil treated at the M. D. Anderson Cancer Center with unilateral radiotherapy techniques that irradiate the involved tonsil region and ipsilateral neck only. Methods and Materials: Of 901 patients with newly diagnosed squamous cell carcinoma of the tonsil treated with radiotherapy at our institution, we identified 102 that were treated using unilateral radiotherapy techniques. All patients had their primary site of disease restricted to the tonsillar fossa or anterior pillar, with <1 cm involvement of the soft palate. Patients had TX (n =more » 17 patients), T1 (n = 52), or T2 (n = 33) disease, with Nx (n = 3), N0 (n = 33), N1 (n = 23), N2a (n = 21), or N2b (n = 22) neck disease. Results: Sixty-one patients (60%) underwent diagnostic tonsillectomy before radiotherapy. Twenty-seven patients (26%) underwent excision of a cervical lymph node or neck dissection before radiotherapy. Median follow-up for surviving patients was 38 months. Locoregional control at the primary site and ipsilateral neck was 100%. Two patients experienced contralateral nodal recurrence (2%). The 5-year overall survival and disease-free survival rates were 95% and 96%, respectively. The 5-year freedom from contralateral nodal recurrence rate was 96%. Nine patients required feeding tubes during therapy. Of the 2 patients with contralateral recurrence, 1 experienced an isolated neck recurrence and was salvaged with contralateral neck dissection only and remains alive and free of disease. The other patient presented with a contralateral base of tongue tumor and involved cervical lymph node, which may have represented a second primary tumor, and died of disease. Conclusions: Unilateral radiotherapy for patients with TX-T2, N0-N2b primary tonsil carcinoma results in high rates of disease control, with low rates of contralateral nodal failure and a low incidence of acute toxicity requiring gastrostomy.« less

Renal expression of aminopeptidase A in rats with two-kidney, one-clip hypertension.

PubMed

Wolf, G; Wenzel, U; Assmann, K J; Stahl, R A

2000-12-01

Angiotensin II (ANG II) is a major factor involved in the progression of chronic renal disease. Although the generation of this vasoactive peptide has been investigated in great detail, only a few studies have hitherto addressed the metabolism of ANG II into fragments such as angiotensin III and IV (ANG III, IV) which may exert physiological effects independent of ANG II. Aminopeptidase A (APA) is the major enzyme degrading ANG II. The aim of the current study was to evaluate glomerular APA expression in rats with two-kidney, one-clip hypertension. The left renal artery was restricted with a 0.2-mm silver clip. Kidneys were harvested 1 and 4 weeks after surgery. APA enzyme and protein expression was evaluated in kidney sections. Total APA enzyme activity and mRNA expression was assessed in isolated glomeruli. Degradation of exogenous ANG II by isolated glomeruli was measured with reverse-phase high-performance liquid chromatography. APA enzyme activity, protein, and mRNA expression were stimulated in the clipped kidney 1 week after surgery compared with the contralateral kidney or normal controls. In contrast, 4 weeks after clipping APA activity and expression was higher in the contralateral kidney. In parallel to these findings, degradation of ANG II was greatest in isolated glomeruli obtained from the clipped kidney after 1 week. However, preparations from the contralateral kidney 4 weeks after surgery were more active in the metabolism of exogenous ANG II. The present study provides evidence that APA is complexly regulated in in vivo situations with an activated local renin-ANG II system. ANG II appears to play a direct role in this regulation. However, since conversion of ANG II to ANG III by APA is the initial step leading to the formation of ANG IV which may exert detrimental effects not mediated through classical ANG II receptors, a local increase in APA activity may contribute to the progression of chronic renal disease even during complete AT(1)-receptor blockade.

Motor palsies of cranial nerves (excluding VII) after vaccination: reports to the US Vaccine Adverse Event Reporting System.

PubMed

Woo, Emily Jane; Winiecki, Scott K; Ou, Alan C

2014-01-01

We reviewed cranial nerve palsies, other than VII, that have been reported to the US Vaccine Adverse Event Reporting System (VAERS). We examined patterns for differences in vaccine types, seriousness, age, and clinical characteristics. We identified 68 reports of cranial nerve palsies, most commonly involving the oculomotor (III), trochlear (IV), and abducens (VI) nerves. Isolated cranial nerve palsies, as well as palsies occurring as part of a broader clinical entity, were reported. Forty reports (59%) were classified as serious, suggesting that a cranial nerve palsy may sometimes be the harbinger of a broader and more ominous clinical entity, such as a stroke or encephalomyelitis. There was no conspicuous clustering of live vs. inactivated vaccines. The patient age range spanned the spectrum from infants to the elderly. Independent data may help to clarify whether, when, and to what extent the rates of cranial nerve palsies following particular vaccines may exceed background levels.

Patellofemoral Instability in Children: Correlation Between Risk Factors, Injury Patterns, and Severity of Cartilage Damage.

PubMed

Kim, Hee Kyung; Shiraj, Sahar; Kang, Chang Ho; Anton, Christopher; Kim, Dong Hoon; Horn, Paul S

2016-06-01

The purpose of this study was to compare MRI findings between groups with and without patellofemoral instability and to correlate the MRI findings with the severity of patellar cartilage damage. Fifty-three children with patellofemoral instability and 53 age- and sex-matched children without patellofemoral instability (15.9 ± 2.4 years) were included. Knee MRI with T2-weighted mapping was performed. On MR images, femoral trochlear dysplasia, patellofemoral malalignment, medial retinaculum injury, and bone marrow edema were documented. The degree of patellar cartilage damage was evaluated on MR images by use of a morphologic grading scale (0-4) and on T2 maps with mean T2 values at the medial, central, and lateral facets. MRI findings were compared between the two groups. In cases of patellofemoral instability, MRI findings were correlated with the severity of cartilage damage at each region. Trochlear structure and alignment were significantly different between the two groups (Wilcoxon p < 0.0001). In patellofemoral instability, a high-riding patella was associated with central patellar cartilage damage with a higher morphologic grade and T2 value (Spearman p < 0.05). The severity of medial retinacular injury and presence of bone marrow edema at either the medial patella or the lateral femoral condyle were associated with a higher grade of medial patellar cartilage damage (Wilcoxon p < 0.05). None of the other findings correlated with the severity of patellar cartilage damage. Patients with patellofemoral instability have significantly different trochlear structure and alignment than those who do not, and these differences are known risk factors for patellofemoral instability. However, the only risk factors or injury patterns that directly correlated with the severity of patellar cartilage damage were patella alta, medial stabilizer injury, and bone marrow edema.

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation.

PubMed

Ferlic, Peter Wilhelm; Runer, Armin; Dirisamer, Florian; Balcarek, Peter; Giesinger, Johannes; Biedermann, Rainer; Liebensteiner, Michael Christian

2018-05-01

The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, medio-lateral width of the tibia, width of the patella and the proximal-distal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. Level III.

The anterior trochlear line as a reference for femoral component positioning in total knee arthroplasty.

PubMed

Morizane, Kazuki; Takahashi, Toshiaki; Konishi, Fumihiko; Yamamoto, Haruyasu

2011-12-01

A new radiographic method using the anterior and posterior femoral condyles as a landmark to determine the rotational alignment of the femoral component in TKA had been developed. The new radiograph presents an axial view of the distal femur. The patients were asked to lie in the supine position and flex the knee approximately 120° to 130°. Radiographs were applied at an inclination angle of 20° to 30°. The condylar twist angle (CTA), the external rotational angle between the posterior condylar (PC) line and the clinical transepicondylar axis (TEA), and the trochlear line angle (TLA), and the internal rotational angle between the anterior trochlear line and the clinical TEA were measured. Images were taken of 129 knees in 87 patients with osteoarthritis of the knee. The measurement values obtained using our method with those obtained using 3D reconstructed images from a 3-dimensional helical CT system (n = 35) were compared. The average CTA was 5.7° ± 2.8° and the average TLA was -5.6° ± 3.2°. The CTA was negatively correlated with the tibiofemoral angle (TFA). The average TLA was positively correlated with the TFA. The average difference between the TLA values obtained with this view and those obtained using the 3D-CT was 0.5° ± 1.6°. The relationship between the radiograph and 3D-CT in TLA was higher than that in CTA. This radiographic technique allows easy and simultaneous measurement of the CTA and TLA and may provide an alternative method for assessing the TEA of the femur during preoperative planning for TKA.

The use of a cartilage decellularized matrix scaffold for the repair of osteochondral defects: the importance of long-term studies in a large animal model.

PubMed

Vindas Bolaños, R A; Cokelaere, S M; Estrada McDermott, J M; Benders, K E M; Gbureck, U; Plomp, S G M; Weinans, H; Groll, J; van Weeren, P R; Malda, J

2017-03-01

To investigate the effect of decellularized cartilage-derived matrix (CDM) scaffolds, by itself and as a composite scaffold with a calcium phosphate (CaP) base, for the repair of osteochondral defects. It was hypothesized that the chondral defects would heal with fibrocartilaginous tissue and that the composite scaffold would result in better bone formation. After an 8-week pilot experiment in a single horse, scaffolds were implanted in eight healthy horses in osteochondral defects on the medial trochlear ridge of the femur. In one joint a composite CDM-CaP scaffold was implanted (+P), in the contralateral joint a CDM only (-P) scaffold. After euthanasia at 6 months, tissues were analysed by histology, immunohistochemistry, micro-CT, biochemistry and biomechanical evaluation. The 8-week pilot showed encouraging formation of bone and cartilage, but incomplete defect filling. At 6 months, micro-CT and histology showed much more limited filling of the defect, but the CaP component of the +P scaffolds was well integrated with the surrounding bone. The repair tissue was fibrotic with high collagen type I and low type II content and with no differences between the groups. There were also no biochemical differences between the groups and repair tissue was much less stiff than normal tissue (P < 0.0001). The implants failed to produce reasonable repair tissue in this osteochondral defect model, although the CaP base in the -P group integrated well with the recipient bone. The study stresses the importance of long-term in vivo studies to assess the efficacy of cartilage repair techniques. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Clinical and Radiographic Results of Attune and PFC Sigma Knee Designs at 2-Year Follow-Up: A Prospective Matched-Pair Analysis.

PubMed

Ranawat, Chitranjan S; White, Peter B; West, Sarah; Ranawat, Amar S

2017-02-01

Anterior knee pain (AKP) and/or crepitation are important causes of dissatisfaction after total knee arthroplasty (TKA). Aim of this prospective, matched-pair study was to compare 2 different designs of patellofemoral (ie, trochlear groove) TKA. The Attune knee has an anatomic trochlear groove with a medialized dome patellar component vs the PFC Sigma with a single radius trochlear groove with a domed shaped patella. Between January 2010 and December 2014, 100 consecutive Attune TKAs were matched to 100 PFC Sigma TKAs based on age, gender, side, and body mass index. All surgeries were performed via medial parapatellar approach and used cemented, posterior-stabilized implants with patellar resurfacing. Clinical evaluations were assessed using Knee Society Scores (KSS) and a patient-administered questionnaire at 2-year follow-up (range, 1.5-3 years). Based on the KSS clinical rating system, excellent clinical results were achieved in 89.4% and 90.7% of Attune and PFC Sigma TKAs, respectively. There were no significant differences in the KS pain or function scores. The overall incidence of AKP was significantly lower with the Attune knee compared to that of the PFC Sigma (12.5% vs 25.8%; P = .02). The incidence of hearing or feeling noise was also less with the Attune knee (17.7% vs 30.9%; P = .02). The incidence of painful crepitation was low in both groups (1.0% vs 4.1%) with no significant difference between groups (P = .37). Both groups had similar high satisfaction scores of 8.6 and 8.4 for the Attune and PFC groups, respectively (P = .09). At 2-year follow-up, there were no differences between the PFC Sigma and Attune knees in KSS or satisfaction. However, the Attune group had a lesser incidence of AKP and crepitation. Further studies should focus on AKP and noise in cruciate-retaining knees. Copyright © 2016 Elsevier Inc. All rights reserved.

Injury to the Premature Cerebellum: Outcome is Related to Remote Cortical Development

PubMed Central

Limperopoulos, Catherine; Chilingaryan, Gevorg; Sullivan, Nancy; Guizard, Nicolas; Robertson, Richard L.; du Plessis, Adré J.

2014-01-01

Cerebellar injury is an important complication of preterm birth with far-reaching neuropsychiatric sequelae. We have previously shown a significant association between isolated injury to the premature cerebellum and subsequent impairment of regional volumetric growth in the contralateral cerebrum. In the current study, we examine the relationship between these remote regional impairments of cerebral volumetric growth and domain-specific functional deficits in these children. In 40 ex-preterm infants with isolated cerebellar injury, we performed neurodevelopmental evaluations and quantitative magnetic resonance imaging (MRI) studies at a mean age of 34 months. We measured cortical gray matter volumes in 8 parcellated regions of each cerebral hemisphere, as well as right and left cerebellar volumes. We show highly significant associations between early signs of autism and dorsolateral prefrontal cortex volume (P < 0.001); gross motor scores and sensorimotor cortical volumes (P < 0.001); and cognitive and expressive language scores and premotor and mid-temporal cortical volumes (P < 0.001). By multivariate analyses, each unit increase in the corresponding regional cerebral volume was associated with lower odds of abnormal outcome score, adjusted for age at MRI and contralateral cerebellar volume. This is the first report linking secondary impairment of remote cerebral cortical growth and functional disabilities in survivors of prematurity-related cerebellar brain injury. PMID:23146968

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. This study will further our knowledge of meniscal deficiency and osteoarthritis and provide a baseline for more common forms of medial meniscal injuries (vertical, horizontal, radial), with various degrees of circumferential fiber function remaining.

Radiographic Risk Factors for Contralateral Rupture in Dogs with Unilateral Cranial Cruciate Ligament Rupture

PubMed Central

Chuang, Connie; Ramaker, Megan A.; Kaur, Sirjaut; Csomos, Rebecca A.; Kroner, Kevin T.; Bleedorn, Jason A.; Schaefer, Susan L.; Muir, Peter

2014-01-01

Background Complete cranial cruciate ligament rupture (CR) is a common cause of pelvic limb lameness in dogs. Dogs with unilateral CR often develop contralateral CR over time. Although radiographic signs of contralateral stifle joint osteoarthritis (OA) influence risk of subsequent contralateral CR, this risk has not been studied in detail. Methodology/Principal Findings We conducted a retrospective longitudinal cohort study of client-owned dogs with unilateral CR to determine how severity of radiographic stifle synovial effusion and osteophytosis influence risk of contralateral CR over time. Detailed survival analysis was performed for a cohort of 85 dogs after case filtering of an initial sample population of 513 dogs. This population was stratified based on radiographic severity of synovial effusion (graded on a scale of 0, 1, and 2) and severity of osteophytosis (graded on a scale of 0, 1, 2, and 3) of both index and contralateral stifle joints using a reproducible scoring method. Severity of osteophytosis in the index and contralateral stifles was significantly correlated. Rupture of the contralateral cranial cruciate ligament was significantly influenced by radiographic OA in both the index and contralateral stifles at diagnosis. Odds ratio for development of contralateral CR in dogs with severe contralateral radiographic stifle effusion was 13.4 at one year after diagnosis and 11.4 at two years. Odds ratio for development of contralateral CR in dogs with severe contralateral osteophytosis was 9.9 at one year after diagnosis. These odds ratios were associated with decreased time to contralateral CR. Breed, age, body weight, gender, and tibial plateau angle did not significantly influence time to contralateral CR. Conclusion Subsequent contralateral CR is significantly influenced by severity of radiographic stifle effusion and osteophytosis in the contralateral stifle, suggesting that synovitis and arthritic joint degeneration are significant factors in the disease mechanism underlying the arthropathy. PMID:25254499

Preoperative ultrasonographic evaluation of the contralateral patent processus vaginalis at the level of the internal inguinal ring is useful for predicting contralateral inguinal hernias in children: a prospective analysis.

PubMed

Kaneda, H; Furuya, T; Sugito, K; Goto, S; Kawashima, H; Inoue, M; Hosoda, T; Masuko, T; Ohashi, K; Ikeda, T; Koshinaga, T; Hoshino, M; Goto, H

2015-08-01

The current study aimed to verify the usefulness of preoperative ultrasonographic evaluation of contralateral patent processus vaginalis (PPV) at the level of the internal inguinal ring. This was a prospective study of patients undergoing unilateral inguinal hernia repair at two institutions during 2010-2011. The sex, age at initial operation, birth weight, initial operation side, and the preoperative diameter of the contralateral PPV as determined using ultrasonography (US) were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of the preoperative major diameter of the contralateral PPV. The follow-up period was 36 months. All 105 patients who underwent unilateral hernia repair completed 36 months of follow-up, during which 11 patients (10.5 %) developed a contralateral hernia. The following covariates were not associated with contralateral hernia development: sex (p = 0.350), age (p = 0.185), birth weight (p = 0.939), and initial operation side (p = 0.350). The preoperative major diameter of the contralateral PPV determined using US was significantly wider among patients with a contralateral hernia than those without a contralateral hernia (p = 0.001). When the 105 patients were divided into two groups according to cut-off values of the preoperative major diameter of the contralateral PPV (wide group, >2.0 mm; narrow group, ≤2.0 mm), a significant association was observed between the preoperative major diameter of the contralateral PPV and patient outcomes (p = 0.001). We used US and confirmed the usefulness of a preoperative evaluation of the major diameter of the contralateral PPV at the level of the internal inguinal ring in pediatric patients with unilateral inguinal hernias.

A Simplified Approach to Teaching Medical Students Ocular Movements and the Rationale in Testing the Oculomotor, Trochlear, and Abducent Nerves

ERIC Educational Resources Information Center

Bernd, Paulette; Jakway, Jacqueline

2008-01-01

The actions of the individual extraocular muscles are best explained to medical students in a lecture format by showing the relationship of each muscle to the axes of the globe and the walls of the bony orbit. The lateral and medial rectus muscles cross only the vertical axis, and consequently, cause only abduction and adduction, respectively.…

Risk of contralateral avascular necrosis (AVN) after total hip arthroplasty (THA) for non-traumatic AVN.

PubMed

Goker, Berna; Block, Joel A

2006-01-01

The risk of developing bilateral disease progressing to total hip arthroplasty (THA) among patients who undergo unilateral THA for non-traumatic avascular necrosis (AVN) remains poorly understood. An analysis of the time-course to contralateral THA, as well as the effects of underlying AVN risk factors, is presented. Forty-seven consecutive patients who underwent THA for AVN were evaluated. Peri-operative and annual post-operative antero-posterior pelvis radiographs were examined for evidence of contralateral involvement. Patient age, weight, height, underlying AVN risk factor(s), date of onset of contralateral hip pain if occurred, and date of contralateral THA if performed, were recorded. Bone scan, computerized tomography and magnetic resonance imaging data were utilized when available. Twenty-one patients (46.6%) underwent contralateral THA for AVN within a median of 9 months after the initial THA (range 0-93, interquartile range 28.5 months). The median follow-up for patients without contralateral THA was 75 months (range 3-109, interquartile range 69 months). Thirty-four patients had radiographic findings of contralateral AVN at study entry; 25 were symptomatic bilaterally at entry and 7 developed contralateral symptoms within a mean time of 12 months (median 10 months, interquartile range 12 months). None of the 13 patients who were free of radiographic evidence of contralateral AVN at study entry developed evidence of AVN during the follow-up. AVN associated with glucocorticoid use was more likely to manifest as bilateral disease than either idiopathic AVN or ethanol-associated AVN (P=0.02 and P=0.03 respectively). Radiographically-evident AVN in the contralateral hip at THA is unlikely to remain asymptomatic for a prolonged period of time. Conversely, asymptomatic contralateral hips without radiographic evidence of AVN are unlikely to develop clinically significant AVN.

Adaptive functional change of the contralateral kidney after partial nephrectomy.

PubMed

Choi, Se Young; Yoo, Sangjun; You, Dalsan; Jeong, In Gab; Song, Cheryn; Hong, Bumsik; Hong, Jun Hyuk; Ahn, Hanjong; Kim, Choung-Soo

2017-08-01

Partial nephrectomy aims to maintain renal function by nephron sparing; however, functional changes in the contralateral kidney remain unknown. We evaluate the functional change in the contralateral kidney using a diethylene triamine penta-acetic acid (DTPA) renal scan and determine factors predicting contralateral kidney function after partial nephrectomy. A total of 699 patients underwent partial nephrectomy, with a DTPA scan before and after surgery to assess the separate function of each kidney. Patients were divided into three groups according to initial contralateral glomerular filtration rate (GFR; group 1 : <30 ml·min -1 ·1.73 m -2 , group 2 : 30-45 ml·min -1 ·1.73 m -2 , and group 3 : ≥45 ml·min -1 ·1.73 m -2 ). Multiple-regression analysis was used to identify the factors associated with increased GFR of the contralateral kidney over a 4-yr postoperative period. Patients in group 1 had a higher mean age and hypertension history, worse American Society of Anesthesiologists score, and larger tumor size than in the other two groups. The ipsilateral GFR changes at 4 yr after partial nephrectomy were -18.9, -3.6, and 3.9% in groups 1 , 2 , and 3 , respectively, whereas the contralateral GFR changes were 10.8, 25.7, and 38.8%. Age [β: -0.105, 95% confidence interval (CI): -0.213; -0.011, P < 0.05] and preoperative contralateral GFR (β: -0.256, 95% CI: -0.332; -0.050, P < 0.01) were significant predictive factors for increased GFR of the contralateral kidney after 4 yr. The contralateral kidney compensated for the functional loss of the ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in younger patients with decreased contralateral renal function. Copyright © 2017 the American Physiological Society.

Distinct Laterality in Forelimb-Movement Representations of Rat Primary and Secondary Motor Cortical Neurons with Intratelencephalic and Pyramidal Tract Projections.

PubMed

Soma, Shogo; Saiki, Akiko; Yoshida, Junichi; Ríos, Alain; Kawabata, Masanori; Sakai, Yutaka; Isomura, Yoshikazu

2017-11-08

Two distinct motor areas, the primary and secondary motor cortices (M1 and M2), play crucial roles in voluntary movement in rodents. The aim of this study was to characterize the laterality in motor cortical representations of right and left forelimb movements. To achieve this goal, we developed a novel behavioral task, the Right-Left Pedal task, in which a head-restrained male rat manipulates a right or left pedal with the corresponding forelimb. This task enabled us to monitor independent movements of both forelimbs with high spatiotemporal resolution. We observed phasic movement-related neuronal activity (Go-type) and tonic hold-related activity (Hold-type) in isolated unilateral movements. In both M1 and M2, Go-type neurons exhibited bias toward contralateral preference, whereas Hold-type neurons exhibited no bias. The contralateral bias was weaker in M2 than M1. Moreover, we differentiated between intratelencephalic (IT) and pyramidal tract (PT) neurons using optogenetically evoked spike collision in rats expressing channelrhodopsin-2. Even in identified PT and IT neurons, Hold-type neurons exhibited no lateral bias. Go-type PT neurons exhibited bias toward contralateral preference, whereas IT neurons exhibited no bias. Our findings suggest a different laterality of movement representations of M1 and M2, in each of which IT neurons are involved in cooperation of bilateral movements, whereas PT neurons control contralateral movements. SIGNIFICANCE STATEMENT In rodents, the primary and secondary motor cortices (M1 and M2) are involved in voluntary movements via distinct projection neurons: intratelencephalic (IT) neurons and pyramidal tract (PT) neurons. However, it remains unclear whether the two motor cortices (M1 vs M2) and the two classes of projection neurons (IT vs PT) have different laterality of movement representations. We optogenetically identified these neurons and analyzed their functional activity using a novel behavioral task to monitor movements of the right and left forelimbs separately. We found that contralateral bias was reduced in M2 relative to M1, and in IT relative to PT neurons. Our findings suggest that the motor information processing that controls forelimb movement is coordinated by a distinct cell population. Copyright © 2017 the authors 0270-6474/17/3710904-13$15.00/0.

Contralateral Cruciate Survival in Dogs with Unilateral Non-Contact Cranial Cruciate Ligament Rupture

PubMed Central

Muir, Peter; Schwartz, Zeev; Malek, Sarah; Kreines, Abigail; Cabrera, Sady Y.; Buote, Nicole J.; Bleedorn, Jason A.; Schaefer, Susan L.; Holzman, Gerianne; Hao, Zhengling

2011-01-01

Background Non-contact cranial cruciate ligament rupture (CrCLR) is an important cause of lameness in client-owned dogs and typically occurs without obvious injury. There is a high incidence of bilateral rupture at presentation or subsequent contralateral rupture in affected dogs. Although stifle synovitis increases risk of contralateral CrCLR, relatively little is known about risk factors for subsequent contralateral rupture, or whether therapeutic intervention may modify this risk. Methodology/Principal Findings We conducted a longitudinal study examining survival of the contralateral CrCL in client-owned dogs with unilateral CrCLR in a large baseline control population (n = 380), and a group of dogs that received disease-modifying therapy with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline (n = 16), and were followed for one year. Follow-up in treated dogs included analysis of mobility, radiographic evaluation of stifle effusion and arthritis, and quantification of biomarkers of synovial inflammation. We found that median survival of the contralateral CrCL was 947 days. Increasing tibial plateau angle decreased contralateral ligament survival, whereas increasing age at diagnosis increased survival. Contralateral ligament survival was reduced in neutered dogs. Our disease-modifying therapy did not significantly influence contralateral ligament survival. Correlative analysis of clinical and biomarker variables with development of subsequent contralateral rupture revealed few significant results. However, increased expression of T lymphocyte-associated genes in the index unstable stifle at diagnosis was significantly related to development of subsequent non-contact contralateral CrCLR. Conclusion Subsequent contralateral CrCLR is common in client-owned dogs, with a median ligament survival time of 947 days. In this naturally occurring model of non-contact cruciate ligament rupture, cranial tibial translation is preceded by development of synovial inflammation. However, treatment with arthroscopic lavage, intra-articular hyaluronic acid and oral doxycycline does not significantly influence contralateral CrCL survival. PMID:21998650

Contralateral Masking in Bilateral Cochlear Implant Patients: A Model of Medial Olivocochlear Function Loss

PubMed Central

Aronoff, Justin M.; Padilla, Monica; Fu, Qian-Jie; Landsberger, David M.

2015-01-01

Contralateral masking is the phenomenon where a masker presented to one ear affects the ability to detect a signal in the opposite ear. For normal hearing listeners, contralateral masking results in masking patterns that are both sharper and dramatically smaller in magnitude than ipsilateral masking. The goal of this study was to investigate whether medial olivocochlear (MOC) efferents are needed for the sharpness and relatively small magnitude of the contralateral masking function. To do this, bilateral cochlear implant patients were tested because, by directly stimulating the auditory nerve, cochlear implants circumvent the effects of the MOC efferents. The results indicated that, as with normal hearing listeners, the contralateral masking function was sharper than the ipsilateral masking function. However, although there was a reduction in the magnitude of the contralateral masking function compared to the ipsilateral masking function, it was relatively modest. This is in sharp contrast to the results of normal hearing listeners where the magnitude of the contralateral masking function is greatly reduced. These results suggest that MOC function may not play a large role in the sharpness of the contralateral masking function but may play a considerable role in the magnitude of the contralateral masking function. PMID:25798581

Contralateral radiculopathy after transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: A Case Series.

PubMed

Hu, Hong-Tao; Ren, Liang; Sun, Xian-Ze; Liu, Feng-Yu; Yu, Jin-He; Gu, Zhen-Fang

2018-04-01

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative lumbar disc disorder. Contralateral radiculopathy, as a complication of TLIF, has been recognized in this institution, but is rarely reported in the literature. In this article, we report 2 cases of contralateral radiculopathy after TLIF in our institution and its associated complications. In the 2 cases, the postoperative computed tomography (CT) and magnetic resonance image (MRI) showed obvious upward movement of the superior articular process, leading to contralateral foraminal stenosis. Revision surgery was done at once to partially resect the opposite superior facet and to relieve nerve root compression. After revision surgery, the contralateral radiculopathy disappeared. Contralateral radiculopathy is an avoidable potential complication. It is very important to create careful preoperative plans and to conscientiously plan the use of intraoperative techniques. In case of postoperative contralateral leg pain, the patients should be examined by CT and MRI. If CT and MRI show that the superior articular process significantly migrated upwards, which leads to contralateral foraminal stenosis, revision surgery should be done at once to partially resect the contralateral superior facet so as to relieve nerve root compression and avoid possible long-term impairment.

Slump Test: Effect of Contralateral Knee Extension on Response Sensations in Asymptomatic Subjects and Cadaver Study.

PubMed

Shacklock, Michael; Yee, Brian; Van Hoof, Tom; Foley, Russ; Boddie, Keith; Lacey, Erin; Poley, J Bryan; Rade, Marinko; Kankaanpää, Markku; Kröger, Heikki; Airaksinen, Olavi

2016-02-01

Part 1: A randomized, single-blind study on the effect of contralateral knee extension on sensations produced by the slump test (ST) in asymptomatic subjects. Part 2: A cadaver study simulating the nerve root behavior of part 1. Part 1: Test if contralateral knee extension consistently reduces normal stretch sensations with the ST.Part 2: Ascertain in cadavers an explanation for the results. In asymptomatic subjects, contralateral knee extension reduces stretch sensations with the ST. In sciatica patients, contralateral SLR also can temporarily reduce sciatica. We studied this methodically in asymptomatic subjects before considering a clinical population. Part 1: Sixty-one asymptomatic subjects were tested in control (ST), sham, or intervention (contralateral ST) groups and their sensation response intensity compared.Part 2: Caudal tension was applied to the L5 nerve root of 3 cadavers and tension behavior of the contralateral neural tissue recorded visually. Part 1: Reduction of stretch sensations occurred in the intervention group but not in control and sham groups (P ≤ 0.001).Part 2: Tension in the contralateral lumbar nerve roots and dura reduced in a manner consistent with the responses in the intervention (contralateral ST) group. Part 1: In asymptomatic subjects, normal thigh stretch sensations with the ST reduced consistently with the contralateral ST, showing that this is normal and may now be compared with patients with sciatica.Part 2: Contralateral reduction in lumbar neural tension with unilateral application of tension-producing movements also occurred in cadavers, supporting the proposed explanatory hypothesis.

Nonpalpable testes: Ultrasound and contralateral testicular hypertrophy predict the surgical access, avoiding unnecessary laparoscopy.

PubMed

Berger, Christoph; Haid, Bernhard; Becker, Tanja; Koen, Mark; Roesch, Judith; Oswald, Josef

2018-04-01

In up to 20% of patients presenting with undescended testes, one or both are non-palpable. Whereas the most reliable means to exclude an abdominal testis is laparoscopy, there has been a lot of debate about the role of inguinal ultrasound (US) in detecting non-palpable inguinal testis. While we do not aim to add another paper claiming the benefits of US, we wanted to determine the excess capability of US to determine the correct surgical approach - inguinal or laparoscopy. In the light of avoiding unnecessary diagnostic laparoscopies, even the cost-effectiveness raised in many current papers might be called into question. Of a total of 684 boys who underwent surgery for undescended testes at our department between 2011 and 2014, in 58 (8.5%), one or both testes were neither palpable preoperatively nor under general anesthesia. These boys were examined by two experienced pediatric urologists clinically as well as by US. Besides the size of the contralateral testis, the presence of a testis in the inguinal channel was investigated. The additional impact of US over clinical exam and consideration of the size of the contralateral testis was assessed by means of intra-individual comparisons using Cochran-Q as well as McNemar tests. Clinical exam without considering the size of the contralateral testis had a sensitivity of 9% (95% CI 2-24%) and a specificity of 100% (95% CI 86-100%) to accurately predict the surgical approach deemed appropriate postoperatively. The consideration of the size of the contralateral testis - taken as an isolated factor - accurately predicted the surgical approach with a sensitivity of 21% (95% CI 9-38%) and a specificity of 88% (95% CI 68-97%). Ultrasound accounted for a sensitivity of 53% (95% CI 35-70%) and a specificity of 100% (95% CI 86-100%). The addition of US increased the sensitivity to correctly predict an inguinal incision from 29% to 71% and specificity slightly increased from 88% to 92%. This difference is significant (p = 0.008) in the bilateral McNemar test (Figure). Inguinal US of non-palpable testes and measurement of the contralateral testis are synergistic in predicting the surgical approach. The addition of ultrasound to a clinical exam, performed also under general anesthesia and by an experienced pediatric urologist significantly increases the prediction of the correct surgical approach. Our results translate into five boys needing an US of the NPT to prevent one laparoscopy. Whereas cost-effectiveness of US might be debatable in regard to different healthcare systems, it is proven to be an effective, non-harmful tool to avoid unnecessary diagnostic laparoscopies. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Adaptive remodeling at the pedicle due to pars fracture: a finite element analysis study.

PubMed

İnceoğlu, Serkan; Mageswaran, Prasath; Modic, Michael T; Benzel, Edward C

2014-09-01

Spondylolysis is a common condition among the general population and a major cause of back pain in young athletes. This condition can be difficult to detect with plain radiography and has been reported to lead to contralateral pars fracture or pedicle fracture in the terminal stages. Interestingly, some patients with late-stage spondylolysis are observed to have radiographic or CT evidence of a sclerotic pedicle on the side contralateral to the spondylolysis. Although computational studies have shown stress elevation in the contralateral pedicle after a pars fracture, it is not known if these changes would cause sclerotic changes in the contralateral pedicle. The objective of this study was to investigate the adaptive remodeling process at the pedicle due to a contralateral spondylolysis using finite element analysis. A multiscale finite element model of a vertebra was obtained by combining a continuum model of the posterior elements with a voxel-based pedicle section. Extension loading conditions were applied with or without a fracture at the contralateral pars to analyze the stresses in the contralateral pedicle. A remodeling algorithm was used to simulate and assess density changes in the contralateral pedicle. The remodeling algorithm demonstrated an increase in bone formation around the perimeter of the contralateral pedicle with some localized loss of mass in the region of cancellous bone. The authors' results indicated that a pars fracture results in sclerotic changes in the contralateral pedicle. Such a remodeling process could increase overall bone mass. However, focal bone loss in the region of the cancellous bone of the pedicle might predispose the pedicle to microfractures. This phenomenon explains, at least in part, the origin of pedicle stress fractures in the sclerotic contralateral pedicles of patients with unilateral spondylolysis.

The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3).

PubMed

Joo, Y-H; Yoo, I-R; Cho, K-J; Park, J-O; Nam, I-C; Kim, C-S; Kim, S-Y; Kim, M-S

2014-12-01

The purpose of this study was to determine whether preoperative (18) F-FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck. A retrospective review of medical records was performed. Patients treated at a single institute. One hundred and fifty-seven patients whose pathology results were positive for unilateral node metastasis (N1-3) involvement and underwent preoperative (18) F-FDG PET/CT for head and neck squamous cell carcinoma (HNSCC) were reviewed. Prognostic factors and nodal SUVmax were studied to identify the risk of contralateral disease. Thirty-six (22.9%) patients had contralateral cervical lymph node metastases. The (18) F-FDG PET/CT had a sensitivity of 80% and a specificity of 96% in identifying the contralateral cervical lymph node metastases on a level-by-level basis. The median SUVmax values of the ipsilateral and contralateral lymph nodes were 3.99 ± 3.36 (range, 0-20.4) and 2.94 ± 2.04 (range, 0-8.7), respectively (P = 0.001). There was a significant difference in the median SUVmax of contralateral nodes between the benign and malignant cervical lymph nodes (2.31 ± 0.62 versus 3.28 ± 2.43, P = 0.014). The cut-off value of contralateral median SUVmax in the context of contralateral cervical metastasis was 2.5 with the sensitivity of 75% and the specificity of 94%. A median contralateral lymph node SUVmax  ≥ 2.5 was associated with 5-year disease-specific survival (P = 0.038). (18) F-FDG PET/CT median SUVmax cut-off values of contralateral lymph nodes ≥2.5 were associated with contralateral cervical lymph node metastases and 5-year disease-specific survival in HNSCC patients with unilateral metastases. © 2014 John Wiley & Sons Ltd.

Reconstructive surgery for patellofemoral joint incongruency.

PubMed

Neumann, M V; Stalder, M; Schuster, A J

2016-03-01

A retrospective analysis of a heterogeneous patient cohort was performed to determine the outcome and eligibility of a combined trochleaplasty and soft tissue-balancing technique for repair of patellofemoral joint disorders. A strict surgical treatment algorithm including trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle was implemented to restore the patellofemoral joint. A heterogeneous patient cohort including 46 consecutively treated symptomatic knees was reviewed. The median follow-up period was 4.7 years (range 24-109 months). No patellar redislocation occurred post-operatively, and the median Kujala score improved from 62 (9-96) to 88 (47-100) points (p < 0.001) at follow-up. Radiological signs of trochlear dysplasia were corrected, and both patellar height and trochlear depth were significantly restored after surgery. In total, 16% of affected patients with pre-existing patellofemoral degenerative changes showed progression of osteoarthrosis according to the Kellgren and Lawrence classification. The surgical combination of trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle offers excellent clinical and radiological results. The overall results of the present study showed significant improvement of the Kujala score in patients with Dejour grades C and D dysplasia. These results outline the clinical relevance of trochleaplasty with additional soft tissue balancing as an effective joint-preserving method with satisfying results in patients with pre-existing degenerative changes. IV.

[Depiction of the cranial nerves around the cavernous sinus by 3D reversed FISP with diffusion weighted imaging (3D PSIF-DWI)].

PubMed

Ishida, Go; Oishi, Makoto; Jinguji, Shinya; Yoneoka, Yuichiro; Sato, Mitsuya; Fujii, Yukihiko

2011-10-01

To evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution "cranial nerve imaging", which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region.

Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves.

PubMed

Cho, Kwang Ho; Rodríguez-Vázquez, Jose Francisco; Han, Eui Hyeog; Verdugo-López, Samuel; Murakami, Gen; Cho, Baik Hwan

2010-09-20

Development of the meninges in and around the plica ventralis encephali has not been well documented. A distinct mesenchymal structure, the so-called plica ventralis encephali, is sandwiched by the fetal mesencephalic flexure. We histologically examined paraffin-embedded sections from 18 human embryos and fetuses at 6-12 weeks of gestation. In the loose tissues of the plica, the first meninx appeared as a narrow membrane along the oculomotor nerve at 7-8 weeks. Subsequently, the plica ventralis evolved into 3 parts: bilateral lateral mesenchymal condensations and a primitive membranous meninx extending between. Notably, the topographical anatomy of the oculomotor, trochlear and trigeminal nerves did not change: the oculomotor nerve ran along the rostral aspect of the membranous meninx, the trigeminal nerve ran along the caudal side of the lateral mesenchymal condensation, and the trochlear nerve remained embedded in the lateral condensation. Up to 9-10 weeks, the lateral mesenchymal condensations became tongue-like folds; i.e., the primitive form of the tentorium cerebelli, while the membranous meninx became the diaphragma sellae. The falx cerebri seemed to develop from the tongue-like folds. Overall, the final tentorium cerebelli corresponded to the regressed plica ventralis, while the parasellar area originated from the base of the plica and other tissues along the ventral aspects of the basisphenoid and basioccipital. Copyright © 2010 Elsevier GmbH. All rights reserved.

Early revisions of the Femoro-Patella Vialla joint replacement.

PubMed

Williams, D P; Pandit, H G; Athanasou, N A; Murray, D W; Gibbons, C L M H

2013-06-01

The aim of this study was to review the early outcome of the Femoro-Patella Vialla (FPV) joint replacement. A total of 48 consecutive FPVs were implanted between December 2007 and June 2011. Case-note analysis was performed to evaluate the indications, operative histology, operative findings, post-operative complications and reasons for revision. The mean age of the patients was 63.3 years (48.2 to 81.0) and the mean follow-up was 25.0 months (6.1 to 48.9). Revision was performed in seven (14.6%) at a mean of 21.7 months, and there was one re-revision. Persistent pain was observed in three further patients who remain unrevised. The reasons for revision were pain due to progressive tibiofemoral disease in five, inflammatory arthritis in one, and patellar fracture following trauma in one. No failures were related to the implant or the technique. Trochlear dysplasia was associated with a significantly lower rate of revision (5.9% vs 35.7%, p = 0.017) and a lower incidence of revision or persistent pain (11.8% vs 42.9%, p = 0.045). Focal patellofemoral osteoarthritis secondary to trochlear dysplasia should be considered the best indication for patellofemoral replacement. Standardised radiological imaging, with MRI to exclude overt tibiofemoral disease should be part of the pre-operative assessment, especially for the non-dysplastic knee.

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis.

PubMed

Yılmaz, Taner; Süslü, Nilda; Atay, Gamze; Günaydın, Rıza Önder; Bajin, Münir Demir; Özer, Serdar

2015-05-01

The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. This was a retrospective cohort, chart review involving 305 surgically treated patients with T1-3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as 'no,' '<5 mm' or '≥5 mm.' The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.

Choosing the appropriate side for subcutaneous port catheter placement in patients with mastectomy: ipsilateral or contralateral?

PubMed

Nas, Omer Fatih; Hacikurt, Kadir; Kaya, Ahmet; Dogan, Nurullah; Sanal, Bekir; Ozkaya, Guven; Dundar, Halit Ziya; Erdogan, Cuneyt

2017-06-01

To evaluate long-term clinical follow-up results of implanting subcutaneous port catheters (SPCs) on ipsilateral or contralateral with mastectomy side in patients with axillary lymph node dissection. A total of 73 patients composed of ipsilateral (34 catheters) and contralateral (39 catheters) groups, with SPCs were included. All patients had lumpectomy or modified radical mastectomy for breast cancer. Ipsilateral and contralateral groups had similar patient characteristics. Five late complications were seen in the ipsilateral group and 2 late complications in the contralateral group. No statistical significant difference was seen between two groups in regard to late complications. Four complications of the ipsilateral group were classified as major group C and 1 as major group D, while 1 complication of the contralateral group was classified as minor group B and 1 as major group C according to Society of Interventional Radiology (SIR) classification. No statistical significant difference was seen between complication rates of two groups in regard to SIR classification. SPC related complications do not differ in regard to ipsilateral or contralateral side selection on mastectomized patients with breast cancer and lymph node dissection. SPCs can be implanted on ipsilateral or contralateral sides of the operation in these patients.

Unilateral lesion of dorsal hippocampus in adult rats impairs contralateral long-term potentiation in vivo and spatial memory in the early postoperative phase.

PubMed

Li, Hongjie; Wu, Xiaoyan; Bai, Yanrui; Huang, Yan; He, Wenting; Dong, Zhifang

2012-05-01

It is well documented that bilateral hippocampal lesions or unilateral hippocampal lesion at birth causes impairment of contralateral LTP and long-term memory. However, effects of unilateral hippocampal lesion in adults on contralateral in vivo LTP and memory are not clear. We here examined the influence of unilateral electrolytic dorsal hippocampal lesion in adult rats on contralateral LTP in vivo and spatial memory during different postoperative phases. We found that acute unilateral hippocampal lesion had no effect on contralateral LTP. However, contralateral LTP was impaired at 1 week after lesion, and was restored to the control level at postoperative week 4. Similarly, spatial memory was also impaired at postoperative week 1, and was restored at postoperative week 4. In addition, the rats at postoperative week 1 showed stronger spatial exploratory behavior in a novel open-field environment. The sham operation had no effects on contralateral LTP, spatial memory and exploration at either postoperative week 1 or week 4. These results suggest that unilateral dorsal hippocampal lesion in adult rats causes transient contralateral LTP impairment and spatial memory deficit. Copyright © 2012 Elsevier B.V. All rights reserved.

Incidence Rate and Risk Factors for Contralateral Eye Involvement among Patients with AIDS and Cytomegalovirus Retinitis Treated with Local Therapy.

PubMed

Sittivarakul, Wantanee; Benjhawaleemas, Thanyapat; Aui-Aree, Nipat; Jirarattanasopa, Pichai; Liabsuetrakul, Tippawan

2016-10-01

To calculate the incidence of, and to identify the risk factors for developing contralateral eye involvement among patients with AIDS and unilateral cytomegalovirus retinitis (CMV retinitis), who were treated, in the era of highly-active antiretroviral therapy (HAART), with repetitive intravitreal ganciclovir injections. The clinical records of 119 patients were included. The main outcome measurement was the occurrence of contralateral eye involvement. Over a mean follow-up period of 1.6 years, the overall incidence rate of contralateral involvement was 0.17/person-year. The cumulative incidence of contralateral involvement at 6 months and 1 year was 23.8% and 28.4%, respectively. Receiving HAART at the visit before the event was associated with a decreased risk of developing contralateral retinitis (hazard ratio [HR] = 0.26, P = 0.002). The use of HAART, associated with subsequent immune recovery, significantly reduced the incidence of contralateral eye involvement by approximately 75% among patients in our setting.

Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

PubMed Central

Pisanu, Gabriele; Rosso, Federica; Bertolo, Corrado; Dettoni, Federico; Blonna, Davide; Bonasia, Davide Edoardo; Rossi, Roberto

2017-01-01

Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA. PMID:29270562

Vulnerability of the Medial Frontal Corticospinal Projection Accompanies Combined Lateral Frontal and Parietal Cortex Injury in Rhesus Monkey

PubMed Central

Morecraft, R.J.; Ge, J.; Stilwell-Morecraft, K.S.; McNeal, D.W.; Hynes, S.M.; Pizzimenti, M.A.; Rotella, D.L.; Darling, W.G.

2014-01-01

Concurrent damage to the lateral frontal and parietal cortex is common following middle cerebral artery infarction leading to upper extremity paresis, paresthesia and sensory loss. Motor recovery is often poor and the mechanisms that support, or impede this process are unclear. Since the medial wall of the cerebral hemisphere is commonly spared following stroke, we investigated the long-term (6 and 12 month) effects of lateral frontoparietal injury (F2P2 lesion) on the terminal distribution of the corticospinal projection (CSP) from intact, ipsilesional supplementary motor cortex (M2) at spinal levels C5 to T1. Isolated injury to the frontoparietal arm/hand region resulted in a significant loss of contralateral corticospinal boutons from M2 compared to controls. Specifically, reductions occurred in the medial and lateral parts of lamina VII and the dorsal quadrants of lamina IX. There were no statistical differences in the ipsilateral corticospinal projection. Contrary to isolated lateral frontal motor injury (F2 lesion) which results in substantial increases in contralateral M2 labeling in laminae VII and IX (McNeal et al., Journal of Comparative Neurology 518:586-621, 2010), the added effect of adjacent parietal cortex injury to the frontal motor lesion (F2P2 lesion) not only impedes a favorable compensatory neuroplastic response, but results in a substantial loss of M2 CSP terminals. This dramatic reversal of the CSP response suggests a critical trophic role for cortical somatosensory influence on spared ipsilesional frontal corticospinal projections, and that restoration of a favorable compensatory response will require therapeutic intervention. PMID:25349147

Adolescents and female patients are at increased risk for contralateral anterior cruciate ligament reconstruction: a cohort study from the Swedish National Knee Ligament Register based on 17,682 patients.

PubMed

Snaebjörnsson, Thorkell; Hamrin Senorski, Eric; Sundemo, David; Svantesson, Eleonor; Westin, Olof; Musahl, Volker; Alentorn-Geli, Eduard; Samuelsson, Kristian

2017-12-01

The impact of different surgical techniques in index ACL reconstruction for patients undergoing contralateral ACL reconstruction was investigated. The study was based on data from the Swedish National Knee Ligament Register. Patients undergoing index ACL reconstruction and subsequent contralateral ACL reconstruction using hamstring graft under the study period were included. The following variables were evaluated: age at index surgery, gender, concomitant meniscal or cartilage injury registered at index injury, transportal femoral bone tunnel drilling and transtibial femoral bone tunnel drilling. The end-point of primary contralateral ACL surgery was analysed as well as the time-to-event outcomes using survivorship methods including Kaplan-Meier estimation and Cox proportional hazards regression models. A total of 17,682 patients [n = 10,013 males (56.6%) and 7669 females (43.4%)] undergoing primary ACL reconstruction from 1 January 2005 through 31 December 2014 were included in the study. A total of 526 (3.0%) patients [n = 260 males (49.4%) and 266 females (50.6%)] underwent primary contralateral ACL reconstruction after index ACL reconstruction during the study period. Females had a 33.7% greater risk of contralateral ACL surgery [HR 1.337 (95% CI 1.127-1.586); (P = 0 0.001)]. The youngest age group (13-15 years) showed an increased risk of contralateral ACL surgery compared with the reference (36-49) age group [HR 2.771 (95% CI 1.456-5.272); (P = 0.002)]. Decreased risk of contralateral ACL surgery was seen amongst patients with concomitant cartilage injury at index surgery [HR 0.765 (95% CI 0.623-0.939); (P = 0.010)]. No differences in terms of the risk of contralateral ACL surgery were found between anatomic and non-anatomic techniques of primary single-bundle ACL reconstruction, comparing transportal anatomic technique to transtibial non-anatomic, anatomic and partial-anatomic. Age and gender were identified as risk factors for contralateral ACL reconstruction; hence young individuals and females were more prone to undergo contralateral ACL reconstruction. Patients with concomitant cartilage injury at index ACL reconstruction had lower risk for contralateral ACL reconstruction. No significant differences between various ACL reconstruction techniques could be related to increased risk of contralateral ACL reconstruction. Retrospective Cohort Study, Level III.

Impact of contra-lateral breast reshaping on mammographic surveillance in women undergoing breast reconstruction following mastectomy for breast cancer.

PubMed

Nava, Maurizio B; Rocco, Nicola; Catanuto, Giuseppe; Falco, Giuseppe; Capalbo, Emanuela; Marano, Luigi; Bordoni, Daniele; Spano, Andrea; Scaperrotta, Gianfranco

2015-08-01

The ultimate goal of breast reconstruction is to achieve symmetry with the contra-lateral breast. Contra-lateral procedures with wide parenchymal rearrangements are suspected to impair mammographic surveillance. This study aims to evaluate the impact on mammographic detection of mastopexies and breast reductions for contralateral adjustment in breast reconstruction. We retrospectively evaluated 105 women affected by uni-lateral breast cancer who underwent mastectomy and immediate two-stage reconstruction between 2002 and 2007. We considered three groups according to the contra-lateral reshaping technique: mastopexy or breast reduction with inferior dermoglandular flap (group 1); mastopexy or breast reduction without inferior dermoglandular flap (group 2); no contra-lateral reshaping (group 3). We assessed qualitative mammographic variations and breast density in the three groups. Statistically significant differences have been found when comparing reshaped groups with non reshaped groups regarding parenchymal distortions, skin thickening and stromal edema, but these differences did not affect cancer surveillance. The surveillance mammography diagnostic accuracy in contra-lateral cancer detection was not significantly different between the three groups (p = 0.56), such as the need for MRI for equivocal findings at mammographic contra-lateral breast (p = 0.77) and the need for core-biopsies to confirm mammographic suspect of contra-lateral breast cancer (p = 0.90). This study confirms previous reports regarding the safety of mastopexies and breast reductions when performed in the setting of contra-lateral breast reshaping after breast reconstruction. Mammographic accuracy, sensitivity and specificity are not affected by the glandular re-arrangement. These results provide a further validation of the safety of current reconstructive paradigms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Influence of using a single facial vein as outflow in full-face transplantation: A three-dimensional computed tomographic study.

PubMed

Rodriguez-Lorenzo, Andres; Audolfsson, Thorir; Wong, Corrine; Cheng, Angela; Arbique, Gary; Nowinski, Daniel; Rozen, Shai

2015-10-01

The aim of this study was to evaluate the contribution of a single unilateral facial vein in the venous outflow of total-face allograft using three-dimensional computed tomographic imaging techniques to further elucidate the mechanisms of venous complications following total-face transplant. Full-face soft-tissue flaps were harvested from fresh adult human cadavers. A single facial vein was identified and injected distally to the submandibular gland with a radiopaque contrast (barium sulfate/gelatin mixture) in every specimen. Following vascular injections, three-dimensional computed tomographic venographies of the faces were performed. Images were viewed using TeraRecon Software (Teracon, Inc., San Mateo, CA, USA) allowing analysis of the venous anatomy and perfusion in different facial subunits by observing radiopaque filling venous patterns. Three-dimensional computed tomographic venographies demonstrated a venous network with different degrees of perfusion in subunits of the face in relation to the facial vein injection side: 100% of ipsilateral and contralateral forehead units, 100% of ipsilateral and 75% of contralateral periorbital units, 100% of ipsilateral and 25% of contralateral cheek units, 100% of ipsilateral and 75% of contralateral nose units, 100% of ipsilateral and 75% of contralateral upper lip units, 100% of ipsilateral and 25% of contralateral lower lip units, and 50% of ipsilateral and 25% of contralateral chin units. Venographies of the full-face grafts revealed better perfusion in the ipsilateral hemifaces from the facial vein in comparison with the contralateral hemifaces. Reduced perfusion was observed mostly in the contralateral cheek unit and contralateral lower face including the lower lip and chin units. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Contralateral pulmonary metastases in lung cancer

PubMed Central

Onuigbo, Wilson I. B.

1974-01-01

Onuigbo, W. I. B. (1974).Thorax, 29, 132-133. Contralateral pulmonary metastases in lung cancer. It has long been known that lung cancer may attack many organs and yet spare the opposite lung. In 100 cases of this tumour studied at necropsy, only 22 showed contralateral pulmonary spread. Contralateral deposits are generally small and may be related to damaged tissues. Although tissue unsuitability is supposed to underlie the limitation of metastases in recipient organs, this does not apply to the contralateral lung. Since lung tissue is readily accessible to bloodborne cancer cells, research should be directed towards explaining the paradoxical paucity of the metastases. PMID:4825544

Status of the contralateral rotator cuff in patients undergoing rotator cuff repair.

PubMed

Ro, Kyung-Han; Park, Jong-Hoon; Lee, Soon-Hyuck; Song, Dong-Ik; Jeong, Ha-Joon; Jeong, Woong-Kyo

2015-05-01

Although the prevalence of rotator cuff tear (RCT) in the general population has been analyzed, little information is available on the status of the opposite-side rotator cuff in patients who have undergone arthroscopic rotator cuff repair. To identify the characteristics of the contralateral shoulder and to identify factors associated with RCT of the contralateral shoulder in patients who underwent surgery for symptomatic RCT. The hypothesis was that the prevalence of RCT in the contralateral shoulder would be higher in patients with increasingly larger cuff tears requiring surgical intervention. Case series; Level of evidence, 4. The study cohort consisted of 140 patients with RCT who underwent arthroscopic rotator cuff repair. Opposite-shoulder rotator cuff tendons of all patients were evaluated by ultrasonography. Demographic information and factors related to contralateral RCT were investigated, and risk factors associated with contralateral RCT were assessed. Of the 140 patients who underwent arthroscopic rotator cuff repair, 54 (38.6%) had an RCT of the contralateral shoulder. Of 51 patients with partial-thickness and small-sized full-thickness tears of the operated shoulder, 35 (68.6%) had no tears; 14 (27.5%) had partial-thickness tears; and 2 (3.9%) had small-sized full-thickness tears of the contralateral shoulder. Of 75 patients with medium-sized full-thickness tears, 43 (57.3%) had no tears; 12 (16%) had partial-thickness tears; and 20 (26.7%) had full-thickness tears of the contralateral shoulder. Of 14 patients with large to massive full-thickness tears, 8 (57.1%) had no tears; 1 (7.1%) had a partial-thickness tear; and 5 (35.7%) had full-thickness tears of the contralateral shoulder. The prevalence of RCT of the contralateral shoulder differed significantly among groups classified by tear size (P=.007). The mean American Shoulder and Elbow Surgeons score was significantly lower in the RCT than in the nontear group (55.8±16.9 vs 61.6±13.3; P=.03). Of 29 subjects with symptomatic tears involving the nondominant arm, 17 (58.6%) had contralateral asymptomatic RCT, compared with 37 of 111 (33.3%) subjects with symptomatic tears involving the dominant arm (P=.007). The prevalence of RCT of the contralateral asymptomatic shoulder tends to be higher in patients with more symptomatic RCT on one side, in patients with medium-sized or larger RCT in the operated shoulder, and in patients with symptomatic RCT in the nondominant arm. © 2015 The Author(s).

Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome.

PubMed

Le, Trong Binh; Lee, Taeg Ki; Park, Keun-Myoung; Jeon, Yong Sun; Hong, Kee Chun; Cho, Soon Gu

2018-04-25

To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS). Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1-142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed. Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). Median age was 69 years (range, 42-85 years). Median follow-up was 73.5 months (range, 20-134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), "jailing" (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months. Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause. Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion.

PubMed

Yang, Yang; Liu, Zhong-Yu; Zhang, Liang-Ming; Dong, Jian-Wen; Xie, Pei-Gen; Chen, Rui-Qiang; Yang, Bu; Liu, Chang; Liu, Bin; Rong, Li-Min

2017-12-08

Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an advantageous method for treating lumbar degenerative disease; however, some patients show contralateral radiculopathy postoperatively. This study aims to investigate its risk factor. A total of 130 cases who underwent microendoscopy-assisted MIS-TLIF at L4-5 level were divided into symptomatic and asymptomatic groups according to the presence of postoperative contralateral radiculopathy. Both preoperative and postoperative radiographic parameters, as well as their changes were compared between the two groups, including lumbar lordosis (LL), surgical segmental angle (SSA), disc height (DH), contralateral foramen area (CFA) and contralateral canal area (CCA). Screw breach on contralateral L4 pedicle and decompression method (ipsilateral or bilateral canal decompression through unilateral route) were also analyzed as potential risk factors. Receiver operating characteristic (ROC) curve was drawn for the risk factor to determine the optimal threshold for predicting postoperative contralateral radiculopathy. Besides, clinical outcome assessment, involving Visual Analog Score (VAS) for back and leg, Japanese Orthopaedics Association Score (JOA) and Oswestry Disability Index (ODI), was also compared between the two groups before surgery and at final follow-up (at least 3 months after the surgery for asymptomatic patients or final treatments of contralateral radiculopathy for symptomatic cases). Postoperative contralateral radiculopathy occurred in 11 (8.5%) of the 130 patients. Both preoperative and postoperative CFA as well as its change were significantly decreased in symptomatic group compared with asymptomatic group (all P < 0.05). For the remaining four parameters (LL, SSA, DH, CCA), their preoperative, postoperative and change values showed no statistical difference between the two groups (all P > 0.05). Neither screw breach nor decompression method revealed statistical association with this complication (both P > 0.05). Based on ROC curve, the optimal threshold of preoperative CFA was 0.76 cm 2 . At final follow-up, significant improvement in VAS (back and leg), JOA and ODI was observed in both groups compared with preoperative baseline (all P < 0.05), while no difference was found between the two groups (all P > 0.05). Preoperative contralateral foramen stenosis is the risk factor of contralateral radiculopathy following microendoscopy-assisted MIS-TLIF. If preoperative CFA at L4-5 level is not larger than 0.76 cm 2 , prophylactic measures, including both indirect and direct decompression of contralateral foramen, are recommended.

Contralateral Hyperalgesia from Injection of Endothelin-1 into the Ipsilateral Paw Requires Efferent Conduction into the Contralateral Paw.

PubMed

Strichartz, Gary R; Khodorova, Alla; Wang, Jeffrey Chi-Fei; Chen, Yu-Wen; Huang, Chuan-Chin

2015-10-01

Contralateral hyperalgesia, occurring after unilateral injury, is usually explained by central sensitization in spinal cord and brain. We previously reported that injection of endothelin-1 (ET-1) into one rat hindpaw induces prolonged mechanical and chemical sensitization of the contralateral hindpaw. Here, we examined the role of contralateral efferent activity in this process. ET-1 (2 nmol, 10 μL) was injected subcutaneously into the plantar surface of right (ipsilateral) hindpaw (ILP), and the thermal response latency and mechanical threshold for nocifensive withdrawal were determined by the use of, respectively, plantar radiant heating and von Frey filaments, for both ILP and contralateral hindpaws (CLP). Either paw was anesthetized for 60 minutes by direct injection of bupivacaine (0.25%, 40 μL), 30 minutes before ET-1. Alternatively, the contralateral sciatic nerve was blocked for 6 to 12 hours by percutaneous injection of bupivacaine-releasing microspheres 30 minutes before injection of ET-1. Systemic actions of these bupivacaine formulations were simulated by subcutaneous injection at the nuchal midline. After the injection of ET-1, the mechanical threshold of both ILP and CLP decreased by 2 hours, appeared to be lowest around 24 hours, and recovered through 48 hours to preinjection baseline at 72 hours. These hypersensitive responses were suppressed by bupivacaine injected into the ipsilateral paw before ET-1. Injection of the CLP by bupivacaine also suppressed the hypersensitivity of the CLP at all test times, and that of the ILP, except at 2 hours when it increased the sensitivity. This same pattern of change occurred when the contralateral sciatic nerve was blocked by bupivacaine-releasing microspheres. The systemic actions of these bupivacaine formulations were much smaller and only reached significance at 24 hours post-ET-1. Thermal hypersensitivity after ET-1 injection also occurred in both ILP and CLP and showed the same pattern in response to the 2 contralateral anesthetic procedures. These results show that efferent transmission through the contralateral innervation into the paw is necessary for contralateral sensitization by ET-1, suggesting that the release of substances by distal nerve endings is involved. The release of substances in the periphery is essential for contralateral sensitization by ET-1 and may also contribute to secondary hyperalgesia, occurring at loci distant from the primary injury, that occurs after surgery or nerve damage.

Crossed reciprocal inhibition evoked by electrical stimulation of the lamprey spinal cord.

PubMed

Fagerstedt, P; Zelenin, P V; Deliagina, T G; Orlovsky, G N; Grillner, S

2000-09-01

Activation of a motoneuron pool is often accompanied by inhibition of the antagonistic pool through a system of reciprocal inhibition between the two parts of the neuronal network controlling the antagonistic pools. In the present study, we describe the activity of such a system in the isolated spinal cord of the lamprey, when a tonic motor output is evoked by extracellular stimulation (0.5-1 s train of pulses, 20 Hz) of either end of the spinal cord. With two electrodes symmetrically positioned in relation to the midline, stimulation with either of them separately elicited prolonged (1-5 s) ipsilateral ventral root activity. Activity could be abolished by stronger, simultaneously applied, stimulation of the contralateral side of the cord, suggesting that reciprocal inhibition between hemisegments operates when a tonic motor output is generated. Simultaneous stimulation of both sides of the spinal cord with a single electrode with a large tip (300-400 microm in diameter), positioned over the anatomical midline, elicited inconsistent right-side, leftside, or bilateral ventral root responses. A minor displacement (10-20 microm) to the left or right from the midline resulted in activation of ipsilateral motoneurons, whereas the contralateral motoneurons were silent. These findings indicate that a small asymmetry in the excitatory drive to the left and right spinal hemisegments can be further amplified by reciprocal inhibition between the hemisegments. Longitudinal splitting of the spinal cord along the midline resulted in reduced reciprocal inhibition between the hemisegments separated by the lesion. The reduction was proportional to the extent of the split. The inhibition was abolished when the split reached nine segments in length. From these experiments, the longitudinal distribution of the commissural axons responsible for inhibition of contralateral motor output could be estimated.

Systematic arthroscopic investigation of the bovine stifle joint.

PubMed

Hagag, U; Tawfiek, M G; Brehm, W

2015-12-01

The objective of the present study was to establish a protocol for arthroscopic exploration of the bovine stifle joint using craniomedial, caudolateral and caudomedial approaches. An anatomic and arthroscopic study using 26 cadaveric limbs from 13 non-lame adult dairy cows was performed. The craniomedial approach was created between the middle and medial patellar ligaments to investigate the cranial pouches of the stifle joint. The inter-condylar eminence, the proximal aspect of the medial femoral trochlear ridge and the lateral aspect of the lateral femoral condyle were used as starting points for systematic examination of the medial femorotibial, the femoropatellar and the lateral femorotibial joints, respectively. The observed structures were: the suprapatellar pouch, articular surfaces of the patella, femoral trochlear ridges, cruciate ligaments, menisci, and the meniscotibial ligaments. The arthroscopic portal for the caudomedial femorotibial pouch was about 6-8 cm caudal to the medial collateral ligament. The proximal and distal caudolateral femorotibial pouches were explored 3 cm and 1.5 cm caudal to the ipsilateral collateral ligament, respectively. The observed structures were the caudal aspect of femoral condyles, menisci, caudal cruciate ligament, popliteal tendon and the meniscofemoral ligament. Restricted joint size and risk of common peroneal nerve damage were the major limitations for exploration of the caudal femorotibial compartments. The study described the arthroscopic portals and normal intra-articular anatomy of the bovine stifle joint but further investigations are warranted to validate these techniques in clinical cases. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Isolated Displaced Fracture of the Acromion - Case Report].

PubMed

Krtička, M; Ira, D

2016-01-01

Displaced fractures of the acromion are rare injuries. A 45-year-old lady presented with an isolated acromion fracture (type III, Kuhn classification) resulting from a direct blow to the top of her right shoulder in a fall while skiing. After standard clinical and radiological examination of the shoulder, an open reduction and internal plate fixation using a postero-superior approach to the scapula was performed. Early rehabilitation of the arm and shoulder was initiated. At 50 days after surgery the patient achieved a full range of motion in her right shoulder and muscle strength equal to that of the contralateral extremity. By 12 weeks radiographic union of the fracture was recorded. The final functional outcome after open reduction and internal plate fixation of the fracture was comparable with results reported in the literature and, in comparison with conservative treatment, the risk of non-union was significantly reduced. acromion fracture, scapula, osteosynthesis.

Relationship of unilateral total hip arthroplasty (THA) to contralateral and ipsilateral knee joint degeneration - a longitudinal 3T MRI study from the Osteoarthritis Initiative (OAI).

PubMed

Jungmann, P M; Nevitt, M C; Baum, T; Liebl, H; Nardo, L; Liu, F; Lane, N E; McCulloch, C E; Link, T M

2015-07-01

To evaluate the association of prevalent unilateral total hip arthroplasty (THA) with worsening of degenerative knee abnormalities and clinical outcomes in the ipsilateral and contralateral knee. Both knees of 30 individuals in the Osteoarthritis Initiative (OAI) with unilateral THA (n = 14 left, n = 16 right) at baseline were assessed at baseline and at 4-year follow-up for Whole-organ MR Imaging Scores (WORMS), cartilage T2 relaxation times (only available for right knees), Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores and upper leg isometric strength. Right knees of 30 individuals without THA were analyzed as controls. Contralateral knees were compared to ipsilateral knees with paired t-tests and to control knees with multivariate regression analysis adjusting for covariates. In paired analyses, compared to ipsilateral knees, contralateral knees had higher WORMS total (P = 0.008) and cartilage scores (P = 0.007) at baseline. Over 4 years contralateral knees worsened more on WORMS total score (P = 0.008). Cartilage T2 values were higher in knees contralateral to the THA (baseline, P = 0.02; follow-up, P < 0.001). Contralateral knees had greater declines in knee extension strength (P = 0.04) and had a trend for greater worsening in WOMAC pain, stiffness, function and total scores (P = 0.04-0.09). Similar results were found comparing contralateral knees with control knees in multivariate regression models. Prevalent unilateral THA is associated with an greater progression of degenerative findings for the knee contralateral to THA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Contralateral limb during total contact casting. A dynamic pressure and thermometric analysis.

PubMed

Armstrong, D G; Liswood, P J; Todd, W F

1995-12-01

The authors draw attention to the importance of evaluation of the contralateral limb when treating unilateral sequelae secondary to distal symmetrical polyneuropathy. Plantar pressure measurements of the contralateral limb during total contact casting are reviewed. The results of thermometric evaluation before and after initiation of repetitive stress were reviewed. The results suggest that the patient walking in a total contact cast may experience a reduced focal pressure on the contralateral limb when compared with uncasted walking and three-point walking with crutches. Dermal thermometry may be a highly sensitive tool in evaluating even mild increases in repetitive stress. To explain this decrease in contralateral stress, the authors examine the features inherent to the total contact cast and propose the concept of proprioceptive stability.

Intra- and intersegmental influences among central pattern generating networks in the walking system of the stick insect.

PubMed

Mantziaris, Charalampos; Bockemühl, Till; Holmes, Philip; Borgmann, Anke; Daun, Silvia; Büschges, Ansgar

2017-10-01

To efficiently move around, animals need to coordinate their limbs. Proper, context-dependent coupling among the neural networks underlying leg movement is necessary for generating intersegmental coordination. In the slow-walking stick insect, local sensory information is very important for shaping coordination. However, central coupling mechanisms among segmental central pattern generators (CPGs) may also contribute to this. Here, we analyzed the interactions between contralateral networks that drive the depressor trochanteris muscle of the legs in both isolated and interconnected deafferented thoracic ganglia of the stick insect on application of pilocarpine, a muscarinic acetylcholine receptor agonist. Our results show that depressor CPG activity is only weakly coupled between all segments. Intrasegmental phase relationships differ between the three isolated ganglia, and they are modified and stabilized when ganglia are interconnected. However, the coordination patterns that emerge do not resemble those observed during walking. Our findings are in line with recent studies and highlight the influence of sensory input on coordination in slowly walking insects. Finally, as a direct interaction between depressor CPG networks and contralateral motoneurons could not be observed, we hypothesize that coupling is based on interactions at the level of CPG interneurons. NEW & NOTEWORTHY Maintaining functional interleg coordination is vitally important as animals locomote through changing environments. The relative importance of central mechanisms vs. sensory feedback in this process is not well understood. We analyzed coordination among the neural networks generating leg movements in stick insect preparations lacking phasic sensory feedback. Under these conditions, the networks governing different legs were only weakly coupled. In stick insect, central connections alone are thus insufficient to produce the leg coordination observed behaviorally. Copyright © 2017 the American Physiological Society.

Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis.

PubMed

Sanders, Thomas L; Pareek, Ayoosh; Johnson, Nicholas R; Stuart, Michael J; Dahm, Diane L; Krych, Aaron J

2017-04-01

The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Cohort study; Level of evidence, 3. In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P < .001) than individuals without a patellar dislocation. However, the risk of knee arthroplasty was similar between groups (HR, 2.8; 95% CI, 0.6-19.7; P = .2). Recurrent patellar dislocations (HR, 4.5; 95% CI, 1.6-12.6), osteochondral injury (HR, 11.3; 95% CI, 5.0-26.6), and trochlear dysplasia (HR, 3.6; 95% CI, 1.3-10.0) were associated with arthritis after patellar dislocation. Patellar dislocation is a significant risk factor for patellofemoral arthritis, as nearly half of patients have symptoms and radiographic changes consistent with arthritis at 25 years after lateral patellar dislocation. Osteochondral injury, recurrent patellar instability, and trochlear dysplasia are associated with the development of arthritis.

Endothelinergic Contractile Hyperreactivity in Rat Contralateral Carotid to Balloon Injury: Integrated Role for ETB Receptors and Superoxide Anion

PubMed Central

Gimenes, Lilian R.; Gomes, Mayara S.; do Vale, Bruno N.; Cardoso, Cristina R. B.; de Oliveira, Ana M.; Moreira, Josimar D.

2017-01-01

Temporal consequences of neurocompensation to balloon injury on endothelinergic functionality in rat contralateral carotid were evaluated. Rats underwent balloon injury in left carotid and were treated with CP-96345 (NK1 antagonist). Concentration-response curves for endothelin-1 were obtained in contralateral (right) carotid at 2, 8, 16, 30, or 45 days after surgery in the absence or presence of BQ-123 (ETA antagonist), BQ-788 (ETB antagonist), or Tempol (superoxide-dismutase mimic). Endothelin-1-induced calcium mobilization was evaluated in functional assays carried out with BQ-123, BQ-788, or Tempol. Endothelin-1-induced NADPH oxidase-driven superoxide generation was measured by lucigenin chemiluminescence assays performed with BQ-123 or BQ-788. Endothelin-1-induced contraction was increased in contralateral carotid from the sixteenth day after surgery. This response was restored in CP-96345-treated rats. Endothelium removal or BQ-123 did not change endothelin-1-induced contraction in contralateral carotid. This response was restored by BQ-788 or Tempol. Contralateral carotid exhibited an increased endothelin-1-induced calcium mobilization, which was restored by BQ-788 or Tempol. Contralateral carotid exhibited an increased endothelin-1-induced lucigenin chemiluminescence, which was restored by BQ-788. We conclude that the NK1-mediated neurocompensatory response to balloon injury elicits a contractile hyperreactivity to endothelin-1 in rat contralateral carotid by enhancing the muscular ETB-mediated NADPH oxidase-driven generation of superoxide, which activates calcium channels. PMID:29062837

Does the type of somatosensory information from the contralateral finger touch affect grip force control while lifting an object?

PubMed

Chen, Bing; Aruin, Alexander S

2013-11-27

The magnitude of grip force used to lift and transport a hand-held object is decreased if a light finger touch from the contralateral arm is provided to the wrist of the target arm. We investigated whether the type of contralateral arm sensory input that became available with the finger touch to the target arm affects the way grip force is reduced. Nine healthy subjects performed the same task of lifting and transporting an instrumented object with no involvement of the contralateral arm and when an index finger touch of the contralateral arm was provided to the wrist, elbow, and shoulder. Touching the wrist and elbow involved movements of the contralateral arm; no movements were produced while touching the shoulder. Grip force was reduced by approximately the same amount in all conditions with the finger touch compared to the no touch condition. This suggests that information from the muscle and joint receptors of the contralateral arm is used in control of grip force when a finger touch is provided to the wrist and elbow, and cutaneous information is utilized when lifting an object while touching the shoulder. The results of the study provide additional evidence to support the use of a second arm in the performance of activities of daily living and stress the importance of future studies investigating contralateral arm sensory input in grip force control. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb

PubMed Central

Mullaji, Arun B; Shah, Siddharth; Shetty, Gautam M

2017-01-01

Background and purpose — Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods — In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results — Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White’s tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation — Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA. PMID:27794622

Dorsolateral prefrontal cortex bridges bilateral primary somatosensory cortices during cross-modal working memory.

PubMed

Zhao, Di; Ku, Yixuan

2018-05-01

Neural activity in the dorsolateral prefrontal cortex (DLPFC) has been suggested to integrate information from distinct sensory areas. However, how the DLPFC interacts with the bilateral primary somatosensory cortices (SIs) in tactile-visual cross-modal working memory has not yet been established. In the present study, we applied single-pulse transcranial magnetic stimulation (sp-TMS) over the contralateral DLPFC and bilateral SIs of human participants at various time points, while they performed a tactile-visual delayed matching-to-sample task with a 2-second delay. sp-TMS over the contralateral DLPFC or the contralateral SI at either an sensory encoding stage [i.e. 100 ms after the onset of a vibrotactile sample stimulus (200-ms duration)] or an early maintenance stage (i.e. 300 ms after the onset), significantly impaired the accuracy of task performance; sp-TMS over the contralateral DLPFC or the ipsilateral SI at a late maintenance stage (1600 ms and 1900 ms) also significantly disrupted the performance. Furthermore, at 300 ms after the onset of the vibrotactile sample stimulus, there was a significant correlation between the deteriorating effects of sp-TMS over the contralateral SI and the contralateral DLPFC. These results imply that the DLPFC and the bilateral SIs play causal roles at distinctive stages during cross-modal working memory, while the contralateral DLPFC communicates with the contralateral SI in the early delay, and cooperates with the ipsilateral SI in the late delay. Copyright © 2018 Elsevier B.V. All rights reserved.

SOD1 overexpression prevents acute hyperglycemia-induced cerebral myogenic dysfunction: relevance to contralateral hemisphere and stroke outcomes

PubMed Central

Coucha, Maha; Li, Weiguo; Hafez, Sherif; Abdelsaid, Mohammed; Johnson, Maribeth H.; Fagan, Susan C.

2014-01-01

Admission hyperglycemia (HG) amplifies vascular injury and neurological deficits in acute ischemic stroke, but the mechanisms remain controversial. We recently reported that ischemia-reperfusion (I/R) injury impairs the myogenic response in both hemispheres via increased nitration. However, whether HG amplifies contralateral myogenic dysfunction and whether loss of tone in the contralateral hemisphere contributes to stroke outcomes remain to be determined. Our hypothesis was that contralateral myogenic dysfunction worsens stroke outcomes after acute hyperglycemic stroke in an oxidative stress-dependent manner. Male wild-type or SOD1 transgenic rats were injected with saline or 40% glucose solution 10 min before surgery and then subjected to 30 min of ischemia/45 min or 24 h of reperfusion. In another set of animals (n = 5), SOD1 was overexpressed only in the contralateral hemisphere by stereotaxic adenovirus injection 2–3 wk before I/R. Myogenic tone and neurovascular outcomes were determined. HG exacerbated myogenic dysfunction in contralateral side only, which was associated with infarct size expansion, increased edema, and more pronounced neurological deficit. Global and selective SOD1 overexpression restored myogenic reactivity in ipsilateral and contralateral sides, respectively, and enhanced neurovascular outcomes. In conclusion, our results show that SOD1 overexpression nullified the detrimental effects of HG on myogenic tone and stroke outcomes and that the contralateral hemisphere may be a novel target for the management of acute hyperglycemic stroke. PMID:25552308

Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion.

PubMed

Wang, Jian; Wang, Weici; Jin, Bi; Zhang, Yanrong; Xu, Ping; Xiang, Feixiang; Zheng, Yi; Chen, Juan; Sheng, Shi; Ouyang, Chenxi; Li, Yiqing

2016-01-01

Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV) in patients of carotid stenosis (CS) with or without contralateral carotid occlusion (CO) early after carotid endarterectomy (CEA). Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD) and Color Doppler Imaging (CDI) were performed before and early after CEA. Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA) and middle cerebral artery (MCA) on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA) retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA) of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO. Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

Granger causal time-dependent source connectivity in the somatosensory network

NASA Astrophysics Data System (ADS)

Gao, Lin; Sommerlade, Linda; Coffman, Brian; Zhang, Tongsheng; Stephen, Julia M.; Li, Dichen; Wang, Jue; Grebogi, Celso; Schelter, Bjoern

2015-05-01

Exploration of transient Granger causal interactions in neural sources of electrophysiological activities provides deeper insights into brain information processing mechanisms. However, the underlying neural patterns are confounded by time-dependent dynamics, non-stationarity and observational noise contamination. Here we investigate transient Granger causal interactions using source time-series of somatosensory evoked magnetoencephalographic (MEG) elicited by air puff stimulation of right index finger and recorded using 306-channel MEG from 21 healthy subjects. A new time-varying connectivity approach, combining renormalised partial directed coherence with state space modelling, is employed to estimate fast changing information flow among the sources. Source analysis confirmed that somatosensory evoked MEG was mainly generated from the contralateral primary somatosensory cortex (SI) and bilateral secondary somatosensory cortices (SII). Transient Granger causality shows a serial processing of somatosensory information, 1) from contralateral SI to contralateral SII, 2) from contralateral SI to ipsilateral SII, 3) from contralateral SII to contralateral SI, and 4) from contralateral SII to ipsilateral SII. These results are consistent with established anatomical connectivity between somatosensory regions and previous source modeling results, thereby providing empirical validation of the time-varying connectivity analysis. We argue that the suggested approach provides novel information regarding transient cortical dynamic connectivity, which previous approaches could not assess.

Twenty-Year Outcome of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon or Hamstring Autograft.

PubMed

Thompson, Simon Michael; Salmon, Lucy J; Waller, Alison; Linklater, James; Roe, Justin P; Pinczewski, Leo A

2016-12-01

Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. This study aimed to compare the outcomes of isolated ACL reconstruction using the patellar tendon (PT) autograft and the hamstring (HT) autograft in 180 patients over 20 years. Cohort study; Level of evidence, 2. A total of 180 participants undergoing isolated ACL reconstruction between 1993 and 1994 were prospectively recruited. Evaluation was performed at 1, 2, 5, 7, 10, 15, and 20 years after surgery and included the International Knee Documentation Committee (IKDC) knee ligament evaluation with radiographic evaluation, KT-1000 arthrometer side-to-side difference, and subjective scores. Over 20 years, there were 16 patients (18%) and 9 patients (10%) with an ACL graft rupture in the HT and PT groups, respectively (P = .13). ACL graft rupture was associated with male sex (odds ratio [OR], 3.9; P = .007), nonideal tunnel position (OR, 3.6; P = .019), and age <18 years at the time of surgery (OR, 4.6; P = .003). The odds of a contralateral ACL rupture were increased in patients with the PT graft compared with patients with the HT graft (OR, 2.2; P = .02) and those aged <18 years at the time of surgery (OR, 3.4; P = .001). The mean IKDC scores at 20-year follow-up were 86 and 89 for the PT and HT groups, respectively (P = .18). At 20 years, 53% and 57% of the PT and HT groups participated in strenuous or very strenuous activities (P = .55), kneeling pain was present in 63% and 20% of the PT and HT groups (P = .018), and radiographic osteoarthritic change was found in 61% and 41% of the PT and HT groups (P = .008), respectively. Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good subjective outcomes and objective stability. However, further ACL injury is common, particularly in male individuals, younger patients, and those with tunnel malposition. © 2016 The Author(s).

Lateral patellar dislocation: mechanism of disease, radiographic presentation, and management.

PubMed

Abramov, Michael; Stock, Harlan

2013-04-01

Lateral patellar dislocation is a common injury occurring in young active adults. The mechanism is that of twisting injury to the knee on a planted foot with valgus stress. Several predisposing factors, including femoral trochlear dysplasia, patella alta, and lateralization of the tibial tuberosity, contribute to patellar instability and lateral patellar dislocation. Magnetic resonance (MR) imaging of the knee is the modality of choice to evaluate underlying bone contusion patterns, associated soft-tissue injuries, and additional complex ligamentous and osteochondral injuries, many of which are not apparent on conventional radiographs.

Sensitivity to Pigment-Dispersing Factor (PDF) Is Cell-Type Specific among PDF-Expressing Circadian Clock Neurons in the Madeira Cockroach.

PubMed

Gestrich, Julia; Giese, Maria; Shen, Wen; Zhang, Yi; Voss, Alexandra; Popov, Cyril; Stengl, Monika; Wei, HongYing

2018-02-01

Transplantation studies have pinpointed the circadian clock of the Madeira cockroach to the accessory medulla (AME) of the brain's optic lobes. The AME is innervated by approximately 240 adjacent neuropeptidergic neurons, including 12 pigment-dispersing factor (PDF)-expressing neurons anterior to the AME (aPDFMEs). Four of the aPDFMEs project contralaterally, controlling locomotor activity rhythms of the night-active cockroach. The present in vitro Ca 2+ imaging analysis focuses on contralaterally projecting AME neurons and their responses to PDF, GABA, and acetylcholine (ACh). First, rhodamine-dextran backfills from the contralateral optic stalk identified contralaterally projecting AME neurons, which were then dispersed in primary cell cultures. After characterization of PDF, GABA, and ACh responses, PDF immunocytochemistry identified ipsilaterally and contralaterally projecting PDFMEs. All PDF-sensitive clock neurons, PDF-immunoreactive clock neurons, and the majority of ipsilaterally and contralaterally projecting cells were excited by ACh. GABA inhibited all PDF-expressing clock neurons, and about half of other ipsilaterally projecting and most contralaterally projecting clock neurons. For the first time, we identified PDF autoreceptors in PDF-secreting cockroach circadian pacemakers. The medium-sized aPDFMEs and all other contralaterally projecting PDF-sensitive clock cells were inhibited by PDF. The ipsilaterally remaining small PDF-sensitive clock cells were activated by PDF. Only the largest aPDFME did not express PDF autoreceptors. We hypothesize that opposing PDF signaling generates 2 different ensembles of clock cells with antiphasic activity, regulating and maintaining a constant phase relationship between rest and activity cycles of the night-active cockroach.

Lifetime Costs of Prophylactic Mastectomies and Reconstruction versus Surveillance.

PubMed

Mattos, David; Gfrerer, Lisa; Reish, Richard G; Hughes, Kevin S; Cetrulo, Curtis; Colwell, Amy S; Winograd, Jonathan M; Yaremchuk, Michael J; Austen, William G; Liao, Eric C

2015-12-01

The past decade has seen an increasing prevalence of prophylactic mastectomy with decreasing ages of patients treated for breast cancer. Data are limited on the fiscal impacts of contralateral prophylactic mastectomy trends, and no study has compared bilateral prophylactic mastectomy with reconstruction to surveillance in high-risk patients. Lifetime third-party payer costs over 30 years were estimated with 2013 Medicare reimbursement rates. Costs were estimated for patients choosing contralateral or bilateral prophylactic mastectomy versus surveillance, with immediate reconstructions using a single-stage implant, tissue expander, or perforator-based free flap approach. Published cancer incidence rates predicted the percentage of surveillance patients that would require mastectomies. Sensitivity analyses were conducted that varied cost growth, discount rate, cancer incidence rate, and other variables. Lifetime costs and present values (3 percent discount rate) were estimated. Lifetime prophylactic mastectomy costs were lower than surveillance costs, $1292 to $1993 lower for contralateral prophylactic mastectomy and $15,668 to $21,342 lower for bilateral prophylactic mastectomy, depending on the reconstruction. Present value estimates were slightly higher for contralateral prophylactic mastectomy over contralateral surveillance but still cost saving for bilateral prophylactic mastectomy compared with bilateral surveillance. Present value estimates are also cost saving for contralateral prophylactic mastectomy when the modeled contralateral breast cancer incidence rate is increased to at least 0.6 percent per year. These findings are consistent with contralateral and bilateral prophylactic mastectomy being cost saving in many scenarios, regardless of the reconstructive option chosen. They suggest that physicians and patients should continue to receive flexibility in deciding how best to proceed clinically in each case.

Mirror-image pain after nerve reconstruction in rats is related to enhanced density of epidermal peptidergic nerve fibers.

PubMed

Kambiz, S; Brakkee, E M; Duraku, L S; Hovius, S E R; Ruigrok, T J H; Walbeehm, E T

2015-05-01

Mirror-image pain is a phenomenon in which unprovoked pain is detected on the uninjured contralateral side after unilateral nerve injury. Although it has been implicated that enhanced production of nerve growth factor (NGF) in the contralateral dorsal root ganglion is important in the development of mirror-image pain, it is not known if this is related to enhanced expression of nociceptive fibers in the contralateral skin. Mechanical and thermal sensitivity in the contralateral hind paw was measured at four different time points (5, 10, 20 and 30weeks) after transection and immediate end-to-end reconstruction of the sciatic nerve in rats. These findings were compared to the density of epidermal (peptidergic and non-peptidergic) nerve fibers on the contralateral hind paw. Mechanical hypersensitivity of the contralateral hind paw was observed at 10weeks PO, a time point in which both subgroups of epidermal nerve fibers reached control values. Thermal hypersensitivity was observed with simultaneous increase in the density of epidermal peptidergic nerve fibers of the contralateral hind paw at 20weeks PO. Both thermal sensitivity and the density of epidermal nerve fibers returned to control values 30weeks PO. We conclude that changes in skin innervation and sensitivity are present on the uninjured corresponding side in a transient pain model. Therefore, the contralateral side cannot serve as control. Moreover, the current study confirms the involvement of the peripheral nervous system in the development of mirror-image pain. Copyright © 2015 Elsevier Inc. All rights reserved.

Functional mapping of the primate auditory system.

PubMed

Poremba, Amy; Saunders, Richard C; Crane, Alison M; Cook, Michelle; Sokoloff, Louis; Mishkin, Mortimer

2003-01-24

Cerebral auditory areas were delineated in the awake, passively listening, rhesus monkey by comparing the rates of glucose utilization in an intact hemisphere and in an acoustically isolated contralateral hemisphere of the same animal. The auditory system defined in this way occupied large portions of cerebral tissue, an extent probably second only to that of the visual system. Cortically, the activated areas included the entire superior temporal gyrus and large portions of the parietal, prefrontal, and limbic lobes. Several auditory areas overlapped with previously identified visual areas, suggesting that the auditory system, like the visual system, contains separate pathways for processing stimulus quality, location, and motion.

Tinnitus Intensity Dependent Gamma Oscillations of the Contralateral Auditory Cortex

PubMed Central

van der Loo, Elsa; Gais, Steffen; Congedo, Marco; Vanneste, Sven; Plazier, Mark; Menovsky, Tomas; Van de Heyning, Paul; De Ridder, Dirk

2009-01-01

Background Non-pulsatile tinnitus is considered a subjective auditory phantom phenomenon present in 10 to 15% of the population. Tinnitus as a phantom phenomenon is related to hyperactivity and reorganization of the auditory cortex. Magnetoencephalography studies demonstrate a correlation between gamma band activity in the contralateral auditory cortex and the presence of tinnitus. The present study aims to investigate the relation between objective gamma-band activity in the contralateral auditory cortex and subjective tinnitus loudness scores. Methods and Findings In unilateral tinnitus patients (N = 15; 10 right, 5 left) source analysis of resting state electroencephalographic gamma band oscillations shows a strong positive correlation with Visual Analogue Scale loudness scores in the contralateral auditory cortex (max r = 0.73, p<0.05). Conclusion Auditory phantom percepts thus show similar sound level dependent activation of the contralateral auditory cortex as observed in normal audition. In view of recent consciousness models and tinnitus network models these results suggest tinnitus loudness is coded by gamma band activity in the contralateral auditory cortex but might not, by itself, be responsible for tinnitus perception. PMID:19816597

Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction.

PubMed

Webster, Kate E; Feller, Julian A; Leigh, Warren B; Richmond, Anneka K

2014-03-01

Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Case-control study; Level of evidence, 3. A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.

Imbalance of community structures in epilepsy

NASA Astrophysics Data System (ADS)

Ortega, G. J.; Herrera Peco, I.; García de Sola, R.; Pastor, J.

2010-09-01

Epilepsy is commonly associated with synchronous activity in the form of spikes and also in developed seizures. Desynchronised activity seems to play an important role also in the seizure process, favouring the initiation of seizures. The aim of the present work is to explore synchronization activity in the inner areas in the temporal lobe of epileptic patients by a novel approach. Two temporal lobe epilepsy (TLE) patients' records have been analyzed through a cluster analysis. Electrical activity in the inner part of the temporal has been recorded by using Foramen Ovale Electrodes (FOE), a semi-invasive technique frequently used in drug resistant epileptic patients. Instead of tracking synchronized activity, we give here special attention to desynchronized activity, mainly those areas which are not included in synchronization clusters. Our results show that electrical activity in the epileptic side behaves in a less cohesive fashion than the contra-lateral side. There exists a clear tendency in the epileptic side to be organized as isolated clusters of electrical activity as compared with the contra-lateral side, which is organized in the form of large clusters of synchronous activity. In particular, we shall give special attention to the cluster desynchronization during the seizures. As we shall show, our results can help in understand several characteristics of the seizures dynamics.

Organization of pontine reticulospinal inputs to motoneurons controlling axial and limb muscles in the neonatal mouse

PubMed Central

Sivertsen, Magne S.; Glover, Joel C.

2014-01-01

Using optical recording of synaptically mediated calcium transients and selective spinal lesions, we investigated the pattern of activation of spinal motoneurons (MNs) by the pontine reticulospinal projection in isolated brain stem-spinal cord preparations from the neonatal mouse. Stimulation sites throughout the region where the pontine reticulospinal neurons reside reliably activated MNs at cervical, thoracic, and lumbar levels. Activation was similar in MNs ipsi- and contralateral to the stimulation site, similar in medial and lateral motor columns that contain trunk and limb MNs, respectively, and similar in the L2 and L5 segments that predominantly contain flexor and extensor MNs, respectively. In nonlesioned preparations, responses in both ipsi- and contralateral MNs followed individual stimuli in stimulus trains nearly one-to-one (with few failures). After unilateral hemisection at C1 on the same side as the stimulation, responses had substantially smaller magnitudes and longer latencies and no longer followed individual stimuli. After unilateral hemisection at C1 on the side opposite to the stimulation, the responses were also smaller, but their latencies were not affected. Thus we distinguish two pontine reticulospinal pathways to spinal MNs, one uncrossed and the other crossed, of which the uncrossed pathway transmits more faithfully and appears to be more direct. PMID:24944221

Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database

PubMed Central

Schilaty, Nathan D.; Nagelli, Christopher; Bates, Nathaniel A.; Sanders, Thomas L.; Krych, Aaron J.; Stuart, Michael J.; Hewett, Timothy E.

2017-01-01

Background: The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. Purpose: To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. Results: Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). Conclusion: The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries differed by sex, occurring in female patients younger than 25 years and male patients aged 26 to 45 years. Allografts continued to be associated with a greater risk of second ACL injuries compared with hamstring and patellar tendon autografts. Nonoperative treatment carried more risk of contralateral tears than ACLR. PMID:28840155

Clinical utility of carotid duplex ultrasound prior to cardiac surgery.

PubMed

Lin, Judith C; Kabbani, Loay S; Peterson, Edward L; Masabni, Khalil; Morgan, Jeffrey A; Brooks, Sara; Wertella, Kathleen P; Paone, Gaetano

2016-03-01

Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution. Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared. Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (<50%); 25 (8.2%) had unilateral moderate stenosis (50%-69%); 10 (3.3%) had bilateral moderate stenosis; 9 (2.9%) had unilateral severe stenosis (70%-99%); 5 (1.6%) had contralateral moderate stenosis; 2 (0.7%) had bilateral severe stenosis; 4 (1.3%) had unilateral occluded with contralateral less than 50% stenosis, 1 (0.3%) had unilateral occluded with contralateral (70%-99%) stenosis; and 1 had bilateral occluded carotid arteries. Primary outcomes of patients who underwent isolated CABG showed no difference in the perioperative mortality (2.9% vs 4.3%; P = .27) and stroke (2.9% vs 2.6%; P = .70) between patients undergoing preoperative duplex scanning and those who did not. Primary outcomes of patients who underwent open heart surgery also showed no difference in the perioperative mortality (5.1% vs 6.9%; P = .14) and stroke (2.6% vs 2.4%; P = .85) between patients undergoing preoperative duplex scanning and those who did not. Operative intervention of severe carotid stenosis prior to isolated CABG occurred in 2 of the 17 patients (11.8%) identified who underwent carotid endarterectomy with CABG. In this study, the correlation between preoperative duplex-documented high-grade carotid stenosis and postoperative stroke was low. Prudent use of preoperative carotid duplex ultrasound should be based on the presence of cerebrovascular symptoms and the type of open heart surgery. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Evaluation of the Contralateral Inguinal Ring in Clinically Unilateral Inguinal Hernia: A Systematic Review and Meta-analysis

PubMed Central

Kokorowski, Paul J; Wang, Hsin-Hsiao Scott; Routh, Jonathan C; Hubert, Katherine C; Nelson, Caleb P

2013-01-01

Purpose The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. Methods We searched MEDLINE, EMBASE, and Cochrane databases (1940–2011) using ‘hernia’ and ‘inguinal’ and either ‘pediatric,’ ‘infant,’ or ‘child,’ to identify studies of pediatric (age≤21 yrs) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I2>50%, or Cochrane’s Q p≥0.10). Results We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3% (95% CI 6.5%–8.1%). Laparoscopic examination identified CPP in 30% (95% CI 26%–34%). Lower age was associated with higher incidence of CPP (p<0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9% (95% CI 0.5%–1.3%). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. Conclusions The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients. PMID:23963735

The BRAFT1799A mutation is not associated with occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma.

PubMed

Wan, Han-Feng; Zhang, Bin; Yan, Dan-Gui; Xu, Zhen-Gang

2015-01-01

The phenomenon of occult carcinoma maybe observed in patients with clinically unilateral papillary thyroid microcarcinoma (PTMC). Although many studies have reported that the BRAFT1799A mutation is associated with aggressive PTMC, the relationship between BRAFT1799A mutation and occult carcinoma is unclear. The aim of this study was to investigate the risk factors, including BRAFT1799A mutation, for occult contralateral carcinoma in clinically unilateral PTMC accompanied by benign nodules in the contralateral lobe. From January 2011 to December 2013,we prospectively enrolled 89 consecutive PTMC patients with clinically unilateral carcinoma accompanied by benign nodules in the contralateral lobe who received a total thyroidectomy and cervical lymph node dissection. BRAFT1799A mutation was tested by pyrosequencing on postoperative paraffin specimens. The frequency and predictive factors for occult contralateral carcinoma were analyzed with respect to the following variables: age, gender, family history, tumor size, presence of Hashimoto thyroiditis, extrathyroidal extension, central lymph node metastasis, multifocality of primary tumor, or BRAFT1799A mutation. A total of 36 patients (40.4%) had occult PTMC in the contralateral lobe. The median diameter of the occult tumors was 0.33±0.21 cm. The BRAFT1799A mutation was found in 38 cases (42.7%). According to the univariate analysis, there were no significant differences between the presence of occult contralateral carcinoma and age, gender, family history, tumor size, presence of Hashimoto thyroiditis, extrathyroidal extension, central lymph node metastasis, multifocality of primary tumor, or BRAFT1799A mutation. Using current methods, it is difficult to preoperatively identify patients with PTMC, and further research is needed to determine predictive factors for the presence of occult contralateral carcinoma in patients with unilateral PTMC.

Can sparing of the superficial contralateral parotid lobe reduce xerostomia following radiotherapy for head and neck cancer?

PubMed

Nevens, Daan; Nuyts, Sandra

2017-12-01

The purpose of this study is to see whether sparing the superficial contralateral parotid lobe can help limiting xerostomia following radiotherapy for head and neck cancer. 88 patients that were included in two prospective randomized studies were analysed in the current study. Using the dosimetry of both the parotid glands, we divided our patients in four groups. Group 1 includes patients where we were able to reduce the radiation dose below the threshold in order to spare both the ipsilateral and contralateral parotid glands, Group 2 consists of patients where only the contralateral parotid gland could be spared. Group 3 consists of patients where only the contralateral superficial parotid lobe could be spared, while in Group 4 not even the contralateral superficial lobe could be spared. When we compared Group 1 and Group 2, we did not observe a significant difference between both groups in terms of xerostomia scores at 6 or 12 months. When we compared these groups with Group 3, we observed significant differences with more xerostomia in Group 3 where only the contralateral superficial lobe was spared. A significant difference was also observed between Group 3 and Group 4 with more xerostomia in Group 4. Sparing of just one superficial parotid lobe results in less xerostomia when compared to not sparing any lobe of both parotid glands. Advances in knowledge: When sparing of the whole contralateral parotid gland is not possible, delineating both the superficial parotid glands and trying to spare at least one of them can mean a way forward in limiting xerostomia in head and neck cancer patients treated with radiotherapy.

Limiting Radiotherapy to the Contralateral Retropharyngeal and High Level II Lymph Nodes in Head and Neck Squamous Cell Carcinoma is Safe and Improves Quality of Life

PubMed Central

Spencer, Christopher R.; Gay, Hiram A.; Haughey, Bruce H.; Nussenbaum, Brian; Adkins, Douglas R.; Wildes, Tanya M.; DeWees, Todd A.; Lewis, James S.; Thorstad, Wade L.

2014-01-01

Background Radiation treatment volumes in head and neck squamous cell carcinoma (HNSCC) are controversial. Here we report the outcomes, failures, and quality of life (QOL) of patients treated using intensity modulated radiation therapy (IMRT) that eliminated treatment of contralateral retropharyngeal lymph nodes (RPLN) in the clinically uninvolved neck. Methods A prospective institutional database identified patients with primary oral cavity, oropharynx, hypopharynx, larynx and unknown primary HNSCC treated using IMRT. There were three temporal groups (G1-3). G1 received comprehensive neck IMRT with parotid sparing, G2 eliminated the contralateral high level II (HLII) lymph nodes, and G3 further eliminated the contralateral RPLN in the clinically uninvolved neck. Patterns of failure and survival analyses were completed and QOL data measured by the MD Anderson Dysphagia Inventory (MDADI) was compared in a subset of patients from G1 and G3. Results There were 748 patients identified. Of the 488 patients treated in G2 or G3, 406 had a clinically uninvolved contralateral neck. There were no failures in the spared RPLNs (95% CI; 0-1.3%) or high contralateral neck (95% CI; 0-0.7%). QOL data was compared between 44 patients in G1 and 51 patients in G3. QOL improved both globally and in all domains assessed for G3 in which reduced radiotherapy volumes were used (p < 0.007). Conclusions For patients with locally advanced HNSCC, eliminating coverage to the contralateral HLII and contralateral RPLN in the clinically uninvolved side of the neck is associated with minimal risk of failure in these regions and significantly improved patient-reported QOL. PMID:25143048

Poor WOMAC scores in contralateral knee negatively impact TKA outcomes: data from the osteoarthritis initiative.

PubMed

Kahn, Timothy L; Soheili, Aydin C; Schwarzkopf, Ran

2014-08-01

While total knee arthroplasty (TKA) has been shown to have excellent outcomes, a significant proportion of patients experience relatively poor post-operative function. In this study, we test the hypothesis that the level of osteoarthritic symptoms in the contralateral knee at the time of TKA is associated with poorer post-operative outcomes in the operated knee. Using longitudinal cohort data from the Osteoarthritis Initiative (OAI), we included 171 patients who received a unilateral TKA. We compared pre-operative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in the contralateral knee to post-operative WOMAC scores in the index knee. Pre-operative contralateral knee WOMAC scores were associated with post-operative index knee WOMAC Total scores, indicating that the health of the pre-operative contralateral knee is a significant factor in TKA outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

The evolution of contralateral control of the body by the brain: is it a protective mechanism?

PubMed

Whitehead, Lorne; Banihani, Saleh

2014-01-01

Contralateral control, the arrangement whereby most of the human motor and sensory fibres cross the midline in order to provide control for contralateral portions of the body, presents a puzzle from an evolutionary perspective. What caused such a counterintuitive and complex arrangement to become dominant? In this paper we offer a new perspective on this question by showing that in a complex interactive control system there could be a significant net survival advantage with contralateral control, associated with the effect of injuries of intermediate severity. In such cases an advantage could arise from a combination of non-linear system response combined with correlations between injuries on the same side of the head and body. We show that a simple mathematical model of these ideas emulates such an advantage. Based on this model, we conclude that effects of this kind are a plausible driving force for the evolution of contralateral control.

Breeding implications resulting from classification of patellae luxation in dogs.

PubMed

van Grevenhof, E M; Hazewinkel, H A W; Heuven, H C M

2016-08-01

Patellar luxation (PL) is one of the major hereditary orthopaedic abnormalities observed in a variety of dog breeds. When the patellae move sideways out of the trochlear groove, this is called PL. The PL score varies between dogs from normal to very severe. Reducing the prevalence of PL by breeding could prevent surgery, thereby improve welfare. Orthopaedic specialists differentiate between normal and loose patellae, where the patellae can be moved to the edge of the trochlear groove, considering scoring loose patellae as normal in the future. Loose patellae are considered acceptable for breeding so far by the breeding organization. The aim of this study was to analyse the genetic background of PL to decide on the importance of loose patellae when breeding for healthy dogs. Data are available from two dog breeds, that is Flat-coated Retrievers (n = 3808) and Kooiker dogs (n = 794), with a total of 4602 dogs. Results show that loose patellae indicate that dogs are genetically more susceptible to develop PL because family members of the dogs with loose patellae showed more severe PL. In addition, the estimated breeding values for dogs with loose patellae indicate that breeding values of dogs with loose patellae were worse than breeding values obtained for dogs with a normal score. Given these results, it is advised to orthopaedic specialists to continue to score loose patellae as a separate class and to dog breeders to minimize the use of dogs in breeding with a genetically higher susceptibility for PL. © 2015 Blackwell Verlag GmbH.

Use of high-field and low-field magnetic resonance imaging to describe the anatomy of the proximal portion of the tarsal region of nonlame horses.

PubMed

Biggi, Marianna; Dyson, Sue J

2018-03-01

OBJECTIVE To use high-field and low-field MRI to describe the anatomy of the proximal portion of the tarsal region (proximal tarsal region) of nonlame horses. SAMPLE 25 cadaveric equine tarsi. PROCEDURES The proximal portion of 1 tarsus from each of 25 nonlame horses with no history of tarsal lameness underwent high-field (1.5-T) and low-field (0.27-T) MRI. Resulting images were used to subjectively describe the anatomy of that region and obtain measurements of the collateral ligaments of the tarsocrural joint. RESULTS Long and short components of the lateral and medial collateral ligaments of the tarsocrural joint were identified. Various bundles of the short collateral ligaments were difficult to delineate on low-field images. Ligaments typically had low signal intensity in all sequences; however, multiple areas of increased signal intensity were identified at specific locations in most tarsi. This signal intensity was attributed to focal magic angle effect associated with orientation of collagen fibers within the ligaments at those locations. Subchondral bone of the distal aspect of the tibia was uniform in thickness, whereas that of the medial trochlear ridge of the talus was generally thicker than that of the lateral trochlear ridge. In most tarsi, subchondral bone of the talocalcaneal joint decreased in thickness from proximal to distal. CONCLUSIONS AND CLINICAL RELEVANCE Results generated in this study can be used as a reference for interpretation of MRI images of the proximal tarsal region in horses.

A cadaveric investigation into the demographic and bony alignment properties associated with osteoarthritis of the patellofemoral joint.

PubMed

Weinberg, Douglas S; Tucker, Braden J; Drain, Joseph P; Wang, David M; Gilmore, Allison; Liu, Raymond W

2016-06-01

Patellofemoral joint osteoarthritis is common, although circumstances dictating its evolution and pathogenesis remain unclear. Advances in surgical technique have improved the ability to modify long-bone alignment in the coronal, sagittal, and axial planes. However, to our knowledge, there is no significant long-term data available in regard to the relationship between anatomic alignment parameters most amenable to surgical modification and patellofemoral joint osteoarthritis. Five-hundred and seventy-one cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle, medial proximal tibial angle, tibial slope, femoral version, tibial torsion, the position of the tibial tubercle relative to the width of the tibial plateau, trochlear depth, and patellar size were measured using validated techniques. A previously published grading system for patellofemoral joint arthritis was used to quantify macroscopic signs of degenerative joint disease. Increasing age (standardized beta 0.532, p<0.001), female gender (standardized beta 0.201, p=0.002), and decreasing mechanical lateral distal femoral angle (standardized beta -0.128, p=0.025) were independent correlates of increased patellofemoral joint osteoarthritis. A relatively more laterally positioned tibial tubercle trended towards predicting patellofemoral joint osteoarthritis (standardized beta 0.080, p=0.089). These findings confirm that patellofemoral joint osteoarthritis is strongly associated with increasing age and female gender. Valgus alignment of the distal femur, a relatively more lateral location of the tibial tubercle, and a shallower trochlear grove appear to have modest effects on the development of patellofemoral joint osteoarthritis. Copyright © 2016 Elsevier B.V. All rights reserved.

Patellar position in weight-bearing radiographs compared with non-weight-bearing: significance for the detection of osteoarthritis.

PubMed

Skou, Nikolaj; Egund, Niels

2017-03-01

Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18-87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.

Magnetic resonance imaging can accurately assess the long-term progression of knee structural changes in experimental dog osteoarthritis.

PubMed

Boileau, C; Martel-Pelletier, J; Abram, F; Raynauld, J-P; Troncy, E; D'Anjou, M-A; Moreau, M; Pelletier, J-P

2008-07-01

Osteoarthritis (OA) structural changes take place over decades in humans. MRI can provide precise and reliable information on the joint structure and changes over time. In this study, we investigated the reliability of quantitative MRI in assessing knee OA structural changes in the experimental anterior cruciate ligament (ACL) dog model of OA. OA was surgically induced by transection of the ACL of the right knee in five dogs. High resolution three dimensional MRI using a 1.5 T magnet was performed at baseline, 4, 8 and 26 weeks post surgery. Cartilage volume/thickness, cartilage defects, trochlear osteophyte formation and subchondral bone lesion (hypersignal) were assessed on MRI images. Animals were killed 26 weeks post surgery and macroscopic evaluation was performed. There was a progressive and significant increase over time in the loss of knee cartilage volume, the cartilage defect and subchondral bone hypersignal. The trochlear osteophyte size also progressed over time. The greatest cartilage loss at 26 weeks was found on the tibial plateaus and in the medial compartment. There was a highly significant correlation between total knee cartilage volume loss or defect and subchondral bone hypersignal, and also a good correlation between the macroscopic and the MRI findings. This study demonstrated that MRI is a useful technology to provide a non-invasive and reliable assessment of the joint structural changes during the development of OA in the ACL dog model. The combination of this OA model with MRI evaluation provides a promising tool for the evaluation of new disease-modifying osteoarthritis drugs (DMOADs).

A simple method of measuring tibial tubercle to trochlear groove distance on MRI: description of a novel and reliable technique.

PubMed

Camp, Christopher L; Heidenreich, Mark J; Dahm, Diane L; Bond, Jeffrey R; Collins, Mark S; Krych, Aaron J

2016-03-01

Tibial tubercle-trochlear groove (TT-TG) distance is a variable that helps guide surgical decision-making in patients with patellar instability. The purpose of this study was to compare the accuracy and reliability of an MRI TT-TG measuring technique using a simple external alignment method to a previously validated gold standard technique that requires advanced software read by radiologists. TT-TG was calculated by MRI on 59 knees with a clinical diagnosis of patellar instability in a blinded and randomized fashion by two musculoskeletal radiologists using advanced software and by two orthopaedists using the study technique which utilizes measurements taken on a simple electronic imaging platform. Interrater reliability between the two radiologists and the two orthopaedists and intermethods reliability between the two techniques were calculated using interclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). ICC and CCC values greater than 0.75 were considered to represent excellent agreement. The mean TT-TG distance was 14.7 mm (Standard Deviation (SD) 4.87 mm) and 15.4 mm (SD 5.41) as measured by the radiologists and orthopaedists, respectively. Excellent interobserver agreement was noted between the radiologists (ICC 0.941; CCC 0.941), the orthopaedists (ICC 0.978; CCC 0.976), and the two techniques (ICC 0.941; CCC 0.933). The simple TT-TG distance measurement technique analysed in this study resulted in excellent agreement and reliability as compared to the gold standard technique. This method can predictably be performed by orthopaedic surgeons without advanced radiologic software. II.

Peripapillary Pachychoroid in Nonarteritic Anterior Ischemic Optic Neuropathy

PubMed Central

Nagia, Lina; Huisingh, Carrie; Johnstone, John; Kline, Lanning B.; Clark, Mark; Girard, Michael J. A.; Mari, Jean Martial; Girkin, Christopher A.

2016-01-01

Purpose This study examined the peripapillary choroidal thickness (PCT) in nonarteritic ischemic optic neuropathy (NAION) in comparison to contralateral eyes and normal eyes. Methods We used enhanced depth imaging spectral-domain optical coherence tomography to image the optic nerve head of 20 NAION, 10 contralateral eyes, and 102 normal eyes. Following compensation, the scans were manually delineated to identify relevant surfaces including Bruch's membrane opening (BMO), Bruch's membrane, and anterior sclera. The PCT was defined as the measurement between Bruch's membrane and the anterior sclera and was measured at increasing distance from BMO. Models adjusted for age, BMO area, and axial length were used to compare the mean PCT between NAION and normal eyes, and contralateral eyes and normal eyes. Paired t-tests were used to compare the PCT between NAION and contralateral eyes. Results The mean PCT was thicker in NAION and contralateral eyes when compared with normal eyes at all distances from BMO (P < 0.001). The PCT was not significantly thicker in contralateral eyes when compared with affected NAION eyes. Choroidal thickness was thinnest in the inferior quadrant in all eyes regardless of the group. Conclusions Increased peripapillary choroidal thickness was noted in both NAION and contralateral eyes. The thicker choroid may be an associated feature or a result of the disorder. Although further longitudinal study is required to determine causation, these findings may suggest that a thickened peripapillary choroid may be a component of the disk-at-risk clinical phenotype. PMID:27583829

[Prediction of occult carcinoma in contralateral nodules based on the ultrasonic features of unilateral papillary thyroid carcinoma].

PubMed

Yang, L M; Li, Q; Zhao, B W; Lyu, J G; Xu, H S; Xu, L L; Li, S Y; Gao, L; Zhu, J

2017-04-07

Objective: To investigate the occurrence of occult carcinoma in contralateral lobes based on the ultrasonic features of unilateral papillary thyroid carcinoma. Methods: The study included 202 consecutives cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from June 2014 to December 2015. All patients received total thyroidectomies, and with postoperative pathological examination they were divided into two groups, one including 60 cases with positive occult cancer and another one consisting of 142 cases with negative occult cancer. Univariate and multivariate analyses were performed to analyze the sonographic features of unilateral papillary thyroid carcinoma relevant to the occurrence of occult carcinoma in the contralateral nodules. Results: Univariate analysis indicated occult carcinoma in the contralateral lobes was associated with Hashimoto's thyroiditis(χ(2)=3.955, P =0.047), unclear border (χ(2)=4.375, P =0.036)and multifocality in the ipsilateral(χ(2)=7.375, P =0.007), but not with tumors maximum size, location, A/T, shape, internal structure, internal echo, acoustic halo, calcification, capsular invasion and blood flow signal in the lobe with carcinoma on another side. Multivariate analysis showed unclear border ( OR =2.727, P =0.010) and multifocality in the ipsilateral( OR =2.807, P =0.005)of carcinoma were independent predictive factor for contralateral occult PTC. Conclusions: Unclear border and multifocality of PTC in the ipsilateral were closely relevant to the occurrence of occult carcinoma in the contralateral nodules.

Convergent synaptic inputs from the caudal fastigial nucleus and the superior colliculus onto pontine and pontomedullary reticulospinal neurons.

PubMed

Takahashi, Mayu; Sugiuchi, Yuriko; Shinoda, Yoshikazu

2014-02-01

The caudal fastigial nucleus (FN) is known to be related to the control of eye movements and projects mainly to the contralateral reticular nuclei where excitatory and inhibitory burst neurons for saccades exist [the caudal portion of the nucleus reticularis pontis caudalis (NRPc), and the rostral portion of the nucleus reticularis gigantocellularis (NRG) respectively]. However, the exact reticular neurons targeted by caudal fastigioreticular cells remain unknown. We tried to determine the target reticular neurons of the caudal FN and superior colliculus (SC) by recording intracellular potentials from neurons in the NRPc and NRG of anesthetized cats. Neurons in the rostral NRG received bilateral, monosynaptic excitation from the caudal FNs, with contralateral predominance. They also received strong monosynaptic excitation from the rostral and caudal contralateral SC, and disynaptic excitation from the rostral ipsilateral SC. These reticular neurons with caudal fastigial monosynaptic excitation were not activated antidromically from the contralateral abducens nucleus, but most of them were reticulospinal neurons (RSNs) that were activated antidromically from the cervical cord. RSNs in the caudal NRPc received very weak monosynaptic excitation from only the contralateral caudal FN, and received either monosynaptic excitation only from the contralateral caudal SC, or monosynaptic and disynaptic excitation from the contralateral caudal and ipsilateral rostral SC, respectively. These results suggest that the caudal FN helps to control also head movements via RSNs targeted by the SC, and these RSNs with SC topographic input play different functional roles in head movements.

Auditory enhancement of increments in spectral amplitude stems from more than one source.

PubMed

Carcagno, Samuele; Semal, Catherine; Demany, Laurent

2012-10-01

A component of a test sound consisting of simultaneous pure tones perceptually "pops out" if the test sound is preceded by a copy of itself with that component attenuated. Although this "enhancement" effect was initially thought to be purely monaural, it is also observable when the test sound and the precursor sound are presented contralaterally (i.e., to opposite ears). In experiment 1, we assessed the magnitude of ipsilateral and contralateral enhancement as a function of the time interval between the precursor and test sounds (10, 100, or 600 ms). The test sound, randomly transposed in frequency from trial to trial, was followed by a probe tone, either matched or mismatched in frequency to the test sound component which was the target of enhancement. Listeners' ability to discriminate matched probes from mismatched probes was taken as an index of enhancement magnitude. The results showed that enhancement decays more rapidly for ipsilateral than for contralateral precursors, suggesting that ipsilateral enhancement and contralateral enhancement stem from at least partly different sources. It could be hypothesized that, in experiment 1, contralateral precursors were effective only because they provided attentional cues about the target tone frequency. In experiment 2, this hypothesis was tested by presenting the probe tone before the precursor sound rather than after the test sound. Although the probe tone was then serving as a frequency cue, contralateral precursors were again found to produce enhancement. This indicates that contralateral enhancement cannot be explained by cuing alone and is a genuine sensory phenomenon.

Ipsilateral hemiparesis in ischemic stroke patients.

PubMed

Inatomi, Y; Nakajima, M; Yonehara, T; Ando, Y

2017-07-01

To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients. Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI. Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine. Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Simple shielding reduces dose to the contralateral breast during prone breast cancer radiotherapy

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

Goyal, Uma, E-mail: uma.goyal@gmail.com; Locke, Angela; Smith-Raymond, Lexie

Our goal was to design a prone breast shield for the contralateral breast and study its efficacy in decreasing scatter radiation to the contralateral breast in a prone breast phantom setup receiving radiation therapy designed for breast cancer. We constructed a prone breast phantom setup consisting of (1) A thermoplastic mask with a left-sided depression created by a water balloon for a breast shape; (2) 2 plastic bags to hold water in the thermoplastic mask depression; (3) 2000 mL of water to fill the thermoplastic mask depression to create a water-based false breast; (4) 1-cm thick bolus placed in themore » contralateral breast holder; (5) 2 lead (Pb) sheets, each 0.1-cm thick for blocking scatter radiation in the contralateral bolus-based false breast; (6) a prone breast board to hold the thermoplastic mask, water, bolus, and lead; (7) 9 cm solid water on top of the breast board to simulate body; (8) a diode was used to verify dose for each treatment field of the treated water-based breast; (9) metal–oxide–semiconductor-field effect transistor (MOSFET) dosimeters to measure dose to the contralateral bolus-based breast. The phantom prone breast setup was CT simulated and treatment was designed with 95% isodose line covering the treated breast. The maximum dose was 107.1%. Megavoltage (MV) port images ensured accurate setup. Measurements were done using diodes on the treated water-based breast and MOSFET dosimeters at the medial and lateral sides of the contralateral bolus-based breast without and with the Pb shield. Five treatments were done for each of the 3 data sets and recorded individually for statistical purposes. All treatments were completed with 6 MV photons at 200 cGy per treatment. The dose contributions from each of the 3 data sets including 15 treatments total without and with the prone lead shield to the medial and lateral portions of contralateral bolus-based breast were averaged individually. Unshielded dose means were 37.11 and 2.94 cGy, and shielded dose means were 12.68 and 1.54 cGy, respectively. When comparing medial and lateral portions of the contralateral bolus-based doses without and with Pb, the shield significantly reduced dose to both sides of the contralateral breast (medial p = 2.64 × 10{sup −14}, lateral p = 4.91 × 10{sup −6}). The prone 0.2-cm Pb shield significantly reduced scatter dose to the contralateral breast on the order of 2 to 3 times. Reductions may be clinically relevant for women younger than 45 years by decreasing the risk of contralateral radiation-induced breast cancer in patients receiving radiation therapy for breast cancer. This shield is simple as it would be a part of the prone breast board during treatments, but future studies are warranted for safety and efficacy clinically.« less

Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve?

PubMed

Gao, Kai-Ming; Lao, Jie; Guan, Wen-Jie; Hu, Jing-Jing

2018-01-01

If a partial contralateral C 7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C 7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C 7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C 7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C 7 root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C 7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy, the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C 7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C 7 nerve.

Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve?

PubMed Central

Gao, Kai-ming; Lao, Jie; Guan, Wen-jie; Hu, Jing-jing

2018-01-01

If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy, the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve. PMID:29451212

Trans-falcine and contralateral sub-frontal electrode placement in pediatric epilepsy surgery: technical note.

PubMed

Pindrik, Jonathan; Hoang, Nguyen; Tubbs, R Shane; Rocque, Brandon J; Rozzelle, Curtis J

2017-08-01

Phase II monitoring with intracranial electroencephalography (ICEEG) occasionally requires bilateral placement of subdural (SD) strips, grids, and/or depth electrodes. While phase I monitoring often demonstrates a preponderance of unilateral findings, individual studies (video EEG, single photon emission computed tomography [SPECT], and positron emission tomography [PET]) can suggest or fail to exclude a contralateral epileptogenic onset zone. This study describes previously unreported techniques of trans-falcine and sub-frontal insertion of contralateral SD grids and depth electrodes for phase II monitoring in pediatric epilepsy surgery patients when concern about bilateral abnormalities has been elicited during phase I monitoring. Pediatric patients with medically refractory epilepsy undergoing stage I surgery for phase II monitoring involving sub-frontal and/or trans-falcine insertion of SD grids and/or depth electrodes at the senior author's institution were retrospectively reviewed. Intra-operative technical details of sub-frontal and trans-falcine approaches were studied, while intra-operative complications or events were noted. Operative techniques included gentle subfrontal retraction and elevation of the olfactory tracts (while preserving the relationship between the olfactory bulb and cribriform plate) to insert SD grids across the midline for coverage of the contralateral orbito-frontal regions. Trans-falcine approaches involved accessing the inter-hemispheric space, bipolar cauterization of the anterior falx cerebri below the superior sagittal sinus, and sharp dissection using a blunt elevator and small blade scalpel. The falcine window allowed contralateral SD strip, grid, and depth electrodes to be inserted for coverage of the contralateral frontal regions. The study cohort included seven patients undergoing sub-frontal and/or trans-falcine insertion of contralateral SD strip, grid, and/or depth electrodes from February 2012 through June 2015. Five patients (71%) experienced no intra-operative events related to contralateral ICEEG electrode insertion. Intra-operative events of frontal territory venous engorgement (1/7, 14%) due to sacrifice of anterior bridging veins draining into the SSS and avulsion of a contralateral bridging vein (1/7, 14%), probably due to prior anterior corpus callosotomy, each occurred in one patient. There were no intra-operative or peri-operative complications in any of the patients studied. Two patients required additional surgery for supplemental SD strip and/or depth electrodes via burr hole craniectomy to enhance phase II monitoring. All patients proceeded to stage II surgery for resection of ipsilateral epileptogenic onset zones without adverse events. Trans-falcine and sub-frontal insertion of contralateral SD strip, grid, and depth electrodes are previously unreported techniques for achieving bilateral frontal coverage in phase II monitoring in pediatric epilepsy surgery. This technique obviates the need for contralateral craniotomy and parenchymal exposure with limited, remediable risks. Larger case series using the method described herein are now necessary.

Gravity versus manual external rotation stress view in evaluating ankle stability: a prospective study.

PubMed

LeBa, Thu-Ba; Gugala, Zbigniew; Morris, Randal P; Panchbhavi, Vinod K

2015-06-01

The purpose of this prospective study was to determine whether gravity versus manual external rotation stress testing effectively detects widening of the medial clear space in isolated ankle fractures when compared with the uninjured contralateral side. Manual external rotation stress and gravity stress tests were performed on injured and uninjured ankles of ankle fracture patients in a clinic setting. Medial clear space measurements were recorded and differences between gravity and manual stress views were determined. Twenty consecutive patients with ankle injury were enrolled in the study. When compared with the uninjured side, gravity stress views showed a statistically significant (P = .017) increase in medial clear space widening (1.85 ± 1.07 mm) compared with manual stress view widening (1.35 ± 1.04 mm). This study suggests that gravity stress views are as effective as manual external rotation stress views in detecting medial clear space widening in isolated fibular fractures. Diagnostic, Level II: Prospective, comparative trial. © 2014 The Author(s).

A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy

PubMed Central

Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Ozaki, Makoto; Muragaki, Yoshihiro; Okada, Yoshikazu

2014-01-01

We are reporting the case of a 56-year-old woman who developed loss of consciousness during awake craniotomy. A thin subdural haematoma in the contralateral side of the craniotomy was identified with intraoperative magnetic resonance imaging and subsequently removed. Our case indicates that contralateral acute subdural haematoma could be a cause of deterioration of the conscious level during awake craniotomy. PMID:25301378

Contralateral ear occlusion for improving the reliability of otoacoustic emission screening tests.

PubMed

Papsin, Emily; Harrison, Adrienne L; Carraro, Mattia; Harrison, Robert V

2014-01-01

Newborn hearing screening is an established healthcare standard in many countries and testing is feasible using otoacoustic emission (OAE) recording. It is well documented that OAEs can be suppressed by acoustic stimulation of the ear contralateral to the test ear. In clinical otoacoustic emission testing carried out in a sound attenuating booth, ambient noise levels are low such that the efferent system is not activated. However in newborn hearing screening, OAEs are often recorded in hospital or clinic environments, where ambient noise levels can be 60-70 dB SPL. Thus, results in the test ear can be influenced by ambient noise stimulating the opposite ear. Surprisingly, in hearing screening protocols there are no recommendations for avoiding contralateral suppression, that is, protecting the opposite ear from noise by blocking the ear canal. In the present study we have compared transient evoked and distortion product OAEs measured with and without contralateral ear plugging, in environmental settings with ambient noise levels <25 dB SPL, 45 dB SPL, and 55 dB SPL. We found out that without contralateral ear occlusion, ambient noise levels above 55 dB SPL can significantly attenuate OAE signals. We strongly suggest contralateral ear occlusion in OAE based hearing screening in noisy environments.

The Aortic Bifurcation Angle as a Factor in Application of the Outback for Femoropopliteal Lesions in Ipsilateral Versus Contralateral Approaches.

PubMed

Raskin, Daniel; Khaitovich, Boris; Balan, Shmuel; Silverberg, Daniel; Halak, Moshe; Rimon, Uri

2018-01-01

To assess the technical success of the Outback reentry device in contralateral versus ipsilateral approaches for femoropopliteal arterial occlusion. A retrospective review of patients treated for critical limb ischemia (CLI) using the Outback between January 2013 and July 2016 was performed. Age, gender, length and site of the occlusion, approach site, aortic bifurcation angle, and reentry site were recorded. Calcification score was assigned at both aortic bifurcation and reentry site. Technical success was assessed. During the study period, a total of 1300 endovascular procedures were performed on 489 patients for CLI. The Outback was applied on 50 femoropopliteal chronic total occlusions. Thirty-nine contralateral and 11 ipsilateral antegrade femoral were accessed. The device was used successfully in 41 patients (82%). There were nine failures, all in the contralateral approach group. Six due to inability to deliver the device due to acute aortic bifurcation angle and three due to failure to achieve luminal reentry. Procedural success was significantly affected by the aortic bifurcation angle (p = 0.013). The Outback has high technical success rates in treatment of femoropopliteal occlusion, when applied from either an ipsi- or contralateral approach. When applied in contralateral access, acute aortic bifurcation angle predicts procedural failure.

Miniopen Transforaminal Lumbar Interbody Fusion with Unilateral Fixation: A Comparison between Ipsilateral and Contralateral Reherniation

PubMed Central

Liu, Fubing; Jiang, Chun

2016-01-01

The aim of this study was to evaluate the risk factors between ipsilateral and contralateral reherniation and to compare the effectiveness of miniopen transforaminal lumbar interbody fusion (TLIF) with unilateral fixation for each group. From November 2007 to December 2014, clinical and radiographic data of each group (ipsilateral or contralateral reherniation) were collected and compared. Functional assessment (Visual Analog Scale (VAS) score and Japanese Orthopaedic Association (JOA)) and radiographic evaluation (fusion status, disc height, lumbar lordosis (LL), and functional spine unit (FSU) angle) were applied to compare surgical effect for each group preoperatively and at final followup. MacNab questionnaire was applied to further evaluate the satisfactory rate after the discectomy and fusion. No difference except pain-free interval was found between ipsilateral and contralateral groups. There was a significant difference in operative time between two groups. No differences were found in clinical and radiographic data for assessment of surgical effect between two groups. The satisfactory rate was decreasing in both groups with time passing after discectomy. Difference in pain-free interval may be a distinction for ipsilateral and contralateral reherniation. Miniopen TLIF with unilateral pedicle screw fixation can be a recommendable way for single level reherniation regardless of ipsilateral or contralateral reherniation. PMID:27885358

The temporal evolution of electromagnetic markers sensitive to the capacity limits of visual short-term memory.

PubMed

Mitchell, Daniel J; Cusack, Rhodri

2011-01-01

An electroencephalographic (EEG) marker of the limited contents of human visual short-term memory (VSTM) has previously been described. Termed contralateral delay activity, this consists of a sustained, posterior, negative potential that correlates with memory load and is greatest contralateral to the remembered hemifield. The current investigation replicates this finding and uses magnetoencephalography (MEG) to characterize its magnetic counterparts and their neural generators as they evolve throughout the memory delay. A parametric manipulation of memory load, within and beyond capacity limits, allows separation of signals that asymptote with behavioral VSTM performance from additional responses that contribute to a linear increase with set-size. Both EEG and MEG yielded bilateral signals that track the number of objects held in memory, and contralateral signals that are independent of memory load. In MEG, unlike EEG, the contralateral interaction between hemisphere and item load is much weaker, suggesting that bilateral and contralateral markers of memory load reflect distinct sources to which EEG and MEG are differentially sensitive. Nonetheless, source estimation allowed both the bilateral and the weaker contralateral capacity-limited responses to be localized, along with a load-independent contralateral signal. Sources of global and hemisphere-specific signals all localized to the posterior intraparietal sulcus during the early delay. However the bilateral load response peaked earlier and its generators shifted later in the delay. Therefore the hemifield-specific response may be more closely tied to memory maintenance while the global load response may be involved in initial processing of a limited number of attended objects, such as their individuation or consolidation into memory.

Interaural Phase and Level Difference Sensitivity in Low-Frequency Neurons in the Lateral Superior Olive

PubMed Central

Tollin, Daniel J.; Yin, Tom C. T.

2006-01-01

The lateral superior olive (LSO) is believed to encode differences in sound level at the two ears, a cue for azimuthal sound location. Most high-frequency-sensitive LSO neurons are binaural, receiving inputs from both ears. An inhibitory input from the contralateral ear, via the medial nucleus of the trapezoid body (MNTB), and excitatory input from the ipsilateral ear enable level differences to be encoded. However, the classical descriptions of low-frequency-sensitive neurons report primarily monaural cells with no contralateral inhibition. Anatomical and physiological evidence, however, shows that low-frequency LSO neurons receive low-frequency inhibitory input from ipsilateral MNTB, which in turn receives excitatory input from the contralateral cochlear nucleus and low-frequency excitatory input from the ipsilateral cochlear nucleus. Therefore, these neurons would be expected to be binaural with contralateral inhibition. Here, we re-examined binaural interaction in low-frequency (less than ~3 kHz) LSO neurons and phase locking in the MNTB. Phase locking to low-frequency tones in MNTB and ipsilaterally driven LSO neurons with frequency sensitivities < 1.2 kHz was enhanced relative to the auditory nerve. Moreover, most low-frequency LSO neurons exhibited contralateral inhibition: ipsilaterally driven responses were suppressed by raising the level of the contralateral stimulus; most neurons were sensitive to interaural time delays in pure tone and noise stimuli such that inhibition was nearly maximal when the stimuli were presented to the ears in-phase. The data demonstrate that low-frequency LSO neurons of cat are not monaural and can exhibit contralateral inhibition like their high-frequency counterparts. PMID:16291937

Imaging the Spatio-Temporal Dynamics of Supragranular Activity in the Rat Somatosensory Cortex in Response to Stimulation of the Paws

PubMed Central

Morales-Botello, M. L.; Aguilar, J.; Foffani, G.

2012-01-01

We employed voltage-sensitive dye (VSD) imaging to investigate the spatio-temporal dynamics of the responses of the supragranular somatosensory cortex to stimulation of the four paws in urethane-anesthetized rats. We obtained the following main results. (1) Stimulation of the contralateral forepaw evoked VSD responses with greater amplitude and smaller latency than stimulation of the contralateral hindpaw, and ipsilateral VSD responses had a lower amplitude and greater latency than contralateral responses. (2) While the contralateral stimulation initially activated only one focus, the ipsilateral stimulation initially activated two foci: one focus was typically medial to the focus activated by contralateral stimulation and was stereotaxically localized in the motor cortex; the other focus was typically posterior to the focus activated by contralateral stimulation and was stereotaxically localized in the somatosensory cortex. (3) Forepaw and hindpaw somatosensory stimuli activated large areas of the sensorimotor cortex, well beyond the forepaw and hindpaw somatosensory areas of classical somatotopic maps, and forepaw stimuli activated larger cortical areas with greater activation velocity than hindpaw stimuli. (4) Stimulation of the forepaw and hindpaw evoked different cortical activation dynamics: forepaw responses displayed a clear medial directionality, whereas hindpaw responses were much more uniform in all directions. In conclusion, this work offers a complete spatio-temporal map of the supragranular VSD cortical activation in response to stimulation of the paws, showing important somatotopic differences between contralateral and ipsilateral maps as well as differences in the spatio-temporal activation dynamics in response to forepaw and hindpaw stimuli. PMID:22829873

Frontal Eye Fields Control Attentional Modulation of Alpha and Gamma Oscillations in Contralateral Occipitoparietal Cortex

PubMed Central

O'Shea, Jacinta; Jensen, Ole; Bergmann, Til O.

2015-01-01

Covertly directing visuospatial attention produces a frequency-specific modulation of neuronal oscillations in occipital and parietal cortices: anticipatory alpha (8–12 Hz) power decreases contralateral and increases ipsilateral to attention, whereas stimulus-induced gamma (>40 Hz) power is boosted contralaterally and attenuated ipsilaterally. These modulations must be under top-down control; however, the control mechanisms are not yet fully understood. Here we investigated the causal contribution of the human frontal eye field (FEF) by combining repetitive transcranial magnetic stimulation (TMS) with subsequent magnetoencephalography. Following inhibitory theta burst stimulation to the left FEF, right FEF, or vertex, participants performed a visual discrimination task requiring covert attention to either visual hemifield. Both left and right FEF TMS caused marked attenuation of alpha modulation in the occipitoparietal cortex. Notably, alpha modulation was consistently reduced in the hemisphere contralateral to stimulation, leaving the ipsilateral hemisphere relatively unaffected. Additionally, right FEF TMS enhanced gamma modulation in left visual cortex. Behaviorally, TMS caused a relative slowing of response times to targets contralateral to stimulation during the early task period. Our results suggest that left and right FEF are causally involved in the attentional top-down control of anticipatory alpha power in the contralateral visual system, whereas a right-hemispheric dominance seems to exist for control of stimulus-induced gamma power. These findings contrast the assumption of primarily intrahemispheric connectivity between FEF and parietal cortex, emphasizing the relevance of interhemispheric interactions. The contralaterality of effects may result from a transient functional reorganization of the dorsal attention network after inhibition of either FEF. PMID:25632139

Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

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

Batumalai, Vikneswary, E-mail: vikneswary.batumalai@sswahs.nsw.gov.au; South Western Clinical School, University of New South Wales, Sydney, New South Wales; Quinn, Alexandra

Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). Themore » mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.« less

A useful method for assessing differences of compensatory hypertrophy in the contralateral kidney before and after radical nephrectomy in patients with renal cell carcinoma: ellipsoid formula on computed tomography.

PubMed

Park, Bong Hee; Cho, Kang Jun; Kim, Jung Im; Bae, Sang Rak; Lee, Yong Seok; Kang, Sung Hak; Kim, Joon Chul; Han, Chang Hee

2018-02-01

To investigate the usefulness of the ellipsoid formula for assessing compensatory hypertrophy of the contralateral kidney on pre-operative and post-operative CT in renal cell carcinoma (RCC) patients. We retrospectively identified 389 patients who had radical nephrectomy for RCC between 2011  and 2015. Contrast-enhanced CT was performed within 3 months pre-operative and at 1 year post-operative. The kidney volumes were calculated from CT using the ellipsoid formula. We subdivided patients into three groups based on tumour size (I: ≤4 cm, II: 4-7 cm, III: >7 cm). Volumetric renal parameters were compared and multivariate analyses were performed to determine predictors associated with pre-operative  and post-operative compensatory hypertrophy. Kidney volume calculation using the ellipsoid  method took a median of 51 s. Group III had a significantly larger median pre-operative contralateral renal volume than Groups I and II (I:  140.4, II: 141.6, III: 166.7 ml, p < 0.05). However, the median ratio of post-operative contralateral renal volume change was significantly higher in Groups I and II than Group III (I: 0.36, II: 0.23, III: 0.12, p < 0.001). On multivariate analysis, tumour size revealed the strongest positive association with pre-operative contralateral kidney volume (partial regression coefficient: β = 30.8, >7 cm) and ratio of post-operative contralateral kidney volume change (β  = 0.214, I vs III; β = 0.168, II vs III). Kidney volume calculation for assessing pre- and post-operative compensatory hypertrophy of the contralateral kidney in RCC patients can be easily and rapidly performed from CT images using the ellipsoid formula. Advances in knowledge: The ellipsoid formula allows reliable method for assessing pre-operative and post-operative compensatory hypertrophy of the contralateral kidney in RCC.

Stronger efferent suppression of cochlear neural potentials by contralateral acoustic stimulation in awake than in anesthetized chinchilla.

PubMed

Aedo, Cristian; Tapia, Eduardo; Pavez, Elizabeth; Elgueda, Diego; Delano, Paul H; Robles, Luis

2015-01-01

There are two types of sensory cells in the mammalian cochlea, inner hair cells, which make synaptic contact with auditory-nerve afferent fibers, and outer hair cells that are innervated by crossed and uncrossed medial olivocochlear (MOC) efferent fibers. Contralateral acoustic stimulation activates the uncrossed efferent MOC fibers reducing cochlear neural responses, thus modifying the input to the central auditory system. The chinchilla, among all studied mammals, displays the lowest percentage of uncrossed MOC fibers raising questions about the strength and frequency distribution of the contralateral-sound effect in this species. On the other hand, MOC effects on cochlear sensitivity have been mainly studied in anesthetized animals and since the MOC-neuron activity depends on the level of anesthesia, it is important to assess the influence of anesthesia in the strength of efferent effects. Seven adult chinchillas (Chinchilla laniger) were chronically implanted with round-window electrodes in both cochleae. We compared the effect of contralateral sound in awake and anesthetized condition. Compound action potentials (CAP) and cochlear microphonics (CM) were measured in the ipsilateral cochlea in response to tones in absence and presence of contralateral sound. Control measurements performed after middle-ear muscles section in one animal discarded any possible middle-ear reflex activation. Contralateral sound produced CAP amplitude reductions in all chinchillas, with suppression effects greater by about 1-3 dB in awake than in anesthetized animals. In contrast, CM amplitude increases of up to 1.9 dB were found in only three awake chinchillas. In both conditions the strongest efferent effects were produced by contralateral tones at frequencies equal or close to those of ipsilateral tones. Contralateral CAP suppressions for 1-6 kHz ipsilateral tones corresponded to a span of uncrossed MOC fiber innervation reaching at least the central third of the chinchilla cochlea.

Endodontic management of contralateral mandibular first molars with six root canals

PubMed Central

Bhargav, Kambhampati; Sirisha, Kantheti; Jyothi, Mandava; Boddeda, Mohan Rao

2017-01-01

The knowledge of variations in root canal morphology is essential for a successful endodontic outcome. Contralateral mandibular molar with six root canals is a rare entity. Root canal treatment of mandibular molars with aberrant canal configuration can be diagnostically and technically challenging. While dealing with variant mandibular molars, mishaps may happen. This case report describes variations in contralateral mandibular molars and also an endodontic mishap while managing them. PMID:29259369

Surgical induction, histological evaluation, and MRI identification of cartilage necrosis in the distal femur in goats to model early lesions of osteochondrosis.

PubMed

Tóth, F; Nissi, M J; Wang, L; Ellermann, J M; Carlson, C S

2015-02-01

Identify and interrupt the vascular supply to portions of the distal femoral articular-epiphyseal cartilage complex (AECC) in goat kids to induce cartilage necrosis, characteristic of early lesions of osteochondrosis (OC); then utilize magnetic resonance imaging (MRI) to identify necrotic areas of cartilage. Distal femora were perfused and cleared in goat kids of various ages to visualize the vascular supply to the distal femoral AECC. Vessels located on the axial aspect of the medial femoral condyle (MFC) and on the abaxial side of the lateral trochlear ridge were transected in eight 4- to 5-day-old goats to induce cartilage necrosis. Goats were euthanized 1, 2, 3, 4, 5, 6, 9, and 10 weeks post operatively and operated stifles were harvested. Adiabatic T1ρ relaxation time maps of the harvested distal femora were generated using a 9.4 T MR scanner, after which samples were evaluated histologically. Interruption of the vascular supply to the MFC caused lesions of cartilage necrosis in 6/8 goat kids that were demonstrated histologically. Adiabatic T1ρ relaxation time mapping identified these areas of cartilage necrosis in 5/6 cases. No significant findings were detected after transection of perichondrial vessels supplying the lateral trochlear ridge. Cartilage necrosis, characteristic of early OC, can be induced by interrupting the vascular supply to the distal femoral AECC in goat kids. The ability of high field MRI to identify these areas of cartilage necrosis in the AECC using the adiabatic T1ρ sequence suggests that this technique may be useful in the future for the early diagnosis of OC. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The influence of malalignment and ageing following sterilisation by gamma irradiation in an inert atmosphere on the wear of ultra-high-molecular-weight polyethylene in patellofemoral replacements

PubMed Central

Maiti, Raman; Cowie, Raelene M; Fisher, John; Jennings, Louise M

2017-01-01

Complications of patellofemoral arthroplasty often occur soon after implantation and, as well as other factors, can be due to the design of the implant or its surgical positioning. A number of studies have previously considered the wear of ultra-high-molecular-weight polyethylene patellae following suboptimal implantation; however, studies have primarily been carried out under a limited number of degrees of freedom. The aim of this study was to develop a protocol to assess the wear of patellae under a malaligned condition in a six-axis patellofemoral joint simulator. The malalignment protocol hindered the tracking of the patella centrally in the trochlear groove and imparted a constant 5° external rotation (tilt) on the patella button. Following 3 million cycles of wear simulation, this condition had no influence on the wear of ultra-high-molecular-weight polyethylene patellae aged for 4 years compared to well-positioned non-aged implants (p > 0.05). However, under the malaligned condition, ultra-high-molecular-weight polyethylene patellae aged 8–10 years after unpacking (following sterilisation by gamma irradiation in an inert atmosphere) and worn ultra-high-molecular-weight polyethylene components also aged 4 years after unpacking (following the same sterilisation process) exhibited a high rate of wear. Fatigue failure due to elevated contact stress led to delamination of the ultra-high-molecular-weight polyethylene and in some cases complete failure of the patellae. The results suggest that suboptimal tracking of the patella in the trochlear groove and tilt of the patella button could have a significant effect on the wear of ultra-high-molecular-weight polyethylene and could lead to implant failure. PMID:28661229

The influence of malalignment and ageing following sterilisation by gamma irradiation in an inert atmosphere on the wear of ultra-high-molecular-weight polyethylene in patellofemoral replacements.

PubMed

Maiti, Raman; Cowie, Raelene M; Fisher, John; Jennings, Louise M

2017-07-01

Complications of patellofemoral arthroplasty often occur soon after implantation and, as well as other factors, can be due to the design of the implant or its surgical positioning. A number of studies have previously considered the wear of ultra-high-molecular-weight polyethylene patellae following suboptimal implantation; however, studies have primarily been carried out under a limited number of degrees of freedom. The aim of this study was to develop a protocol to assess the wear of patellae under a malaligned condition in a six-axis patellofemoral joint simulator. The malalignment protocol hindered the tracking of the patella centrally in the trochlear groove and imparted a constant 5° external rotation (tilt) on the patella button. Following 3 million cycles of wear simulation, this condition had no influence on the wear of ultra-high-molecular-weight polyethylene patellae aged for 4 years compared to well-positioned non-aged implants (p > 0.05). However, under the malaligned condition, ultra-high-molecular-weight polyethylene patellae aged 8-10 years after unpacking (following sterilisation by gamma irradiation in an inert atmosphere) and worn ultra-high-molecular-weight polyethylene components also aged 4 years after unpacking (following the same sterilisation process) exhibited a high rate of wear. Fatigue failure due to elevated contact stress led to delamination of the ultra-high-molecular-weight polyethylene and in some cases complete failure of the patellae. The results suggest that suboptimal tracking of the patella in the trochlear groove and tilt of the patella button could have a significant effect on the wear of ultra-high-molecular-weight polyethylene and could lead to implant failure.

Primary position and listing's law in acquired and congenital trochlear nerve palsy.

PubMed

Straumann, Dominik; Steffen, Heimo; Landau, Klara; Bergamin, Oliver; Mudgil, Ananth V; Walker, Mark F; Guyton, David L; Zee, David S

2003-10-01

In ocular kinematics, the primary position (PP) of the eye is defined by the position from which movements do not induce ocular rotations around the line of sight (Helmholtz). PP is mathematically linked to the orientation of Listing's plane. This study was conducted to determine whether PP is affected differently in patients with clinically diagnosed congenital (conTNP) and acquired (acqTNP) trochlear nerve palsy. Patients with unilateral conTNP (n = 25) and acqTNP (n = 9) performed a modified Hess screen test. Three-dimensional eye positions were recorded with dual search coils. PP in eyes with acqTNP was significantly more temporal (mean: 21.2 degrees ) than in eyes with conTNP (6.8 degrees ) or healthy eyes (7.2 degrees ). In the pooled data of all patients, the horizontal location of PP significantly correlated with vertical noncomitance with the paretic eye in adduction (R = 0.59). Using a computer model, PP in acqTNP could be reproduced by a neural lesion of the superior oblique (SO) muscle. An additional simulated overaction of the inferior oblique (IO) muscle moved PP back to normal, as in conTNP. Lengthening the SO and shortening the IO muscles could also simulate PP in conTNP. The temporal displacement of PP in acqTNP is a direct consequence of the reduced force of the SO muscle. The reversal of this temporal displacement of PP, which occurs in some patients with conTNP, can be explained by a secondary overaction of the IO muscle. Alternatively, length changes in the SO and IO muscles, or other anatomic anomalies within the orbit, without a neural lesion, may also explain the difference in location of PP between conTNP and acqTNP.

The Relationship of Static Tibial Tubercle-Trochlear Groove Measurement and Dynamic Patellar Tracking.

PubMed

Carlson, Victor R; Sheehan, Frances T; Shen, Aricia; Yao, Lawrence; Jackson, Jennifer N; Boden, Barry P

2017-07-01

The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella. Cohort study (Diagnosis); Level of evidence, 2. The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n = 32) and without (n = 38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion by use of dynamic cine-phase contrast magnetic resonance imaging. For each subject, the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort. The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain ( r 2 = 0.18, P = .02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances 15 mm or more, 8 of 13 subjects (62%) demonstrated neutral or medial patellar tracking patterns. The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.

The oculomotor system of decapod cephalopods: eye muscles, eye muscle nerves, and the oculomotor neurons in the central nervous system.

PubMed

Budelmann, B U; Young, J Z

1993-04-29

Fourteen extraocular eye muscles are described in the decapods Loligo and Sepioteuthis, and thirteen in Sepia; they are supplied by four eye muscle nerves. The main action of most of the muscles is a linear movement of the eyeball, only three muscles produce strong rotations. The arrangement, innervation and action of the decapod eye muscles are compared with those of the seven eye muscles and seven eye muscle nerves in Octopus. The extra muscles in decapods are attached to the anterior and superior faces of the eyes. At least, the anterior muscles, and presumably also the superior muscles, are concerned with convergent eye movements for binocular vision during fixation and capture of prey by the tentacles. The remaining muscles are rather similar in the two cephalopod groups. In decapods, the anterior muscles include conjunctive muscles; these cross the midline and each presumably moves both eyes at the same time during fixation. In the squids Loligo and Sepioteuthis there is an additional superior conjunctive muscle of perhaps similar function. Some of the anterior muscles are associated with a narrow moveable plate, the trochlear cartilage; it is attached to the eyeball by trochlear membranes. Centripetal cobalt fillings showed that all four eye muscle nerves have fibres that originate from somata in the ipsilateral anterior lateral pedal lobe, which is the oculomotor centre. The somata of the individual nerves show different but overlapping distributions. Bundles of small presumably afferent fibres were seen in two of the four nerves. They do not enter the anterior lateral pedal lobe but run to the ventral magnocellular lobe; some afferent fibres enter the brachio-palliovisceral connective and run perhaps as far as the palliovisceral lobe.

Herpes zoster ophthalmicus.

PubMed

Sanjay, Srinivasan; Huang, Philemon; Lavanya, Raghavan

2011-02-01

The management of herpes zoster (HZ) usually involves a multidisciplinary approach aiming to reduce complications and morbidity. Patients with herpes zoster ophthalmicus (HZO) are referred to ophthalmologists for prevention or treatment of its potential complications. Without prompt detection and treatment, HZO can lead to substantial visual disability. In our practice, we usually evaluate patients with HZO for corneal complications such as epithelial, stromal, and disciform keratitis; anterior uveitis; necrotizing retinitis; and cranial nerve palsies in relation to the eye. These are acute and usually sight-threatening. We recommend oral acyclovir in conjunction with topical 3% acyclovir ointment, lubricants, and steroids for conjunctival, corneal, and uveal inflammation associated with HZO. Persistent vasculitis and neuritis may result in chronic ocular complications, the most important of which are neurotrophic keratitis, mucus plaque keratitis, and lipid degeneration of corneal scars. Postherpetic complications, especially postherpetic neuralgia (PHN), are observed in well over half of patients with HZO. The severe, debilitating, chronic pain of PHN is treated locally with cold compresses and lidocaine cream (5%). These patients also receive systemic treatment with NSAIDs, and our medical colleagues cooperate in managing their depression and excruciating pain. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. Ocular surgery for HZO-related complications is performed only after adequately stabilizing pre-existing ocular inflammation, raised intraocular pressure, dry eye, neurotrophic keratitis, and lagophthalmos. Cranial nerve palsies are common and most often involve the facial nerve, although palsy of the oculomotor, trochlear, and abducens nerves may occur in isolation or (rarely) simultaneously. In our setting, complete ophthalmoplegia is seen more often than isolated palsies, but recovery is usually complete. Vasculitis within the orbital apex (orbital apex syndrome) or brainstem dysfunction is postulated to be the cause of cranial nerve palsies. A vaccine of a lyophilized preparation of the oka strain of live, attenuated varicella-zoster virus is suggested for patients who are at risk of developing HZ and has been shown to boost immunity against HZ virus in older patients.

Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty

PubMed Central

Sanders, Thomas L.; Maradit Kremers, Hilal; Schleck, Cathy D.; Larson, Dirk R.; Berry, Daniel J.

2017-01-01

Background: Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. Methods: This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. Results: During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Conclusions: Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from bilateral disease processes that selectively affect the young hip, such as osteonecrosis, or structural hip problems, such as acetabular dysplasia or femoroacetabular impingement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:28244910

The Influence of the Contralateral Knee Prior to Knee Arthroplasty on Post-Arthroplasty Function: The Multicenter Osteoarthritis Study

PubMed Central

Maxwell, Jessica; Niu, Jingbo; Singh, Jasvinder A.; Nevitt, Michael C.; Law, Laura Frey; Felson, David

2013-01-01

Background: Some of the poor functional outcomes of knee arthroplasty may be due to pain in the contralateral, unreplaced knee. We investigated the relationship between the preoperative pain status of the contralateral knee and the risk of a poor postoperative functional outcome in patients who underwent knee arthroplasty. Methods: We analyzed data on 271 patients in the Multicenter Osteoarthritis Study who had undergone knee arthroplasty since the time of enrollment. Eighty-six percent of these patients were white, 72% were female, and the mean age was sixty-seven years. The severity of pain in the knee contralateral to the one that was replaced was measured before the knee arthroplasty with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, with the scores being grouped into four categories (0, 1 to 4, 5 to 9, and 10 to 20). Poor post-arthroplasty function six months or more after surgery was determined with use of the Patient Acceptable Symptom State (PASS) outcome tool and a clinical performance measure of walking speed. We evaluated the relationship between contralateral pain severity and the functional outcomes with use of Poisson regression. Results: Seventy-two (27%) of 264 patients demonstrated poor post-arthroplasty function by failing to attain the threshold PASS score, and seventy-six (30%) of 250 subjects had a slow walking speed. As the pre-arthroplasty pain in the contralateral knee increased, there was a steady increase in the proportion with poor post-arthroplasty function (p < 0.0001 for PASS and p = 0.04 for slow walking speed). Compared with patients who had no pre-arthroplasty pain in the contralateral knee, those in the highest category of contralateral pain severity had 4.1 times the risk (95% confidence interval, 1.5 to 11.5) of having poor self-reported post-arthroplasty function. Patients in whom both knees had been replaced at the time of outcome collection were less likely to have poor self-reported function than those in whom only one knee had been replaced. Conclusions: Preoperative pain in the contralateral knee is strongly associated with self-reported post-arthroplasty functional outcome and may therefore be a useful indicator of prognosis or a potential target of perioperative intervention. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23780536

Sensorimotor Control of the Shoulder in Professional Volleyball Players with Isolated Infraspinatus Muscle Atrophy.

PubMed

Contemori, Samuele; Biscarini, Andrea; Botti, Fabio Massimo; Busti, Daniele; Panichi, Roberto; Pettorossi, Vito Enrico

2017-06-12

Isolated infraspinatus muscle atrophy (IIMA) only affects the hitting shoulder of overhead-activity athletes, and is caused by suprascapular nerve neuropathy. No study has assessed the static and dynamic stability of the shoulder in overhead professional athletes with IIMA to reveal possible shoulder sensorimotor alterations. To assess the shoulder static stability, dynamic stability, and strength in professional volleyball players with IIMA and in healthy control players. Cross-sectional study. Research laboratory. Twenty-four male professional volleyball players (12 players with diagnosed IIMA and 12 healthy players) recruited from local volleyball teams. Static stability was evaluated with two independent force platforms and dynamic stability was assessed with the "Upper Quarter Y Balance Test". The static stability assessment was conducted in different support (single hand and both hand) and vision (open and closed eyes) conditions. Data from each test were analyzed with ANOVA and paired t-test models, to highlight statistical differences within and between groups. In addition to reduced abduction and external rotation strength, athletes with IIMA consistently demonstrated significant less static (P < 0.001) and dynamic stability (P < 0,001), compared with the contralateral shoulder and with healthy athletes. Closed eyes condition significantly enhanced the static stability deficit of the shoulder with IIMA (P = 0.039 and P = 0.034 for both hand and single hand support, respectively), but had no effect in healthy contralateral and healthy players' shoulders. This study highlights an impairment of the sensorimotor control system of the shoulder with IIMA, which likely results from both proprioceptive and strength deficits. This condition could yield subtle alteration in the functional use of the shoulder and predispose it to acute or overuse injuries. The results of this study may help athletic trainers and physical/physiotherapists to prevent shoulder injuries and create specific proprioceptive and neuromuscular training programs.

Does the Dumbbell-Carrying Position Change the Muscle Activity in Split Squats and Walking Lunges?

PubMed

Stastny, Petr; Lehnert, Michal; Zaatar, Amr M Z; Svoboda, Zdenek; Xaverova, Zuzana

2015-11-01

The forward walking lunge (WL) and split squat (SSq) are similar exercises that have differences in the eccentric phase, and both can be performed in the ipsilateral or contralateral carrying conditions. This study aimed to determine the effects of dumbbell-carrying position on the kinematics and electromyographic (EMG) amplitudes of the gluteus medius (Gmed), vastus medialis (VM), vastus lateralis (VL), and biceps femoris during WLs and SSqs. The resistance-trained (RT) and the non-resistance-trained (NT) groups (both n = 14) performed ipsilateral WLs, contralateral WLs, ipsilateral SSqs, and contralateral SSqs in a randomized order in a simulated training session. The EMG amplitude, expressed as a percentage of the maximal voluntary isometric contraction (%MVIC), and the kinematics, expressed as the range of motion (ROM) of the hip and knee, were measured during 5 repetition maximum for both legs. The repeated measure analyses of variance showed significant differences between the RT and NT groups. The NT group showed a smaller knee flexion ROM (p < 0.001, η = 0.36) during both types of WLs, whereas the RT group showed a higher eccentric Gmed amplitude (p < 0.001, η = 0.46) during all exercises and a higher eccentric VL amplitude (p < 0.001, η = 0.63) during contralateral WLs. Further differences were found between contralateral and ipsilateral WLs in both the RT (p < 0.001, η = 0.69) and NT groups (p < 0.001, η = 0.80), and contralateral WLs resulted in higher eccentric Gmed amplitudes. Contralateral WLs highly activated the Gmed (90% MVIC); therefore, this exercise can increase the Gmed maximal strength. The ipsilateral loading condition did not increase the Gmed or VM activity in the RT or NT group.

Malalignment and subchondral bone turnover in contralateral knees of overweight/obese women with unilateral osteoarthritis: implications for bilateral disease.

PubMed

Mazzuca, Steven A; Brandt, Kenneth D; Lane, Kathleen A; Chakr, Rafael

2011-11-01

To explore whether the risk of incident tibiofemoral (TF) osteoarthritis (OA) in the radiographically normal contralateral knee of overweight/obese women with unilateral knee OA is mediated by malalignment and/or preceded by increased turnover of subchondral bone. We used data of post hoc analyses from a randomized controlled trial. Cross-sectional analyses evaluated the baseline association between frontal plane alignment and bone turnover in the medial TF compartment in 78 radiographically normal contralateral knees. Longitudinal analyses ascertained whether incident radiographic OA (TF osteophyte formation within 30 months) was associated with malalignment and/or increased bone turnover at baseline. Alignment subcategories (varus/neutral/valgus) were based on the anatomic axis angle. (99m)Tc-methylene diphosphonate uptake in a late-phase bone scan was quantified in regions of interest in the medial tibia (MT) and medial femur (MF) and adjusted for uptake in a reference segment of the ipsilateral tibial shaft (TS). MF and MT uptake in varus contralateral knees was 50-55% greater than in the TS. Adjusted MT uptake in varus contralateral knees was significantly greater than that in neutral and valgus contralateral knees (mean 1.55 versus 1.38 and 1.43, respectively; P < 0.05). Among 69 contralateral knees followed longitudinally, 22 (32%) developed TF OA. Varus angulation was associated with a marginally significant increase in the odds of incident OA (adjusted odds ratio 3.98, P = 0.067). While the small sample size limited our ability to detect statistically significant risk factors, these data suggest that the risk of developing bilateral TF OA in overweight/obese women may be mediated by varus malalignment. Copyright © 2011 by the American College of Rheumatology.

Differential involvement of ipsilateral and contralateral spinal cord astrocyte D-serine in carrageenan-induced mirror-image pain: role of σ1 receptors and astrocyte gap junctions.

PubMed

Choi, Hoon-Seong; Roh, Dae-Hyun; Yoon, Seo-Yeon; Choi, Sheu-Ran; Kwon, Soon-Gu; Kang, Suk-Yun; Moon, Ji-Young; Han, Ho-Jae; Beitz, Alvin J; Lee, Jang-Hern

2018-02-01

Although we have recently demonstrated that spinal astrocyte gap junctions mediate the development of mirror-image pain (MIP), it is still unclear which astrocyte-derived factor is responsible for the development of MIP and how its production is controlled. In the present study, we focused on the role of ipsilateral versus contralateral D-serine in the development of MIP and investigated the possible involvement of σ1 receptors and gap junctions in astrocyte D-serine production. Following carrageenan injection, mechanical allodynia was tested at various time points to examine the effect of individual drugs. Immunohistochemistry and Western blot analyses were performed to clarify the expression levels of spinal D-serine, serine racemase, σ1 receptors and connexin 43. The expression of ipsilateral D-serine was up-regulated during the early phase of inflammation, while contralateral D-serine increased during the later phase of inflammation. The pharmacological inhibition of D-serine during the early phase blocked the development of both ipsilateral and contralateral mechanical allodynia. However, the inhibition of D-serine during the later phase of inflammation blocked contralateral, but not ipsilateral mechanical allodynia. Furthermore, the inhibition of σ1 receptors during the earlier phase of inflammation inhibited the increase in ipsilateral D-serine. Conversely, the blockade of astrocyte gap junctions suppressed the up-regulation of contralateral D-serine during the later phase of inflammation. Spinal astrocyte D-serine plays an important role in the development of mirror-image pain. Furthermore, σ1 receptors and astrocyte gap junction signalling mediate ipsilateral and contralateral D-serine production respectively. © 2017 The British Pharmacological Society.

Frontal eye fields control attentional modulation of alpha and gamma oscillations in contralateral occipitoparietal cortex.

PubMed

Marshall, Tom R; O'Shea, Jacinta; Jensen, Ole; Bergmann, Til O

2015-01-28

Covertly directing visuospatial attention produces a frequency-specific modulation of neuronal oscillations in occipital and parietal cortices: anticipatory alpha (8-12 Hz) power decreases contralateral and increases ipsilateral to attention, whereas stimulus-induced gamma (>40 Hz) power is boosted contralaterally and attenuated ipsilaterally. These modulations must be under top-down control; however, the control mechanisms are not yet fully understood. Here we investigated the causal contribution of the human frontal eye field (FEF) by combining repetitive transcranial magnetic stimulation (TMS) with subsequent magnetoencephalography. Following inhibitory theta burst stimulation to the left FEF, right FEF, or vertex, participants performed a visual discrimination task requiring covert attention to either visual hemifield. Both left and right FEF TMS caused marked attenuation of alpha modulation in the occipitoparietal cortex. Notably, alpha modulation was consistently reduced in the hemisphere contralateral to stimulation, leaving the ipsilateral hemisphere relatively unaffected. Additionally, right FEF TMS enhanced gamma modulation in left visual cortex. Behaviorally, TMS caused a relative slowing of response times to targets contralateral to stimulation during the early task period. Our results suggest that left and right FEF are causally involved in the attentional top-down control of anticipatory alpha power in the contralateral visual system, whereas a right-hemispheric dominance seems to exist for control of stimulus-induced gamma power. These findings contrast the assumption of primarily intrahemispheric connectivity between FEF and parietal cortex, emphasizing the relevance of interhemispheric interactions. The contralaterality of effects may result from a transient functional reorganization of the dorsal attention network after inhibition of either FEF. Copyright © 2015 the authors 0270-6474/15/351638-10$15.00/0.

Does Roller Massage With a Foam Roll Change Pressure Pain Threshold of the Ipsilateral Lower Extremity Antagonist and Contralateral Muscle Groups? An Exploratory Study.

PubMed

Cheatham, Scott W; Kolber, Morey J

2018-03-01

Foam rolling is a popular intervention used by allied health professionals and the general population. Current research suggests that foam rolling may have an effect on the ipsilateral antagonist muscle group and produce a cross-over effect in the muscles of the contralateral limb. The purpose of this study was to examine the acute effects of foam rolling to the left quadriceps on ipsilateral antagonist hamstrings and contralateral quadriceps muscle group pressure pain threshold (PPT). Through this research, we sought to gather data to further develop the methodology for future studies of this intervention. A pretest-posttest exploratory study. University kinesiology laboratory. 21 healthy adults (age = 27.52 ± 8.9 y). Video-guided foam roll intervention on the left quadriceps musculature. Ipsilateral hamstring (antagonist) and contralateral quadriceps muscle PPT. A significant difference was found between pretest to posttest measures for the ipsilateral hamstrings (t[20] = -6.2, P < 0.001) and contralateral quadriceps (t[20] = -9.1, P < 0.001) suggesting an increase in PPT. These findings suggest that foam rolling of the quadriceps musculature may have an acute effect on the PPT of the ipsilateral hamstrings and contralateral quadriceps muscles. Clinicians should consider these results to be exploratory and future investigations examining this intervention on PPT is warranted.

Reducing contralateral SI activity reveals hindlimb receptive fields in the SI forelimb-stump representation of neonatally amputated rats.

PubMed

Pluto, Charles P; Chiaia, Nicolas L; Rhoades, Robert W; Lane, Richard D

2005-09-01

In adult rats that sustained forelimb amputation on the day of birth, >30% of multiunit recording sites in the forelimb-stump representation of primary somatosensory cortex (SI) also respond to cutaneous hindlimb stimulation when cortical GABA(A+B) receptors are blocked (GRB). This study examined whether hindlimb receptive fields could also be revealed in forelimb-stump sites by reducing one known source of excitatory input to SI GABAergic neurons, the contralateral SI cortex. Corpus callosum projection neurons connect homotopic SI regions, making excitatory contacts onto pyramidal cells and interneurons. Thus in addition to providing monosynaptic excitation in SI, callosal fibers can produce disynaptic inhibition through excitatory synapses with inhibitory interneurons. Based on the latter of these connections, we hypothesized that inactivating the contralateral (intact) SI forelimb region would "unmask" normally suppressed hindlimb responses by reducing the activity of SI GABAergic neurons. The SI forelimb-stump representation was first mapped under normal conditions and then during GRB to identify stump/hindlimb responsive sites. After GRB had dissipated, the contralateral (intact) SI forelimb region was mapped and reversibly inactivated with injections of 4% lidocaine, and selected forelimb-stump sites were retested. Contralateral SI inactivation revealed hindlimb responses in approximately 60% of sites that were stump/hindlimb responsive during GRB. These findings indicate that activity in the contralateral SI contributes to the suppression of reorganized hindlimb receptive fields in neonatally amputated rats.

Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation.

PubMed

Plant, Kerrie; van Hoesel, Richard; McDermott, Hugh; Dawson, Pamela; Cowan, Robert

2016-08-01

To examine post-implantation benefit and time taken to acclimate to the cochlear implant for adult candidates with more hearing in the contralateral non-implanted ear than has been previously considered within local candidacy guidelines. Prospective, within-subject experimental design. Forty postlingual hearing-impaired adult subjects with a contralateral ear word score in quiet ranging from 27% to 100% (median 67%). Post-implantation improvement of 2.4 dB and 4.0 dB was observed on a sentence in coincident babble test at presentation levels of 65 and 55 dB SPL respectively, and a 2.1 dB benefit in spatial release from masking (SRM) advantage observed when the noise location favoured the implanted side. Significant post-operative group mean change of between 2.1 and 3.0 was observed on the sub-scales of the speech, spatial, and qualities (SSQ) questionnaire. Degree of post-implantation speech reception threshold (SRT) benefit on the coincident babble test and on perception of soft speech and sounds in the environment was greater for subjects with less contralateral hearing. The degree of contralateral acoustic hearing did not affect time taken to acclimate to the device. The findings from this study support cochlear implantation for candidates with substantial acoustic hearing in the contralateral ear, and provide guidance regarding post-implantation expectations.

Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study

PubMed Central

Yildizhan, Ahmet; Atar, Elmas K.; Yaycioglu, Soner; Gocmen-Mas, Nuket; Yazici, Canan

2010-01-01

Introduction The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms. Material and methods Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper. Results Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females. Conclusions Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome. PMID:22371809

Isolated and combined effects of asymmetric stance and pushing movement on the anticipatory and compensatory postural control.

PubMed

Lee, Yun-Ju; Aruin, Alexander S

2014-04-01

To investigate effects of symmetric and asymmetric stance and pushing movement on anticipatory and compensatory postural adjustments (APAs and CPAs). Ten healthy volunteers stood symmetrically (feet parallel) or asymmetrically (one foot forward and the other backward) and pushed a handle with both hands or right or left hand. Bilateral EMG activity of the trunk and leg muscles and center of pressure (COP) displacements in the anterior-posterior (AP) and medial-lateral (ML) directions were recorded and analyzed during the APAs and CPAs. Isolated asymmetry of stance was associated with larger muscle activity of the backward leg while isolated asymmetry of pushing movement induced larger trunk muscle activity on the contralateral side. A combined asymmetry of stance and pushing movement resulted in the increase or decrease of the thigh muscle activity and ML COP displacement depending on whether both asymmetries were induced on the same side of the body or on opposite sides. Both isolated and combined asymmetries affect APAs and CPAs in pushing. Using combined asymmetry of stance and arm movement might be beneficial in performing pushing activity. The outcome of the study provides a basis for studying postural control in individuals with unilateral impairment while performing daily tasks involving pushing. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Scalp EEG does not predict hemispherectomy outcome

PubMed Central

Greiner, Hansel M.; Park, Yong D.; Holland, Katherine; Horn, Paul S.; Byars, Anna W.; Mangano, Francesco T.; Smith, Joseph R.; Lee, Mark R.; Lee, Ki-Hyeong

2012-01-01

Background Functional hemispherectomy is effective in carefully selected patients, resulting in a reduction of seizure burden up to complete resolution, improvement of intellectual development, and developmental benefit despite possible additional neurological deficit. Despite apparent hemispheric pathology on brain magnetic resonance imaging (MRI) or other imaging tests, scalp electroencephalography (EEG) could be suggestive of bilateral ictal onset or even ictal onset contralateral to the dominant imaging abnormality. We aimed to investigate the role of scalp EEG lateralization pre-operatively in predicting outcome. Methods We retrospectively reviewed 54 patients who underwent hemispherectomy between 1991 and 2009 at Medical College of Georgia (1991–2006) and Cincinnati Children’s Hospital Medical Center (2006–2009) and had at least one year post-operative follow-up. All preoperative EEGs were reviewed, and classified as either lateralizing or nonlateralizing, for both ictal and interictal EEG recordings. Results Of 54 patients, 42 (78%) became seizure free. Twenty-four (44%) of 54 had a nonlateralizing ictal or interictal EEG. Further analysis was based on etiology of epilepsy, including malformation of cortical development (MCD), Rasmussen syndrome (RS), and stroke (CVA). EEG nonlateralization did not predict poor outcome in any of the etiology groups evaluated. Conclusion Scalp EEG abnormalities in contralateral or bilateral hemispheres do not, in isolation, predict a poor outcome from hemispherectomy. Results of other non-invasive and invasive evaluations should be used to determine candidacy. PMID:21813300

Unilateral hypoplasia with contralateral hypertrophy of anterior belly of digastric muscle: a case report.

PubMed

Ochoa-Escudero, Martin; Juliano, Amy F

2016-10-01

Anomalies of the anterior belly of the digastric muscle (DM) are uncommon. We present a case of hypoplasia of the anterior belly of the left DM with hypertrophy of the anterior belly of the contralateral DM. The importance of recognizing this finding is to differentiate hypoplasia of the anterior belly of the DM from denervation atrophy, and not to confuse contralateral hypertrophy with a submental mass or lymphadenopathy. In denervation atrophy of the anterior belly of the DM, associated atrophy of the ipsilateral mylohyoid muscle is present. Hypertrophy of the anterior belly of the contralateral DM can be differentiated from a submental mass or lymphadenopathy by recognizing its isodensity on computed tomography and isointensity on magnetic resonance imaging to other muscles, without abnormal contrast enhancement.

Effect of excessive contralateral trunk tilt on pitching biomechanics and performance in high school baseball pitchers.

PubMed

Oyama, Sakiko; Yu, Bing; Blackburn, J Troy; Padua, Darin A; Li, Li; Myers, Joseph B

2013-10-01

There is a growing number of pitching-related upper extremity injuries among young baseball pitchers; however, there is a lack of data on the identification of injury prevention strategies, particularly the prevention of injuries through the instruction/modification of technique. The identification of technical parameters that are associated with increased joint loading is needed. To investigate the effects of excessive contralateral trunk tilt, a common technique identifiable by video observation, on pitching biomechanics and performance in high school baseball pitchers. The hypothesis was that this strategy is associated with greater joint loading and poor pitching performance. Descriptive laboratory study; Level of evidence, 3. The 3-dimensional pitching biomechanics, ball speed, and frontal view of the pitching technique from 72 high school baseball pitchers were captured on video and analyzed. The videos were reviewed to determine if the pitcher's trunk was excessively contralaterally tilted at the instant of maximal shoulder external rotation by examining whether the side of the pitcher's head ipsilateral to the throwing limb deviated by more than a head width from a vertical line passing through the pitcher's stride foot ankle. Upper extremity kinetics and upper extremity/trunk kinematics between pitchers with and without excessive contralateral trunk tilt were compared using independent t tests. Compared with pitchers who did not demonstrate excessive contralateral trunk tilt, those with excessive contralateral trunk tilt pitched at a higher ball speed (mean, 32.6 ± 2.2 vs 31.1 ± 2.9 m/s, respectively; P = .019) and experienced a greater elbow proximal force (mean, 103.9 ± 12.7 vs 93.2 ± 13.9 %weight, respectively; P = .001), shoulder proximal force (mean, 104.8 ± 14.1 vs 94.3 ± 15.5 %weight, respectively; P = .004), elbow varus moment (mean, 4.29 ± 0.73 vs 3.84 ± 0.8 %height*weight, respectively; P = .017), and shoulder internal rotation moment (mean, 4.21 ± 0.71 vs 3.75 ± 0.78 %height*weight, respectively; P = .011). Pitchers with excessive contralateral trunk tilt demonstrated less upper torso flexion at stride foot contact, less upper torso rotation, and greater upper torso contralateral flexion at maximal shoulder external rotation and ball release (P < .05). Excessive contralateral trunk tilt is a strategy that is associated with higher ball speeds and increased joint loading. Pitching with excessive contralateral trunk tilt, which can be identified through screening of the pitching technique, is associated with a benefit in performance and increased joint loading. Future study is warranted to determine if this strategy should be encouraged or discouraged by baseball coaches.

Loudness enhancement following contralateral stimulation.

NASA Technical Reports Server (NTRS)

Galambos, R.; Bauer, J.; Picton, T.; Squires, K.; Squires , N.

1972-01-01

The apparent loudness of a tone pip can be increased by 15 dB or more if it is preceded by a tone burst to the contralateral ear. The experiment is done by delaying the pip, S1, by a variable time, Delta-T, after the offset of a contralateral tone; the listener assesses the loudness of S1 by adjusting the intensity of a second tone pip, S2, that follows S1 by 1500 msec. Some parametric explorations of the phenomenon are reported here.

Restoration of the Patient-Specific Anatomy of the Proximal and Distal Parts of the Humerus: Statistical Shape Modeling Versus Contralateral Registration Method.

PubMed

Vlachopoulos, Lazaros; Lüthi, Marcel; Carrillo, Fabio; Gerber, Christian; Székely, Gábor; Fürnstahl, Philipp

2018-04-18

In computer-assisted reconstructive surgeries, the contralateral anatomy is established as the best available reconstruction template. However, existing intra-individual bilateral differences or a pathological, contralateral humerus may limit the applicability of the method. The aim of the study was to evaluate whether a statistical shape model (SSM) has the potential to predict accurately the pretraumatic anatomy of the humerus from the posttraumatic condition. Three-dimensional (3D) triangular surface models were extracted from the computed tomographic data of 100 paired cadaveric humeri without a pathological condition. An SSM was constructed, encoding the characteristic shape variations among the individuals. To predict the patient-specific anatomy of the proximal (or distal) part of the humerus with the SSM, we generated segments of the humerus of predefined length excluding the part to predict. The proximal and distal humeral prediction (p-HP and d-HP) errors, defined as the deviation of the predicted (bone) model from the original (bone) model, were evaluated. For comparison with the state-of-the-art technique, i.e., the contralateral registration method, we used the same segments of the humerus to evaluate whether the SSM or the contralateral anatomy yields a more accurate reconstruction template. The p-HP error (mean and standard deviation, 3.8° ± 1.9°) using 85% of the distal end of the humerus to predict the proximal humeral anatomy was significantly smaller (p = 0.001) compared with the contralateral registration method. The difference between the d-HP error (mean, 5.5° ± 2.9°), using 85% of the proximal part of the humerus to predict the distal humeral anatomy, and the contralateral registration method was not significant (p = 0.61). The restoration of the humeral length was not significantly different between the SSM and the contralateral registration method. SSMs accurately predict the patient-specific anatomy of the proximal and distal aspects of the humerus. The prediction errors of the SSM depend on the size of the healthy part of the humerus. The prediction of the patient-specific anatomy of the humerus is of fundamental importance for computer-assisted reconstructive surgeries.

Contralateral Bias of High Spatial Frequency Tuning and Cardinal Direction Selectivity in Mouse Visual Cortex

PubMed Central

Zeitoun, Jack H.; Kim, Hyungtae

2017-01-01

Binocular mechanisms for visual processing are thought to enhance spatial acuity by combining matched input from the two eyes. Studies in the primary visual cortex of carnivores and primates have confirmed that eye-specific neuronal response properties are largely matched. In recent years, the mouse has emerged as a prominent model for binocular visual processing, yet little is known about the spatial frequency tuning of binocular responses in mouse visual cortex. Using calcium imaging in awake mice of both sexes, we show that the spatial frequency preference of cortical responses to the contralateral eye is ∼35% higher than responses to the ipsilateral eye. Furthermore, we find that neurons in binocular visual cortex that respond only to the contralateral eye are tuned to higher spatial frequencies. Binocular neurons that are well matched in spatial frequency preference are also matched in orientation preference. In contrast, we observe that binocularly mismatched cells are more mismatched in orientation tuning. Furthermore, we find that contralateral responses are more direction-selective than ipsilateral responses and are strongly biased to the cardinal directions. The contralateral bias of high spatial frequency tuning was found in both awake and anesthetized recordings. The distinct properties of contralateral cortical responses may reflect the functional segregation of direction-selective, high spatial frequency-preferring neurons in earlier stages of the central visual pathway. Moreover, these results suggest that the development of binocularity and visual acuity may engage distinct circuits in the mouse visual system. SIGNIFICANCE STATEMENT Seeing through two eyes is thought to improve visual acuity by enhancing sensitivity to fine edges. Using calcium imaging of cellular responses in awake mice, we find surprising asymmetries in the spatial processing of eye-specific visual input in binocular primary visual cortex. The contralateral visual pathway is tuned to higher spatial frequencies than the ipsilateral pathway. At the highest spatial frequencies, the contralateral pathway strongly prefers to respond to visual stimuli along the cardinal (horizontal and vertical) axes. These results suggest that monocular, and not binocular, mechanisms set the limit of spatial acuity in mice. Furthermore, they suggest that the development of visual acuity and binocularity in mice involves different circuits. PMID:28924011

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

PubMed Central

von Engelhardt, Lars V; Weskamp, Pia; Lahner, Matthias; Spahn, Gunter; Jerosch, Joerg

2017-01-01

AIM To evaluate our modified deepening trochleoplasty combined with a balanced medial patellofemoral ligament (MPFL) reconstruction for soft tissue alignement. METHODS Thirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients (m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients’ return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee (IKDC) and Lysholm scoring were evaluated. Moreover, patients’ satisfaction with the general outcome, the cosmetic outcome, the pre- and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales. RESULTS There were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points (P < 0.0001). Two of 26 cases (92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases (94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions. CONCLUSION Our technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction. PMID:29312853

Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass.

PubMed

Mansukhani, Neel A; Havelka, George E; Helenowski, Irene B; Rodriguez, Heron E; Hoel, Andrew W; Eskandari, Mark K

2017-07-01

Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent. Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Imaging of Cranial Nerves III, IV, VI in Congenital Cranial Dysinnervation Disorders

PubMed Central

Kim, Jae Hyoung

2017-01-01

Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence. PMID:28534340

SURGICAL CORRECTION OF BILATERAL PATELLAR LUXATION IN AN AMERICAN BLACK BEAR CUB (URSUS AMERICANUS).

PubMed

Bennett, Katarina R; Desmarchelier, Marion R; Bailey, Trina R

2015-06-01

A wild orphaned male American black bear cub ( Ursus americanus ) presented with hind limb gait abnormalities and was found to have bilateral grade 3 laterally luxating patellas. There were no other significant abnormalities detected on neurologic, radiographic, or hematologic examinations. The trochlear grooves were deepened with a chondroplasty, and the redundant soft tissues imbricated. There was a marked improvement in the bear's gait postoperatively, with an apparent full return to function. To the authors' knowledge, patellar luxation has not been reported in the Ursidae family, and the success in this case suggests that this technique may be used in large wild or captive carnivore cubs.

Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report.

PubMed

Kim, Jin-Sung; Choi, Gun; Lee, Sang-Ho

2011-08-01

Technical case report. The authors report a new percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of lumbar disc herniation via a contralateral approach. When there are highly down-migrated lumbar disc herniation along just medial to pedicle and narrow ipsilateral intervertebral foramen, the conventional PELD is not easily accessible via ipsilateral transforaminal route. Five patients manifested gluteal and leg pain because of a soft disc herniation at the L4-L5 level. Transforaminal PELD via a contralateral approach was performed to remove the herniated fragment, achieving complete decompression of the nerve root. The symptom was relieved and the patient was discharged the next day. When a conventional transforaminal PELD is difficult because of some anatomical reasons, PELD via a contralateral route could be a good alternative option in selected cases.

Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain.

PubMed

Brault, J S; Smith, J; Currier, B L

2001-01-15

Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome). To describe the clinical presentation, diagnostic evaluation, and management of facet-related low back pain in a 17-year-old cheerleader and its successful surgical treatment with resection of a contralateral anomalous articulation. Lumbosacral transitional vertebrae are common in the general population. Bertolotti's syndrome is mechanical low back pain associated with these transitional segments. Little is known about the pathophysiology and mechanics of these vertebral segments and their propensity to be pain generators. Treatment of this syndrome is controversial, and surgical intervention has been infrequently reported. A retrospective chart analysis and radiographic review were performed. Repeated fluoroscopically guided injections implicated a symptomatic L6-S1 facet joint contralateral to an anomalous lumbosacral articulation. Eventually, a successful surgical outcome was achieved with resection of the anomalous articulation. Clinicians should consider the possibility that mechanical low back pain may occur from a facet contralateral to a unilateral anomalous lumbosacral articulation, even in a young patient. Although reports of surgical treatment of Bertolotti's syndrome are infrequent, resection of the anomalous articulation provided excellent results in this patient, presumably because of reduced stresses on the symptomatic facet.

Simultaneous cranioplasty and subdural-peritoneal shunting for contralateral symptomatic subdural hygroma following decompressive craniectomy.

PubMed

Lin, Muh-Shi; Chen, Tzu-Hsuan; Kung, Woon-Man; Chen, Shuo-Tsung

2015-01-01

Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications. Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma. The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.

Women's preferences for contralateral prophylactic mastectomy: An investigation using protection motivation theory.

PubMed

Tesson, Stephanie; Richards, Imogen; Porter, David; Phillips, Kelly-Anne; Rankin, Nicole; Musiello, Toni; Marven, Michelle; Butow, Phyllis

2016-05-01

Most women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women's intentions to undergo CPM. Three hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group's research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario. PMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM's advantages) and response costs (CPM's disadvantages) were unique individual predictors of intentions. Decision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors. Patients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.

Analysis of bone-cartilage-stromal progenitor populations in trauma induced and genetic models of heterotopic ossification

PubMed Central

Agarwal, Shailesh; Loder, Shawn; Li, Shuli; Shrestha, Swati; Li, Jon; Zhao, Bin; Mishina, Yuji; James, Aaron; Levi, Benjamin

2016-01-01

Heterotopic ossification (HO), the formation of extra-skeletal bone in soft tissues, is a pathologic process occurring after substantial burns or trauma, or in patients with type I bone morphogenetic protein (BMP) receptor hyperactivating mutations. Identifying the cells responsible for de novo bone formation during adulthood is of critical importance for therapeutic and regenerative purposes. Using a model of trauma-induced HO with hindlimb Achilles’ tenotomy and dorsal burn injury and a genetic non-trauma HO model (Nfatc1-Cre/caAcvr1fl/wt), we demonstrate enrichment of previously defined bone-cartilage-stromal progenitor cells (BCSP: AlphaV+/CD105+/Tie2-/CD45-/Thy1-/6C3-) at the site of HO formation when compared with marrow isolated from the ipsilateral hindlimb, or from tissue of the contralateral, uninjured hindlimb. Upon transplantation into tenotomy sites soon after injury, BCSPs isolated from neonatal mice or developing HO incorporate into the developing lesion in cartilage and bone and express chondrogenic and osteogenic transcription factors. Additionally, BCSPs isolated from developing HO similarly incorporate into new HO lesions upon transplantation. Finally, adventitial cells, but not pericytes, appear to play a supportive role in HO formation. Our findings indicate that BCSPs contribute to de novo bone formation during adulthood and may hold substantial regenerative potential. PMID:27068890

Contralateral approach to iliac artery recanalization with kissing nitinol stents present in the aortic bifurcation☆

PubMed Central

Joseph, George; Hooda, Amit; Thomson, Viji Samuel

2015-01-01

A 69-year-old man, who had earlier undergone reconstruction of the aortic bifurcation with kissing nitinol stents, presented with occlusion of the left external iliac artery. The occlusion was successfully and safely recanalized using contralateral femoral approach with passage of interventional hardware through the struts of the stents in the aortic bifurcation. Presence of contemporary flexible nitinol stents with open-cell design in the aortic bifurcation is not a contraindication to the use of the contralateral femoral approach. PMID:26702686

Transient osteoporosis of the hip with a contralateral delayed involvement: a case report

PubMed Central

Iannò, Bruno; De Gori, Marco; Familiari, Filippo; Pugliese, Teresa; Gasparini, Giorgio

2017-01-01

Summary We describe a case of non-simultaneous bilateral hip pain with bone marrow edema occurring in an adult male, with the contralateral hip being involved 12 years later after the onset of symptoms. On the basis of clinical and imaging findings, together with a complete resolution after conservative management, a post-hoc diagnosis of metachronous bilateral transient osteoporosis of the hip (TOH) was made. Non-simultaneous bilateral presentation of TOH is exceptional, and contralateral involvement with a 12-year delay has never been previously described. PMID:28740530

Diagnosing the occult contralateral inguinal hernia.

PubMed

Koehler, R H

2002-03-01

The incidence of bilateral inguinal hernias reported for total extra peritoneal (TEP) laparoscopic hernia repair, which reaches 45%, appears to be higher than that seen in studies of transabdominal laparoscopic and open repair. Given the unique ability of diagnostic laparoscopy to diagnose occult contralateral hernias (OCH) accurately, this study looked at how concurrent transabdominal diagnostic laparoscopy (TADL) would influence planned TEP repairs. A prospective study oF 100 consecutive TEP cases was conducted. All patients had diagnostic laparoscopy via a 5-mm 45 degrees scope through an umbilical incision with 15 mmHg of pneumoperitoneum, followed by laparoscopic TEPrepair. A contralateral occult hernia was diagnosed and repaired if a true peritoneal eventration through the inguinal region was observed. Among the 100 patients, preoperative diagnosis suggested 31 bilateral hernias (31%), whereas TADL confirmed 25 bilateral hernias (25%). Of these 25 bilateral hernias, TADL confirmed 16 that had been diagnosed preoperatively (64%), but excluded 15 contralateral hernias that were incorrectly diagnosed (37%). Transabdominal diagnostic laparoscopy found nine OCHs, representing 36% of all bilateral hernias and 13% of the 69 preoperatively determined unilateral hernias. The preoperative physician examination false-negative rate for contralateral hernias was 36%, and the false-positive rate was 37%. In 26 cases (26%), TADL changed the operative approach. In this study, patients believed to have unilateral inguinal hernias had OCHs in 13% of cases when examined by TADL. The actual bilateral hernia incidence was 25%, with a 37% false-positive rate for preoperatively diagnosed bilateral hernias. The high rate of bilateral hernias reported by the TEP approach alone suggests that some OCH findings may be an artifact of the TEP dissection. However, failure to search for an OCH could result in up to 13% of patients subsequently requiring a second repair. Because some surgeons are concerned about unnecessary TEP dissection of the asymptomatic contralateral side, the approach described here may offer a solution to accurate diagnosis of the contralateral inguinal region during planned laparoscopic TEP hernia repair.

Contralateral Effects and Binaural Interactions in Dorsal Cochlear Nucleus

PubMed Central

2005-01-01

The dorsal cochlear nucleus (DCN) receives afferent input from the auditory nerve and is thus usually thought of as a monaural nucleus, but it also receives inputs from the contralateral cochlear nucleus as well as descending projections from binaural nuclei. Evidence suggests that some of these commissural and efferent projections are excitatory, whereas others are inhibitory. The goals of this study were to investigate the nature and effects of these inputs in the DCN by measuring DCN principal cell (type IV unit) responses to a variety of contralateral monaural and binaural stimuli. As expected, the results of contralateral stimulation demonstrate a mixture of excitatory and inhibitory influences, although inhibitory effects predominate. Most type IV units are weakly, if at all, inhibited by tones but are strongly inhibited by broadband noise (BBN). The inhibition evoked by BBN is also low threshold and short latency. This inhibition is abolished and excitation is revealed when strychnine, a glycine-receptor antagonist, is applied to the DCN; application of bicuculline, a GABAA-receptor antagonist, has similar effects but does not block the onset of inhibition. Manipulations of discrete fiber bundles suggest that the inhibitory, but not excitatory, inputs to DCN principal cells enter the DCN via its output pathway, and that the short latency inhibition is carried by commissural axons. Consistent with their respective monaural effects, responses to binaural tones as a function of interaural level difference are essentially the same as responses to ipsilateral tones, whereas binaural BBN responses decrease with increasing contralateral level. In comparison to monaural responses, binaural responses to virtual space stimuli show enhanced sensitivity to the elevation of a sound source in ipsilateral space but reduced sensitivity in contralateral space. These results show that the contralateral inputs to the DCN are functionally relevant in natural listening conditions, and that one role of these inputs is to enhance DCN processing of spectral sound localization cues produced by the pinna. PMID:16075189

Does the Dumbbell-Carrying Position Change the Muscle Activity in Split Squats and Walking Lunges?

PubMed Central

Lehnert, Michal; Zaatar, Amr M.Z.; Svoboda, Zdenek; Xaverova, Zuzana

2015-01-01

Abstract Stastny, P, Lehnert, M, Zaatar, AMZ, Svoboda, Z, and Xaverova, Z. Does the dumbbell-carrying position change the muscle activity in split squats and walking lunges? J Strength Cond Res 29(11): 3177–3187, 2015—The forward walking lunge (WL) and split squat (SSq) are similar exercises that have differences in the eccentric phase, and both can be performed in the ipsilateral or contralateral carrying conditions. This study aimed to determine the effects of dumbbell-carrying position on the kinematics and electromyographic (EMG) amplitudes of the gluteus medius (Gmed), vastus medialis (VM), vastus lateralis (VL), and biceps femoris during WLs and SSqs. The resistance-trained (RT) and the non–resistance-trained (NT) groups (both n = 14) performed ipsilateral WLs, contralateral WLs, ipsilateral SSqs, and contralateral SSqs in a randomized order in a simulated training session. The EMG amplitude, expressed as a percentage of the maximal voluntary isometric contraction (%MVIC), and the kinematics, expressed as the range of motion (ROM) of the hip and knee, were measured during 5 repetition maximum for both legs. The repeated measure analyses of variance showed significant differences between the RT and NT groups. The NT group showed a smaller knee flexion ROM (p < 0.001, η2 = 0.36) during both types of WLs, whereas the RT group showed a higher eccentric Gmed amplitude (p < 0.001, η2 = 0.46) during all exercises and a higher eccentric VL amplitude (p < 0.001, η2 = 0.63) during contralateral WLs. Further differences were found between contralateral and ipsilateral WLs in both the RT (p < 0.001, η2 = 0.69) and NT groups (p < 0.001, η2 = 0.80), and contralateral WLs resulted in higher eccentric Gmed amplitudes. Contralateral WLs highly activated the Gmed (90% MVIC); therefore, this exercise can increase the Gmed maximal strength. The ipsilateral loading condition did not increase the Gmed or VM activity in the RT or NT group. PMID:25968228

SU-E-T-373: Evaluation and Reduction of Contralateral Skin /subcutaneous Dose for Tangential Breast Irradiation

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

Butson, M; Carroll, S; Whitaker, M

2015-06-15

Purpose: Tangential breast irradiation is a standard treatment technique for breast cancer therapy. One aspect of dose delivery includes dose delivered to the skin caused by electron contamination. This effect is especially important for highly oblique beams used on the medical tangent where the electron contamination deposits dose on the contralateral breast side. This work aims to investigate and predict as well as define a method to reduce this dose during tangential breast radiotherapy. Methods: Analysis and calculation of breast skin and subcutaneous dose is performed using a Varian Eclipse planning system, AAA algorithm for 6MV x-ray treatments. Measurements weremore » made using EBT3 Gafchromic film to verify the accuracy of planning data. Various materials were tested to assess their ability to remove electron contamination on the contralateral breast. Results: Results showed that the Varian Eclipse AAA algorithm could accurately estimate contralateral breast dose in the build-up region at depths of 2mm or deeper. Surface dose was underestimated by the AAA algorithm. Doses up to 12% of applied dose were seen on the contralateral breast surface and up to 9 % at 2mm depth. Due to the nature of this radiation, being mainly low energy electron contamination, a bolus material could be used to reduce this dose to less than 3%. This is accomplished by 10 mm of superflab bolus or by 1 mm of lead. Conclusion: Contralateral breast skin and subcutaneous dose is present for tangential breast treatment and has been measured to be up to 12% of applied dose from the medial tangent beam. This dose is deposited at shallow depths and is accurately calculated by the Eclipse AAA algorithm at depths of 2mm or greater. Bolus material placed over the contralateral can be used to effectively reduce this skin dose.« less

Ten-m3 Is Required for the Development of Topography in the Ipsilateral Retinocollicular Pathway

PubMed Central

Dharmaratne, Nuwan; Glendining, Kelly A.; Young, Timothy R.; Tran, Heidi; Sawatari, Atomu; Leamey, Catherine A.

2012-01-01

Background The alignment of ipsilaterally and contralaterally projecting retinal axons that view the same part of visual space is fundamental to binocular vision. While much progress has been made regarding the mechanisms which regulate contralateral topography, very little is known of the mechanisms which regulate the mapping of ipsilateral axons such that they align with their contralateral counterparts. Results Using the advantageous model provided by the mouse retinocollicular pathway, we have performed anterograde tracing experiments which demonstrate that ipsilateral retinal axons begin to form terminal zones (TZs) in the superior colliculus (SC), within the first few postnatal days. These appear mature by postnatal day 11. Importantly, TZs formed by ipsilaterally-projecting retinal axons are spatially offset from those of contralaterally-projecting axons arising from the same retinotopic location from the outset. This pattern is consistent with that required for adult visuotopy. We further demonstrate that a member of the Ten-m/Odz/Teneurin family of homophilic transmembrane glycoproteins, Ten-m3, is an essential regulator of ipsilateral retinocollicular topography. Ten-m3 mRNA is expressed in a high-medial to low-lateral gradient in the developing SC. This corresponds topographically with its high-ventral to low-dorsal retinal gradient. In Ten-m3 knockout mice, contralateral ventrotemporal axons appropriately target rostromedial SC, whereas ipsilateral axons exhibit dramatic targeting errors along both the mediolateral and rostrocaudal axes of the SC, with a caudal shift of the primary TZ, as well as the formation of secondary, caudolaterally displaced TZs. In addition to these dramatic ipsilateral-specific mapping errors, both contralateral and ipsilateral retinocollicular TZs exhibit more subtle changes in morphology. Conclusions We conclude that important aspects of adult visuotopy are established via the differential sensitivity of ipsilateral and contralateral axons to intrinsic guidance cues. Further, we show that Ten-m3 plays a critical role in this process and is particularly important for the mapping of the ipsilateral retinocollicular pathway. PMID:23028443

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

PubMed Central

2013-01-01

Objective To report a rare case of unilateral cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. Case report A 33-year-old female visited our hospital for severe, right-sided, temporal headache, chemosis, periorbital edema, and proptosis. These signs were associated with congested erythematous nasal mucosa with purulent discharge from the right superior nasal meatus. Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment. Conclusions Sphenoiditis can cause contralateral cavernous sinus thrombosis. Early surgical sphenoidotomy and aggressive medical treatment are the cornerstones of successful management of this life-threatening complication. PMID:23497466

Lumbar disc herniation with contralateral radiculopathy: do we neglect the epidural fat?

PubMed

Yang, Jun-Song; Zhang, Dong-Jie; Hao, Ding-Jun

2015-01-01

Lumbar disc herniation (LDH) is the most common cause of radiculopathy, whose pathological entity underlying nerve root compression is usually on the same side as the symptoms. However, LDH causing contralateral radiculopathy are sometimes encountered by pain physicians. There have been tremendous developments in the treatment options for LDH; the situation of LDH causing contralateral radiculopathy is indeed a dilemma for some pain physicians. We will report a case of a patient with a L4-5 disc herniation whose left herniated disc caused radiculopathy on the right side. After a percutaneous lumbar endoscopic discectomy via the side ipsilateral to the symptomatic side, this case obtained a significant symptom remission. The migrated epidural fat is discussed as a cause of associated contralateral neurological deficit. Only via a surgical approach ipsilateral to the herniated side, could there be a clinical improvement postoperatively.

Postoperative recovery of hippocampal contralateral diffusivity in medial temporal lobe epilepsy.

PubMed

Thivard, Lionel; Tanguy, Marie-Laure; Adam, Claude; Clémenceau, Stéphane; Dezamis, Edouard; Lehéricy, Stéphane; Dormont, Didier; Chiras, Jacques; Baulac, Michel; Dupont, Sophie

2007-03-01

To search for a recovery after surgery of mean diffusivity (MD) values in the contralateral nonsclerotic hippocampus of patients with medial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). Twenty-four MTLE patients (12 right-sided and 12 left-sided MTLE) and 36 healthy volunteers were investigated using diffusion tensor imaging. A region-of-interest approach was used to measure pre- and postoperative interictal hippocampal MD values in patients. Diffusion abnormalities in contralateral nonsclerotic hippocampus recovered after surgery (p<0.0001). A subgroup of 14 patients exhibited a clear increase in MD values whereas the remaining 10 patients were stable. No significant difference was found between the two subgroups for each of the electroclinical data studied including early postoperative outcome, all patients being either seizure free or with rare persistent auras. This finding suggests that diffusion abnormalities in contralateral hippocampus may represent a functional mechanism linked to the active epileptic process.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

PubMed Central

Fan, Song; Tang, Qiong-lan; Lin, Ying-jin; Chen, Wei-liang; Li, Jin-song; Huang, Zhi-quan; Yang, Zhao-hui; Wang, You-yuan; Zhang, Da-ming; Wang, Hui-jing; Dias-Ribeiro, Eduardo; Cai, Qiang; Wang, Lei

2011-01-01

Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently. PMID:22010576

An anatomical analysis of the mini-modified orbitozygomatic and supra-orbital approaches.

PubMed

Figueiredo, Eberval G; Deshmukh, Puspha; Nakaji, Peter; Shu, Edson Bor Seng; Crawford, Neil; Spetzler, Robert F; Preul, Mark C

2012-11-01

Seven sides of cadaver heads were used to compare the surgical exposures provided by the mini-modified orbitozygomatic (MOz) and supra-orbital (SO) approaches. The Optotrak 3020 computerized tracking system (Northern Digital, Waterloo, ON, Canada) was utilized to evaluate the area of anatomical exposure defined by six points: (1) ipsilateral sphenoid ridge; (2) most distal point of the ipsilateral middle cerebral artery (MCA); (3) most distal point of the ipsilateral posterior cerebral artery (PCA); (4) most distal point of the contralateral PCA; (5) most distal point of the contralateral MCA; and (6) contralateral sphenoid ridge. Additionally, angles of approach for the ipsilateral MCA bifurcation, ipsilateral ICA bifurcation, basilar artery tip, contralateral MCA and ICA bifurcation and anterior communicating artery (AcomA) were evaluated, first for SO and then for MOz. An image guidance system was used to evaluate the limits of surgical exposure. No differences in the area of surgical exposure were noted (p>0.05). Vertical angles were significantly wider for the ipsilateral and contralateral ICA bifurcation, AcomA, contralateral MCA and basilar tip (p<0.05) for MOz. No differences in horizontal angles were observed between the approaches for the six targets (p>0.05). There were no differences in the limits of exposure. MOz affords no additional surgical working space. However, our results demonstrate systematically that vertical exposure is improved. The MOz should be performed while planning an approach to these regions and a wider exposure in the vertical axis is needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Topographic measurements of eyelids and orbit in enucleated eyes with hydroxyapatite integrated implant versus PMMA implant.

PubMed

Gradinaru, S; Totir, M; Iancu, R; Leasu, C; Pricopie, S; Yasin, S; Ciuluvica, R; Ungureanu, E

2014-01-01

This study reports our results relating to palpebral eyelid fissure and orbital measurements following evisceration with orbital implantation of hydroxyapatite integrated implant and PMMA implant. This study is a prospective study of 43 patients that underwent evisceration for different ocular affections at University Emergency Hospital Bucharest, Ophthalmology department between January 2009 and September 2010 (Group A comprising of twenty patients had the coralline hydroxyapatite implant -Integrated Ocular Implants, USA and Group B comprising of twenty-three received non-integrated PMMA ocular implants) .The outcomes measured were the degree of exo /enophthalmos, horizontal eyelid fissure and palpebral fissure height at 4 years after surgical intervention related to measurement to the contralateral eye. Horizontal eyelid fissure (HEF) was suffering a shortening of 7.4% in the group B versus the contralateral eye, and only 1.9% in the group A related to the contralateral eye. Eyelid fissure height was greater in the group B with 5.2% regarding the contralateral eye, and 1.2% in group A. The degree of enophthalmia was higher in the group B of 4 mm versus the contralateral eye and lower in group A 1.5 mm regarding the contralateral eye. . Although a hydroxyapatite implant may be not as economic as a PMMA implant, a patient must be warned about the effect on its ocular structures in time and that cosmetic appearance over years will change more dramatically than in the fellow normal eye. Therefore preoperative counseling of the patient is crucial in long term patient satisfaction.

Contralateral versus ipsilateral rTMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: comparative study.

PubMed

Khedr, E M; Abo-Elfetoh, N; Rothwell, J C; El-Atar, A; Sayed, E; Khalifa, H

2010-07-01

Repetitive transcranial magnetic stimulation (rTMS) applied over left temporoparietal cortex has been reported to have a long-term therapeutic effect on tinnitus. We compare the impact of 1 and 25 Hz rTMS delivered either contralateral or ipsilateral to symptoms in 62 patients with unilateral chronic tinnitus. Patients were randomly assigned to one of four treatment groups: with stimulation at 1 or 25 Hz applied either ipsilateral or contralateral to symptoms. Two thousand pulses per session were given daily for 2 weeks. Changes in tinnitus handicap inventory (THI), self-rating scores of loudness, awareness, and annoyance were measured monthly for 10 months. Duration of residual inhibition (RI) and psychiatric morbidity were evaluated monthly for 3 months. There was a significant main effect of time (P < 0.0001) and a significant time x side interaction (P = 0.032) between groups. This was because of the fact that contralateral stimulation had a greater effect on THI than ipsilateral stimulation; it was also superior to left side stimulation (P = 0.027). Ratings of loudness improved more after contralateral rTMS (P = 0.037). Twenty patients had no remaining tinnitus after 3 months; the remainder had a significant increase in RI. Patients with the shortest history of tinnitus tended to respond better to rTMS. There was a significant correlation between changes in THI score and changes in Hamilton anxiety and depression scores. Ten daily treatments of 1 and 25 Hz rTMS contralateral to the side of tinnitus have a greater beneficial effect on symptoms than either ipsilateral or left side stimulation.

Neural Correlates of the Antinociceptive Effects of Stimulating the Anterior Pretectal Nucleus in Rats.

PubMed

Genaro, Karina; Prado, Wiliam A

2016-11-01

Stimulation-evoked antinociception (SEA) from the anterior pretectal nucleus (APtN) activates mechanisms that descend to the spinal cord through the dorsolateral funiculus, but the encephalic route followed by the descending pathways from the APtN is not completely known. This study evaluated the changes in the SEA from the APtN in the Wistar rat tail-flick test after lidocaine-induced neural block or N-methyl-d-aspartate-induced neurotoxic lesion of the deep mesencephalic nucleus (DpMe), tegmental pedunculopontine nucleus (PPTg), or lateral paragigantocellular nucleus (LPGi). The SEA from the APtN was less intense after neural block of the contralateral DpMe or PPTg or the ipsilateral LPGi, but was not changed by the neural block of the ipsilateral DpMe or PPTg or the contralateral LPGi. Antinociception did not occur when APtN stimulation was carried out 5 minutes after lidocaine or 6 days after N-methyl-d-aspartate injections into the contralateral DpMe and the ipsilateral LPGi, or into the contralateral PPTg and the ipsilateral LPGi. We conclude that the SEA from the APtN activates 2 descending pain inhibitory pathways, one relaying in the ipsilateral LPGi and another relaying sequentially in the contralateral DpMe and PPTg. The antinociceptive effect of the APtN stimulation involves 2 descending pathways: one relaying in the ipsilateral LPGi and another descending contralaterally via relays in the DpMe and PPTg. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Effect of task set-modulating attentional capture depends on the distractor cost in visual search: evidence from N2pc.

PubMed

Zhao, Dandan; Liang, Shengnan; Jin, Zhenlan; Li, Ling

2014-07-09

Previous studies have confirmed that attention can be modulated by the current task set while involuntarily captured by salient items. However, little is known on which factors the modulation of attentional capture is dependent on when the same stimuli with different task sets are presented. In the present study, participants conducted two visual search tasks with the same search arrays by varying target and distractor settings (color singleton as target, onset singleton as distractor, named as color task, and vice versa). Ipsilateral and contralateral color distractors resulted in two different relative saliences in two tasks, respectively. Both reaction times (RTs) and N2-posterior-contralateral (N2pc) results showed that there was no difference between ipsilateral and contralateral color distractors in the onset task. However, both RTs and the latency of N2pc showed a delay to the ipsilateral onset distractor compared with the contralateral onset distractor. Moreover, the N2pc observed under the contralateral distractor condition in the color task was reversed, and its amplitude was attenuated. On the basis of these results, we proposed a parameter called distractor cost (DC), computed by subtracting RTs under the contralateral distractor condition from the ipsilateral condition. The results suggest that an enhanced DC might be related to the modification of N2pc in searching for the color target. Taken together, these findings provide evidence that the effect of task set-modulating attentional capture in visual search is related to the DC.

Clinical Study of 27 Patients with Medial Medullary Infarction.

PubMed

Akimoto, Takayoshi; Ogawa, Katsuhiko; Morita, Akihiko; Suzuki, Yutaka; Kamei, Satoshi

2017-10-01

Medial medullary infarction (MMI) is a rare ischemic stroke. Frequency of each neurological finding in MMI was different in each study. We retrospectively evaluated the medical records of patients with cerebral infarction who were admitted between March 1998 and October 2015. Patients in our study were diagnosed as having MMI by magnetic resonance image examination. Of 2727 patients with ischemic stroke, 27 patients (20 males and 7 females) had MMI. The MMI was complicated by infarcts located in the pons (n = 6), cerebellum (n = 2), and lateral medulla (n = 1). One patient had bilateral MMI. Large-artery atherosclerosis was the most common etiology. Motor weakness of the extremities was the most common neurological finding. Diminished contralateral superficial sensation was more common than diminished contralateral vibratory sensation, and these 2 types of sensory disturbance were often complicated. The patients with large MMI significantly more often accompanied diminished touch (P = .003), pain (P = .017), and vibratory (P = .019) sensation. Facial weakness was shown more common contralateral to the infarcts than ipsilateral (n = 8 contralateral, n = 1 ipsilateral). Lingual palsy was also more common contralateral to the lesions (n = 3 contralateral, n = 1 ipsilateral). One patient alone fulfilled the classical Dejerine triad. In MMI, motor weakness of extremities was commonly shown, and complication of diminished sensations indicated the large infarcts. As for facial weakness and lingual palsy, the supranuclear type was more prominent than the infranuclear type. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

Kamitani, Takeshi, E-mail: kamitani@radiol.med.kyushu-u.ac.jp; Kawanami, Satoshi, E-mail: kawanami-01@mac.com; Asayama, Yoshiki, E-mail: asayama@radiol.med.kyushu-u.ac.jp

PurposeTo evaluate the frequency and the predictive factor of each feeding artery on intra-arterial infusion chemotherapy (IAIC) in primary tongue cancer.Materials and MethodsWe retrospectively evaluated 20 patients who received IAIC for primary tongue cancer. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery. Tumor diameter, and extension to the contralateral side, tongue extrinsic muscles (TEMs), and lateral mesopharyngeal wall were determined based on magnetic resonance imaging or computed tomography findings.ResultsThe main feeding artery was the ipsilateral lingual artery (LA) in 15 of the 20 examined tumors and the contralateral LAmore » in the other 5. Ten cancers had only one feeding artery, and multiple feeding arteries were detected in the remaining 10. Tumors >4 cm (n = 9), those with extension to the contralateral side (n = 13), and those with extension to TEMs (n = 15) were supplied by significantly larger numbers of feeding arteries compared to tumors without these features (P = 0.01, 0.049, and 0.02, respectively). The frequency of feeding from the contralateral LA was 64 % (9/14) and 17 % (1/6) in tumors with and without extension to the contralateral side, respectively. Feeding from a facial artery (FA) was not detected in tumors ≤4 cm, while 5 of the 9 (56 %) tumors >4 cm were supplied by a FA (P = 0.01).ConclusionA careful search for feeding arteries is required, especially in large tumors with extension to the contralateral side or to TEMs.« less

Neuronal Basis of Crossed Actions from the Reticular Formation on Feline Hindlimb Motoneurons

PubMed Central

Jankowska, Elzbieta; Hammar, Ingela; Slawinska, Urszula; Maleszak, Katarzyna; Edgley, Stephen A.

2007-01-01

Pathways through which reticulospinal neurons can influence contralateral limb movements were investigated by recording from mo-toneurons innervating hindlimb muscles. Reticulospinal tract fibers were stimulated within the brainstem or in the lateral funiculus of the thoracic spinal cord contralateral to the motoneurons. Effects evoked by ipsilaterally descending reticulospinal tract fibers were eliminated by a spinal hemisection at an upper lumbar level. Stimuli applied in the brainstem evoked EPSPs, IPSPs, or both at latencies of 1.42 ± 0.03 and 1.53 ± 0.04 msec, respectively, from the first components of the descending volleys and with properties indicating a disynaptic linkage, in most contralateral motoneurons: EPSPs in 76% and IPSPs in 26%. EPSPs with characteristics of monosynaptically evoked responses, attributable to direct actions of crossed axon collaterals of reticulospinal fibers, were found in a small proportion of the motoneurons, whether evoked from the brainstem (9%) or from the thoracic cord (12.5%). Commissural neurons, which might mediate the crossed disynaptic actions (i.e., were antidromically activated from contralateral motor nuclei and monosynaptically excited from the ipsilateral reticular formation), were found in Rexed’s lamina VIII in the midlumbar segments (L3–L5). The results reveal that although direct actions of reticulospinal fibers are much more potent on ipsilateral motoneurons, interneuronally mediated actions are as potent contralaterally as ipsilaterally, and midlumbar commissural neurons are likely to contribute to them. They indicate a close coupling between the spinal interneuronal systems used by the reticulospinal neurons to coordinate muscle contractions ipsilaterally and contralaterally. PMID:12629191

Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

PubMed

Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

2010-02-01

: A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

[Development of Non-Arteritic Anterior Ischaemic Optic Neuropathy in the Initially Unaffected Fellow Eye in Patients Treated with Systemic Corticosteroids].

PubMed

Pahor, Artur; Pahor, Dusica

2017-11-01

Background The objective of this prospective pilot study was to evaluate the results of systemic corticosteroid therapy in patient with non-arteritic anterior ischaemic neuropathy of the optical nerve (NAION) for an observation period of one year and to measure the NAION incidence in the initially healthy contralateral eye of these patients. Patients and Methods All patients diagnosed with acute NAION who were admitted to our ward during 2014 and who fulfilled all inclusion criteria for systemic corticosteroid therapy were included in the study. The inclusion criteria were corrected visual acuity of 0.3 or less and duration of illness of less than 2 weeks. All patients were examined by a rheumatologist and given a complete ophthalmological examination, including fluorescein angiography and examination of the visual field. Only 3 of the 23 patients fulfilled our inclusion criteria for corticoid treatment and were then treated. 10 patients served as controls. The treatment plan started with an initial dose of 80 mg prednisolone during the first two weeks. The dose was then tapered over 3 to 4 months. Results The mean best corrected visual acuity on admission was 0.12 and 0.35 after one year. The mean duration of treatment was 3.3 months. Treatment was discontinued after 5 to 6 months or 8 to 9 months after the initial examination. All patients then developed NAION on the contralateral eye. The mean visual acuity on the contralateral eye was 0.73. After 4 month follow-up, the visual acuity in two patients had decreased to 1.0 and in one patient was reduced from 0.8 to 0.4. No steroid treatment was initiated for the contralateral eye. No NAION was found in the contralateral eye in the control group. Conclusion Corticosteroid treatment improved vision in all patients with NAION in comparison with the untreated contralateral eye. In a single patient, visual acuity decreased in the contralateral eye. Our study confirmed that corticosteroid treatment may be a predisposing factor for the development of NAION am in the contralateral eye. Additional studies with more patients are needed to confirm our results. Georg Thieme Verlag KG Stuttgart · New York.

Proprioception in patients with posterior cruciate ligament tears: A meta-analysis comparison of reconstructed and contralateral normal knees

PubMed Central

Ko, Seung-Nam

2017-01-01

Posterior cruciate ligament (PCL) reconstruction for patients with PCL insufficiency has been associated with postoperative improvements in proprioceptive function due to mechanoreceptor regeneration. However, it is unclear whether reconstructed PCL or contralateral normal knees have better proprioceptive function outcomes. This meta-analysis was designed to compare the proprioceptive function of reconstructed PCL or contralateral normal knees in patients with PCL insufficiency. All studies that compared proprioceptive function, as assessed with threshold to detect passive movement (TTDPM) or joint position sense (JPS) in PCL reconstructed or contralateral normal knees were included. JPS was calculated by reproducing passive positioning (RPP). Five studies met the inclusion/exclusion criteria for the meta-analysis. The proprioceptive function, defined as TTDPM (95% CI: 0.25 to 0.51°; P<0.00001) and RPP (95% CI: 0.19 to 0.45°; P<0.00001), was significantly different between the reconstructed PCL and contralateral normal knees. The mean difference in angle of error between the reconstructed PCL and contralateral normal knees was 0.06° greater in TTDPM than by RPP. In addition, results from subgroup analyses, based on the starting angles and the moving directions of the knee, that evaluated TTDPM at 15° flexion to 45° extension, TTDPM at 45° flexion to 110° flexion, RPP in flexion, and RPP in extension demonstrated that mean angles of error were significantly greater, by 0.38° (P = 0.0001), 0.36° (P = 0.02), 0.36° (P<0.00001), and 0.23° (P = 0.04), respectively, in reconstructed PCL than in contralateral normal knees. The proprioceptive function of PCL reconstructed knees was decreased, compared with contralateral normal knees, as determined by both TTDPM and RPP. In addition, the amount of loss of proprioception was greater in TTDPM than in RPP, even with minute differences. Results from subgroup analysis, that evaluated the mean angles of error in moving directions through RPP, suggested that the moving direction of flexion has a significantly greater mean for angles of error than the moving direction of extension. Although the level of differences between various parameters were statistically significant, further studies are needed to determine whether the small differences (>1°) of the loss of proprioception are clinically relevant. PMID:28922423

Contralateral Dpoae Suppression in Humans at Very Low Sound Intensities

NASA Astrophysics Data System (ADS)

Janssen, T.; Gehr, D. D.; Kevanishvili, Z.

2003-02-01

Different functions are attributed to the olivo-cochlear bundle system (OCBS) such as protecting the ear from acoustic injury, improving signal detection in noise, and mediating selective attention. OCBS reflex strength can be evaluated, in animals as well as in humans, by measuring the degree of suppression of an ipsilateral DPOAE by a contralateral sound. The purpose of the study was to evaluate OCBS reflex strength depending on ipsilateral stimulus level, especially at threshold, by means of extrapolated DPOAE I/O-functions. Additionally, DPOAE was measured at near-to-threshold contralateral stimulus levels when using low-level ipsilateral stimulation for investigating possible enhancement of outer hair cell motion in the presence of low-level contralateral sound. The recording of the 2f1-f2 DPOAE in the presence or absence of contralateral sound was performed in normally hearing human subjects at f2 = 2 kHz. DPOAE I/O-functions were measured in a primary tone level range from L2 = 20 to L2 = 65 dB SPL (L1 = 0.4L2 + 39, f2/f1=1.2). Broad-band noise (BBN), narrow-band noise from 1720 to 2320 Hz (NBN), and pure tones (PT) at f2, 2f1-f2, geometric mean of f1 and f2, and 0.1oct + f2 were used for contralateral stimulation. The contralateral stimulus level (Ls) was decreased from 70 down to 10 dB SPL in 10 dB steps. DPOAE suppression was highest at the lowest primary tone level and was more pronounced for BBN and NBN than for pure tones, suggesting a more diffuse than a strong tonotopic organisation of the OCBS. The contralateral stimulus level at which significant DPOAE suppression occurred (p < 0.05) was different for the different stimuli being 20, 40, and 70 dB SPL for BBN, NBN, and pure-tone (f2), respectively. Significant DPOAE suppression to BBN and NBN occurred at Ls well below audiological middle-ear reflex threshold. DPOAE time course was different for Ls below and above middle-ear reflex threshold. Thus, middle-ear muscle contraction is suggested not to be involved in DPOAE suppression at low Ls. No enhancement of DPOAE could be found. The findings suggest the OCBS to be functioning in a more protective way than for improving signal detection in noise.

Contralateral occlusion is not a clinically important reason for choosing carotid artery stenting for patients with significant carotid artery stenosis.

PubMed

Brewster, Luke P; Beaulieu, Robert; Kasirajan, Karthik; Corriere, Matthew A; Ricotta, Joseph J; Patel, Siddharth; Dodson, Thomas F

2012-11-01

Contralateral carotid artery occlusion by itself carries an increased risk of stroke. Carotid endarterectomy (CEA) in the presence of contralateral carotid artery occlusion has high reported rates of perioperative morbidity and mortality. Our objective was to determine if there is a clinical benefit to patients who receive carotid artery stenting (CAS) compared to CEA in the presence of contralateral carotid artery occlusion. We conducted a retrospective medical chart review over a 4.5-year institutional experience of persons with contralateral carotid artery occlusion and ipsilateral carotid artery stenosis who underwent CAS or CEA. The main outcome measures were 30-day cardiac, stroke, and mortality rate, and midterm mortality. Of a total of 713 patients treated for carotid artery stenosis during this time period, 57 had contralateral occlusion (~8%). Thirty-nine of these patients were treated with CAS, and 18 with CEA. The most common indications for CAS were prior neck surgery (18), contralateral internal carotid occlusion (nine), and prior neck radiation (seven). The average age was 70 ± 8.5 for CEA and 66.7 ± 9.3 for CAS (P = .20). Both groups were predominantly men (CEA 12 of 18; CAS 28 of 39; P = .76), with similar prevalence of symptomatic lesions (CEA 8 of 18, CAS 20 of 39; P = .77). Two patients died within 30 days in the CAS group (5%). No deaths occurred within 30 days in the CEA group (P = .50); the mortality rate for CAS and CEA combined was 3.5%. No perioperative strokes or myocardial infarction occurred in either group. Two transient ischemic attacks occurred after CAS. At mean follow-up of 29.4 ± 16 months (CEA) and 28 ± 14.4 months (CAS; range, 1.5-48.5 months), seven deaths occurred in the CAS group and one in the CEA group (17.9% vs 5.5%; P = .40). There were two reinterventions in the CAS group for in-stent restenosis and there were no reoperations in the CEA group. Although CEA and CAS can both be performed with good perioperative results and acceptable midterm mortality, the observed outcomes do not support use of contralateral carotid artery occlusion as a selection criterion for CAS over CEA in the absence of other indications. Copyright © 2012 Society for Vascular Surgery. All rights reserved.

Evaluating the dose to the contralateral breast when using a dynamic wedge versus a regular wedge.

PubMed

Weides, C D; Mok, E C; Chang, W C; Findley, D O; Shostak, C A

1995-01-01

The incidence of secondary cancers in the contralateral breast after primary breast irradiation is several times higher than the incidence of first time breast cancer. Studies have shown that the scatter radiation to the contralateral breast may play a large part in the induction of secondary breast cancers. Factors that may contribute to the contralateral breast dose may include the use of blocks, the orientation of the field, and wedges. Reports have shown that the use of regular wedges, particularly for the medial tangential field, gives a significantly higher dose to the contralateral breast compared to an open field. This paper compares the peripheral dose outside the field using a regular wedge, a dynamic wedge, and an open field technique. The data collected consisted of measurements taken with patients, solid water and a Rando phantom using a Varian 2300CD linear accelerator. Ion chambers, thermoluminescent dosimeters (TLD), diodes, and films were the primary means for collecting the data. The measurements show that the peripheral dose outside the field using a dynamic wedge is close to that of open fields, and significantly lower than that of regular wedges. This information indicates that when using a medial wedge, a dynamic wedge should be used.

Backward masked fearful faces enhance contralateral occipital cortical activity for visual targets within the spotlight of attention

PubMed Central

Reinke, Karen S.; LaMontagne, Pamela J.; Habib, Reza

2011-01-01

Spatial attention has been argued to be adaptive by enhancing the processing of visual stimuli within the ‘spotlight of attention’. We previously reported that crude threat cues (backward masked fearful faces) facilitate spatial attention through a network of brain regions consisting of the amygdala, anterior cingulate and contralateral visual cortex. However, results from previous functional magnetic resonance imaging (fMRI) dot-probe studies have been inconclusive regarding a fearful face-elicited contralateral modulation of visual targets. Here, we tested the hypothesis that the capture of spatial attention by crude threat cues would facilitate processing of subsequently presented visual stimuli within the masked fearful face-elicited ‘spotlight of attention’ in the contralateral visual cortex. Participants performed a backward masked fearful face dot-probe task while brain activity was measured with fMRI. Masked fearful face left visual field trials enhanced activity for spatially congruent targets in the right superior occipital gyrus, fusiform gyrus and lateral occipital complex, while masked fearful face right visual field trials enhanced activity in the left middle occipital gyrus. These data indicate that crude threat elicited spatial attention enhances the processing of subsequent visual stimuli in contralateral occipital cortex, which may occur by lowering neural activation thresholds in this retinotopic location. PMID:20702500

The influence of target-masker similarity on across-ear interference in dichotic listening

NASA Astrophysics Data System (ADS)

Brungart, Douglas; Simpson, Brian

2004-05-01

In most dichotic listening tasks, the comprehension of a target speech signal presented in one ear is unaffected by the presence of irrelevant speech in the opposite ear. However, recent results have shown that contralaterally presented interfering speech signals do influence performance when a second interfering speech signal is present in the same ear as the target speech. In this experiment, we examined the influence of target-masker similarity on this effect by presenting ipsilateral and contralateral masking phrases spoken by the same talker, a different same-sex talker, or a different-sex talker than the one used to generate the target speech. The results show that contralateral target-masker similarity has the greatest influence on performance when an easily segregated different-sex masker is presented in the target ear, and the least influence when a difficult-to-segregate same-talker masker is presented in the target ear. These results indicate that across-ear interference in dichotic listening is not directly related to the difficulty of the segregation task in the target ear, and suggest that contralateral maskers are least likely to interfere with dichotic speech perception when the same general strategy could be used to segregate the target from the masking voices in the ipsilateral and contralateral ears.

Imaging of Cranial Nerves III, IV, VI in Congenital Cranial Dysinnervation Disorders.

PubMed

Kim, Jae Hyoung; Hwang, Jeong Min

2017-06-01

Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence. © 2017 The Korean Ophthalmological Society.

Successful percutaneous treatment of gluteal claudication secondary to isolated bilateral hypogastric stenoses.

PubMed

Chaer, Rabih A; Faries, Peter L; Lin, Stephanie; Dayal, Rajeev; McKinsey, James F; Kent, K Craig

2006-01-01

We report an unusual case of bilateral buttock claudication at ambulation of less than two blocks in a 57-year-old man with normal lower-extremity segmental pressure on noninvasive exercise testing. He was found to have bilateral high-grade internal iliac artery stenoses on arteriography. Both sides were successfully treated in a staged fashion via a contralateral approach with percutaneous transluminal angioplasty and a balloon-expandable stent, with complete symptom resolution. A clinical vascular examination with normal findings of the common iliac, external iliac, and common and superficial femoral arteries eliminates significant vascular obstruction as a cause of claudication. However, internal iliac occlusive disease may be suspected when symptoms are limited to the gluteal musculature and other causes are eliminated. Percutaneous interventions can be of diagnostic and therapeutic value.

Femoral component rotation in patellofemoral joint replacement.

PubMed

van Jonbergen, Hans-Peter W; Westerbeek, Robin E

2018-06-01

Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up. Forty-one knees in 39 patients had patellofemoral joint replacement using the Zimmer Gender-Solutions patellofemoral prosthesis. Intraoperatively, we determined femoral component rotational alignment using an extramedullary rod aimed at the inferior tip of the medial malleolus. Postoperatively, we measured the angle between the femoral component and the anatomical transepicondylar axis using CT. The amount of rotation was correlated with clinical outcomes at one-year follow-up. Forty knees in 38 patients were available for one-year follow-up. Mean femoral component rotation relative to the anatomical transepicondylar axis was 1.4° external rotation (range, -3.8 to 5.7°). We found no statistically significant correlation between femoral component rotation and change from baseline KOOS subscales at one-year follow-up. Our findings show that when using the medial malleolus as a landmark to guide rotation, the femoral component of the patellofemoral prosthesis was oriented in external rotation relative to the anatomical transepicondylar axis in 80% of knees. Our study did not show a relation between the amount of external rotation and clinical outcomes. Level III. Copyright © 2018 Elsevier B.V. All rights reserved.

Assessment of rock musician's efferent system functioning using contralateral suppression of otoacoustic emissions.

PubMed

Kumar, Prawin; Grover, Vibhu; Publius A, Sam; Sanju, Himanshu Kumar; Sinha, Sachchidanand

2016-12-01

Contralateral suppression of oto acoustic emission (OAE) is referred as activation of efferent system. Previous literature mentioned about the importance of contralateral suppression of OAEs as a tool to assess efferent system in different groups of population. There is dearth of literature to explore the efferent system function in experienced musicians exposed to rock music using TEOAEs and DPOAEs. Two groups of participant (14 rock musicians and 14 non-musicians) in the age range of 18-25 years were involved in the study. Contralateral suppression of TEOAEs and DPOAEs were measured using ILO (Version 6) in both groups. Descriptive statistics showed higher suppression of TEOAEs and DPOAEs in rock-musicians at most of the frequencies in comparison to non-musicians. For DPOAE measures, Mann Whitney U test results revealed significantly greater DPOAE suppression only at 1 kHz and 3 kHz in rock-musicians compared to non-musicians. For within group comparison, Kruskal Wallis test results revealed there were significant difference observed across most of the frequencies i.e. at 1 kHz, 3 kHz and 6 kHz. For TEOAE measures, Mann Whitney U test results revealed that only at 2 kHz, TEOAE suppression in rock-musician was significantly greater compared to non-musicians. Similarly, Kuskal Wallis test results revealed that within group there were no significant differences observed for most of the frequencies except 2 kHz. Based on the above finding, present study concludes that rock musicians are having better efferent system compared to non-musicians. No suppression effect at few frequencies probably indicates more vulnerability at those frequencies. Contralateral suppression of DPOAE shows more significant finding in comparison to contralateral suppression of TEOAEs in present study.

TMS activation of interhemispheric pathways between the posterior parietal cortex and the contralateral motor cortex

PubMed Central

Koch, Giacomo; Ruge, Diane; Cheeran, Binith; Fernandez Del Olmo, Miguel; Pecchioli, Cristiano; Marconi, Barbara; Versace, Viviana; Lo Gerfo, Emanuele; Torriero, Sara; Oliveri, Massimiliano; Caltagirone, Carlo; Rothwell, John C

2009-01-01

Using a twin coil transcranial magnetic stimulation (tc-TMS) approach we have previously demonstrated that facilitation may be detected in the primary motor cortex (M1) following stimulation over the ipsilateral caudal intraparietal sulcus (cIPS). Here we tested the interhemispheric interactions between the IPS and the contralateral motor cortex (M1). We found that conditioning the right cIPS facilitated contralateral M1 when the conditioning stimulus had an intensity of 90% resting motor threshold (RMT) but not at 70% or 110% RMT. Facilitation was maximal when the interstimulus interval (ISI) between cIPS and M1 was 6 or 12 ms. These facilitatory effects were mediated by interactions with specific groups of interneurons in the contralateral M1. In fact, short intracortical inhibition (SICI) was reduced following cIPS stimulation. Moreover, additional comparison of facilitation of responses evoked by anterior–posterior versus posterior–anterior stimulation of M1 suggested that facilitation was more effective on early I1/I2 circuits than on I3 circuits. In contrast to these effects, stimulation of anterior IPS (aIPS) at 90% RMT induced inhibition, instead of facilitation, of contralateral M1 at ISIs of 10–12 ms. Finally, we found similar facilitation between left cIPS and right M1 although the conditioning stimuli had to have a higher intensity compared with stimulation of right cIPS (110% instead of 90% RMT). These findings demonstrate that different subregions of the posterior parietal cortex (PPC) in humans exert both facilitatory and inhibitory effects towards the contralateral primary motor cortex. These corticocortical projections could contribute to a variety of motor tasks such as bilateral manual coordination, movement planning in space and grasping. PMID:19622612

Effect of Different Esthetic Post-Core Materials on Color of Direct-Composite Restorations: A Preliminary Clinical Study.

PubMed

Ayna, Buket; Yılmaz, Berivan D; Izol, Bozan S; Ayna, Emrah; Tacir, İbrahim Halil

2018-06-15

BACKGROUND The purpose of this study was to determine the influence of 2 different esthetic post materials on the final color of direct-composite restorations by using a digital technique under in vivo conditions. MATERIAL AND METHODS We included 22 pulpless incisor teeth treated with conventionally cemented zirconia (n=11) and polyethylene fiber (n=11) posts in the study. Teeth were restored with a hybrid resin. The color of direct-composite restorations and contralateral control teeth was measured using a digital technique. The Commission Internationale de L'Eclairage, or CIE, L*a*b* and RGB color systems were investigated. Descriptive statistical analysis was performed for the CIE L*a*b* values. Color differences (ΔE) for the average L*, a*, and b* color parameters between every pair of groups were calculated (P>.05). RESULTS Significant differences were not found in the color difference luminosity (lum), R, G, B, and L* a* b* values between the zircon-rich glass fiber post (Z) and contralateral control teeth (Cz) (P>.05) and between the polyethylene fiber post (P) and contralateral control teeth (Cp) (P>.05). However, there was a statistically significant difference between the color a* values of the polyethylene fiber post (P) and contralateral control teeth (Cp) (p<0.05). Color differences (ΔE) between the zircon-rich glass fiber post (Z) and contralateral control teeth, and the polyethylene fiber post (P) and contralateral teeth were not statistically significant (P>.05). CONCLUSIONS Definitive restorations were equally affected by the 2 materials. Both materials can be used reliably in clinical practice. However, further research that focuses on the effect of intraoral conditions is needed.

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes.

PubMed

Nuijts, Rudy M M A; Jonker, Soraya M R; Kaufer, Robert A; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-02-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8 investigative sites. Prospective randomized parallel-group patient-masked 2-arm study. This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of Δ = 0.1 logMAR. In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment-emergent ocular adverse events rates were similar between the groups. Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm). Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Terminal Distribution of the Corticospinal Projection from the Hand/Arm Region of the Primary Motor Cortex to the Cervical Enlargement in Rhesus Monkey

PubMed Central

Morecraft, Robert J.; Ge, Jizhi; Stilwell-Morecraft, Kimberly S.; McNeal, David W.; Pizzimenti, Marc A.; Darling, Warren G.

2013-01-01

To further our understanding of the corticospinal projection (CSP) from the hand/arm representation of the primary motor cortex (M1), high-resolution anterograde tracing methodology and stereology were used to investigate the terminal distribution of this connection at spinal levels C5 to T1. The highest number of labeled terminal boutons occurred contralaterally (98%) with few ipsilaterally (2%). Contralaterally, labeled boutons were located within laminae I – X, with the densest distribution found in lamina VII and, to a lesser extent, laminae IX and VI. Fewer terminals were found in other contralateral laminae. Within lamina VII, terminal boutons were most prominent in the dorsomedial, dorsolateral and ventrolateral subsectors. Within lamina IX, the heaviest terminal labeling was distributed dorsally. Ipsilaterally, boutons were found in laminae V – X. The most pronounced distribution occurred in the dorsomedial and ventromedial sectors of lamina VII and fewer labeled boutons were located in other ipsilateral laminae. Segmentally, contralateral lamina VII labeling was highest at levels C5-C7. In contrast, lamina IX labeling was highest at C7-T1 and more widely dispersed amongst the quadrants at C8-T1. Our findings suggest dominant contralateral influence of the M1 hand/arm CSP, a contralateral innervation pattern in lamina VII supporting Kuypers (1982) conceptual framework of a “lateral motor system”, and a projection to lamina IX indicating significant influence on motoneurons innervating flexors acting on the shoulder and elbow rostrally (C5-C7), along with flexors, extensors, abductors and adductors acting on the digits, hand and wrist caudally (C8-T1). PMID:23840034

Computed tomography demonstrates abnormalities of contralateral ear in subjects with unilateral sensorineural hearing loss.

PubMed

Marcus, Sonya; Whitlow, Christopher T; Koonce, James; Zapadka, Michael E; Chen, Michael Y; Williams, Daniel W; Lewis, Meagan; Evans, Adele K

2014-02-01

Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT. IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as "normal" based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 "normal" temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group. Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls. Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from "normal" and/or a lateral semicircular canal bony island central lucency disparity of >5% from "normal" may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Monaural and binaural contributions to interaural-level-difference sensitivity in human auditory cortex.

PubMed

Stecker, G Christopher; McLaughlin, Susan A; Higgins, Nathan C

2015-10-15

Whole-brain functional magnetic resonance imaging was used to measure blood-oxygenation-level-dependent (BOLD) responses in human auditory cortex (AC) to sounds with intensity varying independently in the left and right ears. Echoplanar images were acquired at 3 Tesla with sparse image acquisition once per 12-second block of sound stimulation. Combinations of binaural intensity and stimulus presentation rate were varied between blocks, and selected to allow measurement of response-intensity functions in three configurations: monaural 55-85 dB SPL, binaural 55-85 dB SPL with intensity equal in both ears, and binaural with average binaural level of 70 dB SPL and interaural level differences (ILD) ranging ±30 dB (i.e., favoring the left or right ear). Comparison of response functions equated for contralateral intensity revealed that BOLD-response magnitudes (1) generally increased with contralateral intensity, consistent with positive drive of the BOLD response by the contralateral ear, (2) were larger for contralateral monaural stimulation than for binaural stimulation, consistent with negative effects (e.g., inhibition) of ipsilateral input, which were strongest in the left hemisphere, and (3) also increased with ipsilateral intensity when contralateral input was weak, consistent with additional, positive, effects of ipsilateral stimulation. Hemispheric asymmetries in the spatial extent and overall magnitude of BOLD responses were generally consistent with previous studies demonstrating greater bilaterality of responses in the right hemisphere and stricter contralaterality in the left hemisphere. Finally, comparison of responses to fast (40/s) and slow (5/s) stimulus presentation rates revealed significant rate-dependent adaptation of the BOLD response that varied across ILD values. Copyright © 2015. Published by Elsevier Inc.

Health of periodontal tissues and resorption status after orthodontic treatment of impacted maxillary canines.

PubMed

Oz, A Z; Ciger, S

2018-03-01

The aim of the present study was to evaluate the changes of incisor root resorption associated with impacted maxillary canines and health of periodontal tissues around maxillary canines erupted with orthodontic treatment. Twenty patients with a unilateral palatally impacted maxillary canine were included in the study. Cone-beam computed tomography images taken before and after orthodontic treatment were compared with the contralateral canines serving as control teeth. Root resorption was present in 10% of central and 40% of lateral incisors before treatment. After treatment, the incidence of resorption decreased. The thickness of the buccal bone surrounding the impacted canines was similar to that surrounding the contralateral canines, except in the apical area. Periodontal pocket depth and alveolar bone loss were greater for the impacted canine teeth than for the contralateral canines. Incisor root resorption associated with impacted canine teeth showed signs of repair after orthodontic treatment. Slight differences related to periodontal health were found between the previously impacted teeth and contralateral canine teeth.

Automated IMRT planning in Pinnacle : A study in head-and-neck cancer.

PubMed

Kusters, J M A M; Bzdusek, K; Kumar, P; van Kollenburg, P G M; Kunze-Busch, M C; Wendling, M; Dijkema, T; Kaanders, J H A M

2017-12-01

This study evaluates the performance and planning efficacy of the Auto-Planning (AP) module in the clinical version of Pinnacle 9.10 (Philips Radiation Oncology Systems, Fitchburg, WI, USA). Twenty automated intensity-modulated radiotherapy (IMRT) plans were compared with the original manually planned clinical IMRT plans from patients with oropharyngeal cancer. Auto-Planning with IMRT offers similar coverage of the planning target volume as the original manually planned clinical plans, as well as better sparing of the contralateral parotid gland, contralateral submandibular gland, larynx, mandible, and brainstem. The mean dose of the contralateral parotid gland and contralateral submandibular gland could be reduced by 2.5 Gy and 1.7 Gy on average. The number of monitor units was reduced with an average of 143.9 (18%). Hands-on planning time was reduced from 1.5-3 h to less than 1 h. The Auto-Planning module was able to produce clinically acceptable head and neck IMRT plans with consistent quality.

Cross-hemispheric dopamine projections have functional significance

PubMed Central

Fox, Megan E.; Mikhailova, Maria A.; Bass, Caroline E.; Takmakov, Pavel; Gainetdinov, Raul R.; Budygin, Evgeny A.; Wightman, R. Mark

2016-01-01

Dopamine signaling occurs on a subsecond timescale, and its dysregulation is implicated in pathologies ranging from drug addiction to Parkinson’s disease. Anatomic evidence suggests that some dopamine neurons have cross-hemispheric projections, but the significance of these projections is unknown. Here we report unprecedented interhemispheric communication in the midbrain dopamine system of awake and anesthetized rats. In the anesthetized rats, optogenetic and electrical stimulation of dopamine cells elicited physiologically relevant dopamine release in the contralateral striatum. Contralateral release differed between the dorsal and ventral striatum owing to differential regulation by D2-like receptors. In the freely moving animals, simultaneous bilateral measurements revealed that dopamine release synchronizes between hemispheres and intact, contralateral projections can release dopamine in the midbrain of 6-hydroxydopamine–lesioned rats. These experiments are the first, to our knowledge, to show cross-hemispheric synchronicity in dopamine signaling and support a functional role for contralateral projections. In addition, our data reveal that psychostimulants, such as amphetamine, promote the coupling of dopamine transients between hemispheres. PMID:27298371

Distinct Corticostriatal and Intracortical Pathways Mediate Bilateral Sensory Responses in the Striatum.

PubMed

Reig, Ramon; Silberberg, Gilad

2016-12-01

Individual striatal neurons integrate somatosensory information from both sides of the body, however, the afferent pathways mediating these bilateral responses are unclear. Whereas ipsilateral corticostriatal projections are prevalent throughout the neocortex, contralateral projections provide sparse input from primary sensory cortices, in contrast to the dense innervation from motor and frontal regions. There is, therefore, an apparent discrepancy between the observed anatomical pathways and the recorded striatal responses. We used simultaneous in vivo whole-cell and extracellular recordings combined with focal cortical silencing, to dissect the afferent pathways underlying bilateral sensory integration in the mouse striatum. We show that unlike direct corticostriatal projections mediating responses to contralateral whisker deflection, responses to ipsilateral stimuli are mediated mainly by intracortical projections from the contralateral somatosensory cortex (S1). The dominant pathway is the callosal projection from contralateral to ipsilateral S1. Our results suggest a functional difference between the cortico-basal ganglia pathways underlying bilateral sensory and motor processes. © The Author 2016. Published by Oxford University Press.

Pavlovian conditioning between co-administered drugs: elicitation of an apomorphine-induced antiparkinsonian response by scopolamine.

PubMed

Carey, R J

1991-01-01

Sprague-Dawley rats with unilateral 6-OHDA substantia nigra lesions were given combined scopolamine (0.5 mg/kg IP) and apomorphine (0.05 mg/kg SC) treatments. In this animal model, scopolamine, when administered separately, induces ipsilateral rotation and apomorphine, contralateral rotation. When these drugs are co-administered at 0.5 mg/kg and 0.05 mg/kg dose levels, respectively, animals rotate in the contralateral direction, creating the opportunity for the stimulus effect of scopolamine to become associated with the response effect of apomorphine. In tests with scopolamine (0.5 mg/kg), animals that previously had scopolamine and apomorphine co-administered rotated contralaterally in the test chamber, thereby behaving as if they had received apomorphine. Thus, scopolamine exhibited a functionally acquired conditioned stimulus (CS) property by eliciting the apomorphine response of contralateral rotation as a conditioned response. This acquired CS property was extinguished with separate scopolamine trials and reacquired following one scopolamine-apomorphine co-administration trial.

Interaural Level Difference Dependent Gain Control and Synaptic Scaling Underlying Binaural Computation

PubMed Central

Xiong, Xiaorui R.; Liang, Feixue; Li, Haifu; Mesik, Lukas; Zhang, Ke K.; Polley, Daniel B.; Tao, Huizhong W.; Xiao, Zhongju; Zhang, Li I.

2013-01-01

Binaural integration in the central nucleus of inferior colliculus (ICC) plays a critical role in sound localization. However, its arithmetic nature and underlying synaptic mechanisms remain unclear. Here, we showed in mouse ICC neurons that the contralateral dominance is created by a “push-pull”-like mechanism, with contralaterally dominant excitation and more bilaterally balanced inhibition. Importantly, binaural spiking response is generated apparently from an ipsilaterally-mediated scaling of contralateral response, leaving frequency tuning unchanged. This scaling effect is attributed to a divisive attenuation of contralaterally-evoked synaptic excitation onto ICC neurons with their inhibition largely unaffected. Thus, a gain control mediates the linear transformation from monaural to binaural spike responses. The gain value is modulated by interaural level difference (ILD) primarily through scaling excitation to different levels. The ILD-dependent synaptic scaling and gain adjustment allow ICC neurons to dynamically encode interaural sound localization cues while maintaining an invariant representation of other independent sound attributes. PMID:23972599

Early Outcomes of Endoscopic Contralateral Foraminal and Lateral Recess Decompression via an Interlaminar Approach in Patients with Unilateral Radiculopathy from Unilateral Foraminal Stenosis.

PubMed

Kim, Hyeun Sung; Patel, Ravish; Paudel, Byapak; Jang, Jee-Soo; Jang, Il-Tae; Oh, Seong-Hoon; Park, Jae Eun; Lee, Sol

2017-12-01

Percutaneous endoscopic contralateral interlaminar lumbar foraminotomy (PECILF) for lumbar degenerative spinal stenosis is an established procedure. Better preservation of contralateral facet joint compared with that of the approach side has been shown with uniportal bilateral decompression. The aim of this retrospective case series was to analyze the early clinical and radiologic outcomes of stand-alone contralateral foraminotomy and lateral recess decompression using PECILF. Twenty-six consecutive patients with unilateral lower limb radiculopathy underwent contralateral foraminotomy and lateral recess decompression using PECILF. Their clinical outcomes were evaluated with visual analog scale leg pain score, Oswestry Disability Index, and the MacNab criteria. Completeness of decompression was documented with a postoperative magnetic resonance imaging. Mean age for the study group was 62.9 ± 9.2 years and the male/female ratio was 4:9. A total of 30 levels were decompressed, with 18 patients (60%) undergoing decompression at L4-L5, 9 at L5-S1 (30%), 2 at L3-L4 (6.7%), and 1 at L2-L3 (3.3%). Mean estimated blood loss was 27 ± 15 mL per level. Mean operative duration was 48 ± 12 minutes/level. Visual analog scale leg score improved from 7.7 ± 1 to 1.8 ± 0.8 (P < 0.0001). Oswestry Disability Index improved from 64.4 ± 5.8 to 21 ± 4.5 (P < 0.0001). Mean follow-up of the study was 13.7 ± 2.7 months. According to the MacNab criteria, 10 patients (38.5%) had good results, 14 patients (53.8%) had excellent results, and 2 patients (7.7%) had fair results. One patient required revision surgery. Facet-preserving contralateral foraminotomy and lateral recess decompression with PECILF is effective for treatment of lateral recess and foraminal stenosis. Thorough decompression with acceptable early clinical outcomes and minimal perioperative morbidity can be obtained with the contralateral endoscopic approach. Copyright © 2017 Elsevier Inc. All rights reserved.

Two-year analysis for predicting renal function and contralateral hypertrophy after robot-assisted partial nephrectomy: A three-dimensional segmentation technology study.

PubMed

Kim, Dae Keun; Jang, Yujin; Lee, Jaeseon; Hong, Helen; Kim, Ki Hong; Shin, Tae Young; Jung, Dae Chul; Choi, Young Deuk; Rha, Koon Ho

2015-12-01

To analyze long-term changes in both kidneys, and to predict renal function and contralateral hypertrophy after robot-assisted partial nephrectomy. A total of 62 patients underwent robot-assisted partial nephrectomy, and renal parenchymal volume was calculated using three-dimensional semi-automatic segmentation technology. Patients were evaluated within 1 month preoperatively, and postoperatively at 6 months, 1 year and continued up to 2-year follow up. Linear regression models were used to identify the factors predicting variables that correlated with estimated glomerular filtration rate changes and contralateral hypertrophy 2 years after robot-assisted partial nephrectomy. The median global estimated glomerular filtration rate changes were -10.4%, -11.9%, and -2.4% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The ipsilateral kidney median parenchymal volume changes were -24%, -24.4%, and -21% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The contralateral renal volume changes were 2.3%, 9.6% and 12.9%, respectively. On multivariable linear analysis, preoperative estimated glomerular filtration rate was the best predictive factor for global estimated glomerular filtration rate change on 2 years post-robot-assisted partial nephrectomy (B -0.452; 95% confidence interval -0.84 to -0.14; P = 0.021), whereas the parenchymal volume loss rate (B -0.43; 95% confidence interval -0.89 to -0.15; P = 0.017) and tumor size (B 5.154; 95% confidence interval -0.11 to 9.98; P = 0.041) were the significant predictive factors for the degree of contralateral renal hypertrophy on 2 years post-robot-assisted partial nephrectomy. Preoperative estimated glomerular filtration rate significantly affects post-robot-assisted partial nephrectomy renal function. Renal mass size and renal parenchyma volume loss correlates with compensatory hypertrophy of the contralateral kidney. Contralateral hypertrophy of the renal parenchyma compensates for the functional loss of the ipsilateral kidney. © 2015 The Japanese Urological Association.

Central masking with bilateral cochlear implants

PubMed Central

Lin, Payton; Lu, Thomas; Zeng, Fan-Gang

2013-01-01

Across bilateral cochlear implants, contralateral threshold shift has been investigated as a function of electrode difference between the masking and probe electrodes. For contralateral electric masking, maximum threshold elevations occurred when the position of the masker and probe electrode was approximately place-matched across ears. The amount of masking diminished with increasing masker-probe electrode separation. Place-dependent masking occurred in both sequentially implanted ears, and was not affected by the masker intensity or the time delay from the masker onset. When compared to previous contralateral masking results in normal hearing, the similarities between place-dependent central masking patterns suggest comparable mechanisms of overlapping excitation in the central auditory nervous system. PMID:23363113

Automatic gain control of neural coupling during cooperative hand movements.

PubMed

Thomas, F A; Dietz, V; Schrafl-Altermatt, M

2018-04-13

Cooperative hand movements (e.g. opening a bottle) are controlled by a task-specific neural coupling, reflected in EMG reflex responses contralateral to the stimulation site. In this study the contralateral reflex responses in forearm extensor muscles to ipsilateral ulnar nerve stimulation was analyzed at various resistance and velocities of cooperative hand movements. The size of contralateral reflex responses was closely related to the level of forearm muscle activation required to accomplish the various cooperative hand movement tasks. This indicates an automatic gain control of neural coupling that allows a rapid matching of corrective forces exerted at both sides of an object with the goal 'two hands one action'.

Lumbar disc herniation presenting with contralateral symptoms: a case report

PubMed Central

Koh, Zhi Sheng Darren; Lin, Shuxun

2017-01-01

Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy. PMID:28435926

Lumbar disc herniation presenting with contralateral symptoms: a case report.

PubMed

Koh, Zhi Sheng Darren; Lin, Shuxun; Hey, Hwee Weng Dennis

2017-03-01

Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy.

Dose to the contralateral breast: a comparison of two techniques using the enhanced dynamic wedge versus a standard wedge.

PubMed

Warlick, W B; O'Rear, J H; Earley, L; Moeller, J H; Gaffney, D K; Leavitt, D D

1997-01-01

The dose to the contralateral breast has been associated with an increased risk of developing a second breast malignancy. Varying techniques have been devised and described in the literature to minimize this dose. Metal beam modifiers such as standard wedges are used to improve the dose distribution in the treated breast, but unfortunately introduce an increased scatter dose outside the treatment field, in particular to the contralateral breast. The enhanced dynamic wedge is a means of remote wedging created by independently moving one collimator jaw through the treatment field during dose delivery. This study is an analysis of differing doses to the contralateral breast using two common clinical set-up techniques with the enhanced dynamic wedge versus the standard metal wedge. A tissue equivalent block (solid water), modeled to represent a typical breast outline, was designed as an insert in a Rando phantom to simulate a standard patient being treated for breast conservation. Tissue equivalent material was then used to complete the natural contour of the breast and to reproduce appropriate build-up and internal scatter. Thermoluminescent dosimeter (TLD) rods were placed at predetermined distances from the geometric beam's edge to measure the dose to the contralateral breast. A total of 35 locations were used with five TLDs in each location to verify the accuracy of the measured dose. The radiation techniques used were an isocentric set-up with co-planar, non divergent posterior borders and an isocentric set-up with a half beam block technique utilizing the asymmetric collimator jaw. Each technique used compensating wedges to optimize the dose distribution. A comparison of the dose to the contralateral breast was then made with the enhanced dynamic wedge vs. the standard metal wedge. The measurements revealed a significant reduction in the contralateral breast dose with the enhanced dynamic wedge compared to the standard metal wedge in both set-up techniques. The dose was measured at varying distances from the geometric field edge, ranging from 2 to 8 cm. The average dose with the enhanced dynamic wedge was 2.7-2.8%. The average dose with the standard wedge was 4.0-4.7%. Thermoluminescent dosimeter measurements suggest an increase in both scattered electrons and photons with metal wedges. The enhanced dynamic wedge is a practical clinical advance which improves the dose distribution in patients undergoing breast conservation while at the same time minimizing dose to the contralateral breast, thereby reducing the potential carcinogenic effects.

Chronic In Vivo Imaging Shows No Evidence of Dendritic Plasticity or Functional Remapping in the Contralesional Cortex after Stroke

PubMed Central

Johnston, David G.; Denizet, Marie; Mostany, Ricardo

2013-01-01

Most stroke survivors exhibit a partial recovery from their deficits. This presumably occurs because of remapping of lost capabilities to functionally related brain areas. Functional brain imaging studies suggest that remapping in the contralateral uninjured cortex might represent a transient stage of compensatory plasticity. Some postmortem studies have also shown that cortical lesions, including stroke, can trigger dendritic plasticity in the contralateral hemisphere, but the data are controversial. We used longitudinal in vivo two-photon microscopy in the contralateral homotopic cortex to record changes in dendritic spines of layer 5 pyramidal neurons in green fluorescent protein mice. We could not detect de novo growth of dendrites or changes in the density or turnover of spines for up to 4 weeks after stroke. We also used intrinsic optical signal imaging to investigate whether the forepaw (FP) sensory representation is remapped to the spared homotopic cortex after stroke. Stimulation of the contralateral FP reliably produced strong intrinsic signals in the spared hemisphere, but we could never detect a signal with ipsilateral FP stimulation after stroke. This lack of contralateral plasticity at the level of apical dendrites of layer 5 pyramidal neurons and FP sensory maps suggests that the contralesional cortex may not contribute to functional recovery after stroke and that, at least in mice, the peri-infarct cortex plays the dominant role in postischemic plasticity. PMID:22499800

Cervical sympathetic block prolongs the latency and reduces the amplitude of trigeminal somatosensory evoked potentials on the contralateral side.

PubMed

Kawaguchi, Jun; Matsuura, Nobuyuki; Kasahara, Masataka; Ichinohe, Tatsuya

2015-02-01

The purpose of this study was to investigate the latency and amplitude of trigeminal somatosensory evoked potentials to clarify how nerve function on the contralateral side is affected after cervical sympathetic block (CSB). Subjects comprised 16 volunteers. For CSB, the tip of a needle was contacted with the transverse process of the sixth cervical vertebra on the right side, and lidocaine was injected. Trigeminal somatosensory evoked potentials were recorded bilaterally from C5/C6 scalp positions. Pupil diameters were also measured. Electrical stimulations were applied to the left-side lower lip, and trigeminal somatosensory evoked potentials waveforms derived from both sides of the scalp were recorded. Then, electrical stimulations were applied to the right-side of the lower lip, and recording was again performed. Recordings were performed at 5, 15, and 30 minutes after CSB. On the CSB side, pupil diameter decreased at 5 and 15 minutes after CSB. Trigeminal somatosensory evoked potentials at contralateral stimulation showed a prolongation of the latency in both P20 and N25 components on bilateral recording sites 5 and 15 minutes after CSB. Trigeminal somatosensory evoked potentials' amplitude at contralateral stimulation was smaller than at ipsilateral stimulation 5 minutes after CSB. Cervical sympathetic block prolongs the latency and reduces the amplitude of trigeminal somatosensory evoked potentials on the contralateral side.

MMP-2 as an early synovial biomarker for cranial cruciate ligament disease in dogs.

PubMed

Boland, L; Danger, R; Cabon, Q; Rabillard, M; Brouard, S; Bouvy, B; Gauthier, O

2014-01-01

To measure the activity of matrix metalloproteinases (MMP)-2 and -9 in synovial fluid from the stifle joints of dogs with cranial cruciate ligament (CrCL) rupture and to compare that to values from contralateral stifle joints and dogs with clinically normal stifle joints. Additionally, the C-reactive protein (CRP) levels were also measured. Fourteen large breed dogs with unilateral CrCL rupture and 11 large breed normal dogs were included in this prospective clinical study. Synovial fluid was collected from CrCL-ruptured stifle joints, contralateral clinically normal stifle joints of the same dogs, and stifle joints of normal dogs. Serum was also collected. Synovial fluid activities of MMP-2 and MMP-9 and serum CRP level were measured. The MMP-2 activity in synovial fluid was significantly higher in CrCL-ruptured joints compared to contralateral joints and to stifles from normal dogs. There was no significant difference in activity of MMP-2 in contralateral joints of CrCL-ruptured dogs compared to normal dogs. Both serum CRP level and MMP-9 activity did not differ significantly between the studied conditions. It was confirmed that MMP-2 activity is significantly related to CrCL rupture, but there was a failure to demonstrate any significant increase in the contralateral joints compared to the stifle joints of normal dogs. The MMP-2 involvement in progressing CrCL disease still has to be defined.

Chronic in vivo imaging shows no evidence of dendritic plasticity or functional remapping in the contralesional cortex after stroke.

PubMed

Johnston, David G; Denizet, Marie; Mostany, Ricardo; Portera-Cailliau, Carlos

2013-04-01

Most stroke survivors exhibit a partial recovery from their deficits. This presumably occurs because of remapping of lost capabilities to functionally related brain areas. Functional brain imaging studies suggest that remapping in the contralateral uninjured cortex might represent a transient stage of compensatory plasticity. Some postmortem studies have also shown that cortical lesions, including stroke, can trigger dendritic plasticity in the contralateral hemisphere, but the data are controversial. We used longitudinal in vivo two-photon microscopy in the contralateral homotopic cortex to record changes in dendritic spines of layer 5 pyramidal neurons in green fluorescent protein mice. We could not detect de novo growth of dendrites or changes in the density or turnover of spines for up to 4 weeks after stroke. We also used intrinsic optical signal imaging to investigate whether the forepaw (FP) sensory representation is remapped to the spared homotopic cortex after stroke. Stimulation of the contralateral FP reliably produced strong intrinsic signals in the spared hemisphere, but we could never detect a signal with ipsilateral FP stimulation after stroke. This lack of contralateral plasticity at the level of apical dendrites of layer 5 pyramidal neurons and FP sensory maps suggests that the contralesional cortex may not contribute to functional recovery after stroke and that, at least in mice, the peri-infarct cortex plays the dominant role in postischemic plasticity.

Effect of muscle relaxation in the foot on simultaneous muscle contraction in the contralateral hand.

PubMed

Kato, Kouki; Kanosue, Kazuyuki

2016-10-28

We investigated the effects of foot muscle relaxation and contraction on muscle activities in the hand on both ipsilateral and contralateral sides. The subjects sat in an armchair with hands in the pronated position. They were able to freely move their right/left hand and foot. They performed three tasks for both ipsilateral (right hand and right foot) and contralateral limb coordination (left hand and right foot for a total of six tasks). These tasks involved: (1) wrist extension from a flexed (resting) position, (2) wrist extension with simultaneous ankle dorsiflexion from a plantarflexed (resting) position, and (3) wrist extension with simultaneous ankle relaxation from a dorsiflexed position. The subjects performed each task as fast as possible after hearing the start signal. Reaction time for the wrist extensor contraction (i.e. the degree to which it preceded the motor reaction time), as observed in electromyography (EMG), became longer when it was concurrently done with relaxation of the ankle dorsiflexor. Also, the magnitude of EMG activity became smaller, as compared with activity when wrist extensor contraction was done alone or with contraction of the ankle dorsiflexor. These effects were observed not only for the ipsilateral hand, but also for the contralateral hand. Our findings suggest that muscle relaxation in one limb interferes with muscle contraction in both the ipsilateral and contralateral limbs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparison of the inflammatory burden of truly asymptomatic carotid atheroma with atherosclerotic plaques contralateral to symptomatic carotid stenosis: an ultra small superparamagnetic iron oxide enhanced magnetic resonance study

PubMed Central

Tang, Tjun Y; Howarth, Simon P S; Miller, Sam R; Graves, Martin J; U‐King‐Im, Jean‐Marie; Trivedi, Rikin A; Li, Zhi Yong; Walsh, Stewart R; Brown, Andrew P; Kirkpatrick, Peter J; Gaunt, Michael E; Gillard, Jonathan H

2007-01-01

Background Inflammation is a recognised risk factor for the vulnerable atherosclerotic plaque. The aim of this study was to explore whether there is a difference in the degree of magnetic resonance (MR) defined inflammation using ultra small superparamagnetic iron oxide (USPIO) particles within carotid atheroma in completely asymptomatic individuals and the asymptomatic carotid stenosis contralateral to the symptomatic side. Methods 20 symptomatic patients with contralateral disease and 20 completely asymptomatic patients underwent multi‐sequence MR imaging before and 36 h after USPIO infusion. Images were manually segmented into quadrants and signal change in each quadrant was calculated following USPIO administration. Mean signal change was compared across all quadrants in the two groups. Results The mean percentage of quadrants showing signal loss was 53% in the contralateral group compared with 31% in completely asymptomatic individuals (p = 0.025). The mean percentages showing enhancement were 44% and 65%, respectively (p = 0.024). The mean signal difference between the two groups was 8.6% (95% CI 1.6% to 15.6%; p = 0.017). Conclusions Truly asymptomatic plaques seem to demonstrate inflammation but not to the extent of the contralateral asymptomatic stenosis to the symptomatic side. Inflammatory activity may be a significant risk factor in asymptomatic disease. PMID:17578854

Evaluation of the Curative Effect of Umbilical Cord Mesenchymal Stem Cell Therapy for Knee Arthritis in Dogs Using Imaging Technology.

PubMed

Zhang, Bei-Ying; Wang, Bing-Yun; Li, Shao-Chuan; Luo, Dong-Zhang; Zhan, Xiaoshu; Chen, Sheng-Feng; Chen, Zhi-Sheng; Liu, Can-Ying; Ji, Hui-Qin; Bai, Yin-Shan; Li, Dong-Sheng; He, Yang

2018-01-01

The aim of this study was to assess the efficacy of canine umbilical cord mesenchymal stem cells (UC-MSCs) on the treatment of knee osteoarthritis in dogs. Eight dogs were evenly assigned to two groups. The canine model of knee osteoarthritis was established by surgical manipulation of knee articular cartilage on these eight dogs. UC-MSCs were isolated from umbilical cord Wharton's jelly by 0.1% type collagenase I and identified by immunofluorescence staining and adipogenic and osteogenic differentiation in vitro . A suspension of allogeneic UC-MSCs (1 × 10 6 ) and an equal amount of physiological saline was injected into the cavitas articularis in the treated and untreated control groups, respectively, on days 1 and 3 posttreatment. The structure of the canine knee joint was observed by magnetic resonance imaging (MRI), B-mode ultrasonography, and X-ray imaging at the 3rd, 7th, 14th, and 28th days after treatment. Concurrently, the levels of IL-6, IL-7, and TNF- α in the blood of the examined dogs were measured. Moreover, the recovery of cartilage and patella surface in the treated group and untreated group was compared using a scanning electron microscope (SEM) after a 35-day treatment. Results revealed that the isolated cells were UC-MSCs, because they were positive for CD44 and negative for CD34 surface markers, and the cells were differentiated into adipocytes and osteoblasts. Imaging technology showed that as treatment time increased, the high signal in the MRI T2-weighted images decreased, the echo-free space in B ultrasonography images disappeared basically, and the continuous linear hypoechoic region at the trochlear sulcus thickened. On X-ray images, the serrate defect at the ventral cortex of the patella improved, and the low-density gap of the ventral patella and trochlear crest gradually increased in the treated group. On the contrary, the high signal in the MRI T2-weighted images and the echo-free space in B ultrasonography images still increased after a 14-day treatment in the untreated control group, and the linear hypoechoic region was discontinuous. On the X-ray images, there was no improvement in the serrate defect of the ventral cortex of the patella. Results for inflammatory factors showed that the blood levels of IL-6, IL-7, and TNF- α of the untreated control group were significantly higher than those of the treated group ( P < 0.05) 7-14 days posttreatment. The result of SEM showed that the cartilage neogenesis in the treated group had visible neonatal tissue and more irregular arrangement of new tissue fibers than that of the untreated control group. Furthermore, more vacuoles but without collagen fibers were observed in the cartilage of the untreated control group, and the thickness of the neogenetic cartilage in the treated group (65.13 ± 5.29, 65.30 ± 5.83) and the untreated control group (34.27 ± 5.42) showed a significant difference ( P < 0.01). Significantly higher improvement in cartilage neogenesis and recovery was observed in the treated group compared to the untreated control group. The joint fluid and the inflammatory response in the treated group decreased. Moreover, improved recovery in the neogenetic cartilage, damaged skin fascia, and muscle tissue around the joints was more significant in the treated group than in the untreated control group. In conclusion, canine UC-MSCs promote the repair of cartilage and patella injury in osteoarthritis, improve the healing of the surrounding tissues, and reduce the inflammatory response.

Evaluation of the Curative Effect of Umbilical Cord Mesenchymal Stem Cell Therapy for Knee Arthritis in Dogs Using Imaging Technology

PubMed Central

Zhang, Bei-ying; Li, Shao-chuan; Luo, Dong-zhang; Zhan, Xiaoshu; Chen, Sheng-feng; Chen, Zhi-sheng; Liu, Can-ying; Ji, Hui-qin; Bai, Yin-shan; Li, Dong-sheng; He, Yang

2018-01-01

Objective The aim of this study was to assess the efficacy of canine umbilical cord mesenchymal stem cells (UC-MSCs) on the treatment of knee osteoarthritis in dogs. Methods Eight dogs were evenly assigned to two groups. The canine model of knee osteoarthritis was established by surgical manipulation of knee articular cartilage on these eight dogs. UC-MSCs were isolated from umbilical cord Wharton's jelly by 0.1% type collagenase I and identified by immunofluorescence staining and adipogenic and osteogenic differentiation in vitro. A suspension of allogeneic UC-MSCs (1 × 106) and an equal amount of physiological saline was injected into the cavitas articularis in the treated and untreated control groups, respectively, on days 1 and 3 posttreatment. The structure of the canine knee joint was observed by magnetic resonance imaging (MRI), B-mode ultrasonography, and X-ray imaging at the 3rd, 7th, 14th, and 28th days after treatment. Concurrently, the levels of IL-6, IL-7, and TNF-α in the blood of the examined dogs were measured. Moreover, the recovery of cartilage and patella surface in the treated group and untreated group was compared using a scanning electron microscope (SEM) after a 35-day treatment. Results Results revealed that the isolated cells were UC-MSCs, because they were positive for CD44 and negative for CD34 surface markers, and the cells were differentiated into adipocytes and osteoblasts. Imaging technology showed that as treatment time increased, the high signal in the MRI T2-weighted images decreased, the echo-free space in B ultrasonography images disappeared basically, and the continuous linear hypoechoic region at the trochlear sulcus thickened. On X-ray images, the serrate defect at the ventral cortex of the patella improved, and the low-density gap of the ventral patella and trochlear crest gradually increased in the treated group. On the contrary, the high signal in the MRI T2-weighted images and the echo-free space in B ultrasonography images still increased after a 14-day treatment in the untreated control group, and the linear hypoechoic region was discontinuous. On the X-ray images, there was no improvement in the serrate defect of the ventral cortex of the patella. Results for inflammatory factors showed that the blood levels of IL-6, IL-7, and TNF-α of the untreated control group were significantly higher than those of the treated group (P < 0.05) 7–14 days posttreatment. The result of SEM showed that the cartilage neogenesis in the treated group had visible neonatal tissue and more irregular arrangement of new tissue fibers than that of the untreated control group. Furthermore, more vacuoles but without collagen fibers were observed in the cartilage of the untreated control group, and the thickness of the neogenetic cartilage in the treated group (65.13 ± 5.29, 65.30 ± 5.83) and the untreated control group (34.27 ± 5.42) showed a significant difference (P < 0.01). Conclusion Significantly higher improvement in cartilage neogenesis and recovery was observed in the treated group compared to the untreated control group. The joint fluid and the inflammatory response in the treated group decreased. Moreover, improved recovery in the neogenetic cartilage, damaged skin fascia, and muscle tissue around the joints was more significant in the treated group than in the untreated control group. In conclusion, canine UC-MSCs promote the repair of cartilage and patella injury in osteoarthritis, improve the healing of the surrounding tissues, and reduce the inflammatory response. PMID:29861739

Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb.

PubMed

Baril, Donald T; Goodney, Philip P; Robinson, William P; Nolan, Brian W; Stone, David H; Li, YouFu; Cronenwett, Jack L; Schanzer, Andres

2012-08-01

To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P < .0002), and more likely to have had a prior ipsilateral bypass (20% vs 12%; P = .0005). These patients experience increased in-hospital major adverse events, including myocardial infarction (MI; 8.9% vs 4.2%; P = .002), CHF (6.1% vs 3.4%; P = .044), deterioration in renal function (9.0% vs 4.7%; P = .006), and respiratory complications (4.2% vs 2.3%; P = .034). They were less likely to be discharged home (52% vs 72%; P < .0001) and less likely to be ambulatory on discharge (25% vs 55%; P < .0001). Although patients with a prior contralateral amputation experienced increased rates of graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06-2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39-2.68; P < .0001) at 1 year. Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb

PubMed Central

Baril, Donald T.; Goodney, Philip P.; Robinson, William P.; Nolan, Brian W.; Stone, David H.; Li, YouFu; Cronenwett, Jack L.; Schanzer, Andres

2013-01-01

Introduction To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. Methods A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. Results Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P < .0002), and more likely to have had a prior ipsilateral bypass (20% vs 12%; P = .0005). These patients experience increased in-hospital major adverse events, including myocardial infarction (MI; 8.9% vs 4.2%; P = .002), CHF (6.1% vs 3.4%; P = .044), deterioration in renal function (9.0% vs 4.7%; P = .006), and respiratory complications (4.2% vs 2.3%; P = .034). They were less likely to be discharged home (52% vs 72%; P < .0001) and less likely to be ambulatory on discharge (25% vs 55%; P < .0001). Although patients with a prior contralateral amputation experienced increased rates of graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06–2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39–2.68; P < .0001) at 1 year. Conclusions Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation. PMID:22480762

Is the effectiveness of patellofemoral bracing modified by patellofemoral alignment and trochlear morphology?

PubMed

Zhang, Xi; Eyles, Jillian P; Makovey, Joanna; Williams, Matthew J; Hunter, David J

2017-04-21

This study was performed to determine if the effectiveness of patellofemoral bracing as a treatment for patellofemoral osteoarthritis is influenced by patellofemoral joint alignment and trochlear morphology. We hypothesized that those with more extreme patellar malalignment would benefit more from bracing. Thirty-eight patients who had received bracing as part of a comprehensive treatment plan for patellofemoral osteoarthritis were selected for this study. Ten measures of patellar alignment were taken from X-rays. These alignment measures were divided into percentile groups (tertiles) for contingency table analysis. Treatment outcome was measured by Western Ontario and Macmasters Universities Osteoarthritis Index (WOMAC) scores and these were dichotomised into two groups according to "Improved" or "Not Improved" according to the minimum clinically important difference (MCID). Spearman's rho test was performed for continuous variables and Fisher's exact test was performed for correlation between tertile groups and MCID categories. Thirty-eight patients (9 male and 29 female) between the ages of 51 to 89 were included in this study. WOMAC scores ranged from -25 to 41.67, with a mean change of -3.97, 31.6, 44.7 and 31.6% of patients falling into the "Improved" group for Global, Pain and Function scores respectively. We found a non-significant trend shown (p = 0.058, correlation coefficient 0.31) between bisect offset and change in WOMAC global, indicating a trend for higher change in WOMAC scores with increasing bisect offset. Statistically significant correlations were found between mean MCID categories for the WOMAC global and function groups when analysed against percentile groups for bisect offset (p < 0.01) and patellar subluxation distance (p < 0.05), indicating those in higher percentile groups were more likely not to improve after six months. Higher bisect offset and patellar subluxation distance measures were associated with poorer outcomes. However, due to the limited sample size, more studies are required to fully examine this relationship.

Patella Height Correlates With Trochlear Dysplasia: A Computed Tomography Image Analysis.

PubMed

Ferlic, Peter Wilhelm; Runer, Armin; Dammerer, Dietmar; Wansch, Jürgen; Hackl, Wolfgang; Liebensteiner, Michael Christian

2018-06-01

The aim of this study was to investigate the position of the patella relative to the trochlea for a possible correlation with radiologic parameters characterizing the form of the trochlea. The computed tomography scans of 36 cases with patellofemoral instability and 30 without (mean age, 24.7 ± 6.8 years) were studied. The height of the patella relative to the trochlea was evaluated as the distance between the axial slice where the patella (P) showed its widest diameter, as the patella at this level has the greatest potential to form the trochlea, and the proximal entrance of the femoral trochlea (TE). The correlations between this parameter and several radiologic parameters used to evaluate trochlear dysplasia, including trochlea height, transverse trochlea shift, trochlea depth, sulcus angle, lateral and medial trochlea slope, trochlea facet asymmetry, and the Dejour trochlea type, were calculated. The P-TE distance correlated significantly with all trochlea parameters evaluated, with a more dysplastic trochlea in cases of higher position of the patella: medial, central, and lateral trochlea height (0.287

Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance.

PubMed

Graf, Kristin H; Tompkins, Marc A; Agel, Julie; Arendt, Elizabeth A

2018-03-01

An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements. Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient. The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient. The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy. Diagnostic study, Level III.

Repair of full-thickness cartilage defects with cells of different origin in a rabbit model.

PubMed

Yan, Hui; Yu, Changlong

2007-02-01

The purpose of this study was to evaluate the repaired tissues formed in full-thickness cartilage defects in a rabbit model implanted with 4 types of chondrogenic cells, including chondrocytes, mesenchymal stem cells (MSCs) and fibroblasts from rabbit, and human umbilical cord blood (hUCB) stem cells. Chondrocytes, MSCs, and fibroblasts were isolated from 6-week-old New Zealand rabbits; hUCB stem cells were isolated from the umbilical cord blood of newborn children. These 4 types of cells were cultured in vitro and embedded in polylactic acid (PLA) matrices. Full-thickness defects were produced in the femoral trochlear grooves of both knees in 36 adult New Zealand White rabbits. Cell/PLA composites were transplanted into cartilage defects. A total of 5 groups were formed according to implanted cell type: Group A, chondrocytes; Group B, MSCs; Group C, fibroblasts; Group D, hUCB stem cells; and Group E, no cells (control group). Repaired tissues were evaluated grossly, histologically, and immunohistochemically at 6 weeks and 12 weeks after implantation. In Groups A and B, defects were repaired with hyaline-like cartilage. In Group C, defects were repaired with fibrous tissue. In Group D, defects were repaired primarily with fibrous tissue and scattered chondrocytes; in some specimens, defects were repaired with a thin layer of hyaline-like cartilage at 12 weeks. In Group E, defects were repaired with fibrous tissue. Histologic scores in Groups A and B were significantly higher than those in Groups C, D, and E at 6 and 12 weeks after transplantation. Full-thickness cartilage defects treated with chondrocyte or MSC transplantation were repaired with hyaline-like cartilage tissue, and repair was significantly better than in tissues treated with fibroblasts and hUCB stem cells, as well as in the control group. Repaired tissues treated with MSCs appeared to have better cell arrangement, subchondral bone remodeling, and integration with surrounding cartilage than did repaired tissues generated by chondrocyte implantation. MSCs might be the most suitable cell source for cartilage repair. Further investigation into hUCB stem cell transplantation is needed. In our study of rabbits, MSCs supplied the most promising cell source for cartilage repair.

Foveational Complexity in Single Word Identification: Contralateral Visual Pathways Are Advantaged over Ipsilateral Pathways

ERIC Educational Resources Information Center

Obregon, Mateo; Shillcock, Richard

2012-01-01

Recognition of a single word is an elemental task in innumerable cognitive psychology experiments, but involves unexpected complexity. We test a controversial claim that the human fovea is vertically divided, with each half projecting to either the contralateral or ipsilateral hemisphere, thereby influencing foveal word recognition. We report a…

Combined Electric and Contralateral Acoustic Hearing: Word and Sentence Recognition with Bimodal Hearing

ERIC Educational Resources Information Center

Gifford, Rene H.; Dorman, Michael F.; McKarns, Sharon A.; Spahr, Anthony J.

2007-01-01

Purpose: The authors assessed whether (a) a full-insertion cochlear implant would provide a higher level of speech understanding than bilateral low-frequency acoustic hearing, (b) contralateral acoustic hearing would add to the speech understanding provided by the implant, and (c) the level of performance achieved with electric stimulation plus…

Diversity of bilateral synaptic assemblies for binaural computation in midbrain single neurons.

PubMed

He, Na; Kong, Lingzhi; Lin, Tao; Wang, Shaohui; Liu, Xiuping; Qi, Jiyao; Yan, Jun

2017-11-01

Binaural hearing confers many beneficial functions but our understanding of its underlying neural substrates is limited. This study examines the bilateral synaptic assemblies and binaural computation (or integration) in the central nucleus of the inferior colliculus (ICc) of the auditory midbrain, a key convergent center. Using in-vivo whole-cell patch-clamp, the excitatory and inhibitory postsynaptic potentials (EPSPs/IPSPs) of single ICc neurons to contralateral, ipsilateral and bilateral stimulation were recorded. According to the contralateral and ipsilateral EPSP/IPSP, 7 types of bilateral synaptic assemblies were identified. These include EPSP-EPSP (EE), E-IPSP (EI), E-no response (EO), II, IE, IO and complex-mode (CM) neurons. The CM neurons showed frequency- and/or amplitude-dependent EPSPs/IPSPs to contralateral or ipsilateral stimulation. Bilateral stimulation induced EPSPs/IPSPs that could be larger than (facilitation), similar to (ineffectiveness) or smaller than (suppression) those induced by contralateral stimulation. Our findings have allowed our group to characterize novel neural circuitry for binaural computation in the midbrain. Copyright © 2017 Elsevier B.V. All rights reserved.

Contribution of a contralateral hearing aid to perception of consonant voicing, intonation, and emotional state in adult cochlear implantees.

PubMed

Most, Tova; Gaon-Sivan, Gal; Shpak, Talma; Luntz, Michal

2012-01-01

Binaural hearing in cochlear implant (CI) users can be achieved either by bilateral implantation or bimodally with a contralateral hearing aid (HA). Binaural-bimodal hearing has the advantage of complementing the high-frequency electric information from the CI by low-frequency acoustic information from the HA. We examined the contribution of a contralateral HA in 25 adult implantees to their perception of fundamental frequency-cued speech characteristics (initial consonant voicing, intonation, and emotions). Testing with CI alone, HA alone, and bimodal hearing showed that all three characteristics were best perceived under the bimodal condition. Significant differences were recorded between bimodal and HA conditions in the initial voicing test, between bimodal and CI conditions in the intonation test, and between both bimodal and CI conditions and between bimodal and HA conditions in the emotion-in-speech test. These findings confirmed that such binaural-bimodal hearing enhances perception of these speech characteristics and suggest that implantees with residual hearing in the contralateral ear may benefit from a HA in that ear.

Foxg1 regulates retinal axon pathfinding by repressing an ipsilateral program in nasal retina and by causing optic chiasm cells to exert a net axonal growth-promoting activity.

PubMed

Tian, Natasha M; Pratt, Thomas; Price, David J

2008-12-01

Mammalian binocular vision relies on the divergence of retinal ganglion cell axons at the optic chiasm, with strictly controlled numbers projecting contralaterally and ipsilaterally. In mouse, contralateral projections arise from the entire retina, whereas ipsilateral projections arise from ventrotemporal retina. We investigate how development of these patterns of projection is regulated by the contralateral determinant Foxg1, a forkhead box transcription factor expressed in nasal retina and at the chiasm. In nasal retina, loss of Foxg1 causes increased numbers of ipsilateral projections and ectopic expression of the ipsilateral determinants Zic2, Ephb1 and Foxd1, indicating that nasal retina is competent to express an ipsilateral program that is normally suppressed by Foxg1. Using co-cultures that combine Foxg1-expressing with Foxg1-null retinal explants and chiasm cells, we provide functional evidence that Foxg1 promotes contralateral projections through actions in nasal retina, and that in chiasm cells, Foxg1 is required for the generation of a hitherto unrecognized activity supporting RGC axon growth.

Epithelial atypia in biopsies performed for microcalcifications. Practical considerations about 2,833 serially sectioned surgical biopsies with a long follow-up

PubMed Central

MacGrogan, Gaëtan; Mathoulin-Pélissier, Simone; Vincent-Salomon, Anne; Soubeyran, Isabelle; Picot, Véronique; Coindre, Jean-Michel; Mauriac, Louis

2007-01-01

This study analyzes the occurrence of epithelial atypia in 2,833 serially sectioned surgical breast biopsies (SB) performed for microcalcifications (median number of blocks per SB:26) and the occurrence of subsequent cancer after an initial diagnosis of epithelial atypia (median follow-up 160 months). Epithelial atypia (flat epithelial atypia, atypical ductal hyperplasia, and lobular neoplasia) were found in 971 SB, with and without a concomitant cancer in 301 (31%) and 670 (69%) SB, respectively. Thus, isolated epithelial atypia were found in 670 out of the 2,833 SB (23%). Concomitant cancers corresponded to ductal carcinomas in situ and micro-invasive (77%), invasive ductal carcinomas not otherwise specified (15%), invasive lobular carcinomas (4%), and tubular carcinomas (4%). Fifteen out of the 443 patients with isolated epithelial atypia developed a subsequent ipsilateral (n = 14) and contralateral (n = 1) invasive cancer. The high slide rating might explain the high percentages of epithelial atypia and concomitant cancers and the low percentage of subsequent cancer after a diagnosis of epithelial atypia as a single lesion. Epithelial atypia could be more a risk marker of concomitant than subsequent cancer. PMID:17551752

Epithelial atypia in biopsies performed for microcalcifications. practical considerations about 2,833 serially sectioned surgical biopsies with a long follow-up.

PubMed

de Mascarel, Isabelle; MacGrogan, Gaëtan; Mathoulin-Pélissier, Simone; Vincent-Salomon, Anne; Soubeyran, Isabelle; Picot, Véronique; Coindre, Jean-Michel; Mauriac, Louis

2007-07-01

This study analyzes the occurrence of epithelial atypia in 2,833 serially sectioned surgical breast biopsies (SB) performed for microcalcifications (median number of blocks per SB:26) and the occurrence of subsequent cancer after an initial diagnosis of epithelial atypia (median follow-up 160 months). Epithelial atypia (flat epithelial atypia, atypical ductal hyperplasia, and lobular neoplasia) were found in 971 SB, with and without a concomitant cancer in 301 (31%) and 670 (69%) SB, respectively. Thus, isolated epithelial atypia were found in 670 out of the 2,833 SB (23%). Concomitant cancers corresponded to ductal carcinomas in situ and micro-invasive (77%), invasive ductal carcinomas not otherwise specified (15%), invasive lobular carcinomas (4%), and tubular carcinomas (4%). Fifteen out of the 443 patients with isolated epithelial atypia developed a subsequent ipsilateral (n = 14) and contralateral (n = 1) invasive cancer. The high slide rating might explain the high percentages of epithelial atypia and concomitant cancers and the low percentage of subsequent cancer after a diagnosis of epithelial atypia as a single lesion. Epithelial atypia could be more a risk marker of concomitant than subsequent cancer.

Lateral Patellar Instability in the Skeletally Mature Patient: Evaluation and Surgical Management.

PubMed

Diduch, David R; Kandil, Abdurrahman; Burrus, M Tyrrell

2018-05-18

Lateral patellar instability is a common disease process that affects all types of patients. Depending on the patient's anatomy and the results of preoperative imaging, surgical management options include medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and sulcus-deepening trochleoplasty. Medial patellofemoral ligament reconstruction or repair is useful for almost all patients, whereas tibial tubercle osteotomy is helpful to correct a lateralized tibial tubercle and the associated elevated lateral pull of the extensor mechanism. For a select subset of patients with severe trochlear dysplasia, a sulcus-deepening trochleoplasty can be a useful option to prevent future patellar instability. Many technical considerations exist for each procedure, and in most situations, no consensus exists to direct surgeons on the superior technique.

The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

PubMed Central

Fuss, F K

1991-01-01

The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

Severe complication during strabismus surgery.

PubMed

García de Oteyza, J; García de Oteyza, G

2016-04-01

A 4-year-old patient, who presented with an immediate orbital haematoma as a result of a subtenon injection of triamcinolone in the trochlear region of the right eye on finishing a surgical procedure for Brown's syndrome. After one week, when it could be examined better, the presence of a cherry red spot was observed due to the embolisation of the central artery of the retina by triamcinolone crystals. Triamcinolone is an anti-inflammatory drug currently used in Ophthalmology for the treatment of various conditions. Although exceptional, it has been described that its use may provoke embolisations due to the entry of the steroid into the circulation. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

A combined technique for acromioclavicular reconstruction after acute dislocation - technical description and functional outcomes.

PubMed

Moura, Diogo Lino; Reis E Reis, Augusto; Ferreira, João; Capelão, Manuel; Braz Cardoso, José

2018-01-01

This study aims to describe the surgical approach to such injuries and to present the clinical and functional outcomes obtained in a cohort of patients. This is an observational retrospective study that included 153 patients with acute acromioclavicular joint dislocation, operated between 1999 and 2015. Clinical evaluation included the following outcomes: Constant functional scale, development of complications, time to return to previous work/sport activities, and satisfaction index. The contra-lateral (uninjured) shoulder was used as control in subjective outcomes. Radiological evaluation was performed in order to monitor signs of loss of reduction, degenerative joint changes, and coracoclavicular calcifications. The mean age was 29.20 ± 9.53 (16-71), with a large male predominance (91.5%). Follow-up lasted 55.41 ± 24.87 (12-108) months. The mean Constant score attained was 96.45 ± 4.00 (84-100) on operated shoulders and 98.28 ± 1.81 (93-100) on contralateral ones. Almost all patients (98.69%) were satisfied with the surgical results. Worse outcomes were observed in acromioclavicular joint dislocations of increasing grade (from type III to V, but worse for type IV), both concerning the Constant score and return to work or sport. The overall incidence of complications was considered low, with the most prevalent being Kirschner wire failure and isolated coracoclavicular ligament calcifications. The surgical technique described is an excellent option in the treatment of acute acromioclavicular joint dislocations of Rockwood grades III to V. This is corroborated by the excellent clinical and functional outcomes and the low rate of complications.

The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study

PubMed Central

Wahab, Suzaily; Abdul Rahman, Abdul Hamid; Sidek, Dinsuhaimi; Zakaria, Mohd. Normani

2016-01-01

Objective Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. Methods Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. Results We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). Conclusion The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients. PMID:26766950

Decreased contralateral breast volume after mastectomy, adjuvant chemotherapy, and anti-estrogen therapy, in particular in breasts with high density.

PubMed

Ishii, Naohiro; Ando, Jiro; Harao, Michiko; Takemae, Masaru; Kishi, Kazuo

2017-10-01

Adjuvant chemotherapy and anti-estrogenic therapy can result in decreased volume of the contralateral breast, following mastectomy for the treatment of breast cancer. However, no data on the effect of adjuvant therapy on contralateral breast volume have previously been reported. We aimed to evaluate the extent to which adjuvant therapy and differences in breast density contribute to decreased breast volume. We conducted a prospective cohort study, selecting 40 nonconsecutive patients who underwent immediate breast reconstruction with mastectomy and expander insertion followed by expander replacement. We measured the contralateral breast volume before each procedure. The extent of the change was analyzed with respect to adjuvant therapy and breast density measured by preoperative mammography. The greatest decrease in breast volume was 135.1 cm 3 . The decrease in breast volume was significantly larger in the adjuvant therapy (+) group, particularly in patients with high breast density, than in the adjuvant therapy (-) group. Significant differences between the chemotherapy (+), tamoxifen (+) group and the chemotherapy (-), tamoxifen (+) group were not found. Breast density scores had a range of 2.0-3.3 (mean: 2.8). In breast reconstruction, particularly when performed in one stage, preoperative mammography findings are valuable to plastic surgeons, and possible decreases in the contralateral breast volume due to adjuvant therapy, particularly in patients with high breast density, should be considered carefully. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Contralateral suppression of transient-evoked otoacoustic emissions in children with sickle cell disease.

PubMed

Stuart, Andrew; Preast, June L

2012-01-01

In previous studies, otoacoustic emissions (OAEs) have been found to be larger in normal-hearing children with sickle cell disease (SCD). It was hypothesized that some dysfunction or reduction in the medial olivocochlear efferent suppression of outer hair cell activity was responsible for this phenomenon. To test this hypothesis, contralateral suppression of transient-evoked otoacoustic emissions (TEOAEs) was examined in children with and without SCD. Thirteen African American school-aged normal-hearing children with homozygous SCD and 13 age- and gender-matched control children participated. TEOAEs were obtained bilaterally with 80 dB peSPL nonlinear click stimuli. To examine contralateral suppression, TEOAEs were obtained with 60 dB peSPL linear click stimuli with and without a contralateral 65 dB SPL white noise suppressor. Overall and half-octave band TEOAE levels were found to be larger in children with SCD relative to the normal control children (p < 0.05), consistent with previous reports of increased OAE levels. There was no significant difference (p > 0.05) in the absolute or proportional amount of TEOAE suppression as a function of group and ear. There were also no significant correlations or linear predictive relationships between TEOAE suppression and TEOAE level for either ear or group (p > 0.05). These findings do not support the notion that increased OAE levels in children with SCD are a consequence of abnormal medial olivocochlear system function as assessed with contralateral suppression of TEOAEs.

Severe ipsilateral carotid stenosis and middle cerebral artery disease in lacunar ischaemic stroke: innocent bystanders?

PubMed

Mead, G E; Lewis, S C; Wardlaw, J M; Dennis, M S; Warlow, C P

2002-03-01

Lacunar infarcts are thought to be mostly due to intracranial small vessel disease. Therefore, when a stroke patient with a relevant lacunar infarct does have severe ipsilateral internal carotid artery (ICA) or middle cerebral artery (MCA) disease, it is unclear whether the arterial disease is causative or coincidental. If causative, we would expect ICA/MCA disease to be more severe on the symptomatic side than on the asymptomatic side. Therefore, our aim was to compare the severity of ipsilateral with contralateral ICA and MCA disease in patients with lacunar ischaemic stroke. We studied 259 inpatients and outpatients with a recent lacunar ischaemic stroke and no other prior stroke. We used carotid Duplex ultrasound and transcranial Doppler (TCD) ultrasound to identify ICA and MCA disease, and compared our results with previously published data. In our study, there was no difference between the severity of ipsilateral and contralateral ICA stenosis within individuals (median difference 0%, Wilcoxon paired data p=0.24, comparing severity of ipsilateral and contralateral stenosis). The overall prevalence of severe ipsilateral stenosis was 5%, and the prevalence of severe contralateral stenosis was 4% (OR 1.6, 95% CI 0.6, 4.8). There was no difference in the prevalence of ipsilateral and contralateral MCA disease. A systematic review of the other available studies strengthened this conclusion. Carotid stenosis in patients with a lacunar ischaemic stroke may be coincidental. Further studies are required to elucidate the causes of lacunar stroke, and to evaluate the role of carotid endarterectomy.

Perilesional and contralateral white matter evolution and integrity in patients with periventricular nodular heterotopia and epilepsy: a longitudinal diffusion tensor imaging study.

PubMed

Liu, W; Yan, B; An, D; Niu, R; Tang, Y; Tong, X; Gong, Q; Zhou, D

2017-12-01

This study aimed to assess the evolution of perinodular and contralateral white matter abnormalities in patients with periventricular nodular heterotopia (PNH) and epilepsy. Diffusion tensor imaging (DTI) (64 directions) and 3 T structural magnetic resonance imaging were performed in 29 PNH patients (mean age 27.3 years), and 16 patients underwent a second scan (average time between the two scans 1.1 years). Fractional anisotropy and mean diffusivity were measured within the perilesional and contralateral white matter. Longitudinal analysis showed that white matter located 10 mm from the focal nodule displayed characteristics intermediate to tissue 5 mm away, and normal-appearing white matter (NAWM) also established evolution profiles of perinodular white matter in different cortical lobes. Compared to 29 age- and sex-matched healthy controls, significant decreased fractional anisotropy and elevated mean diffusivity values were observed in regions 5 and 10 mm from nodules (P < 0.01), whilst DTI metrics of the remaining NAWM did not differ significantly from controls. Additionally, normal DTI metrics were shown in the contralateral region in patients with unilateral PNH. Periventricular nodular heterotopia is associated with microstructural abnormalities within the perilesional white matter and the extent decreases with increasing distance from the nodule. In the homologous contralateral region, white matter diffusion metrics were unchanged in unilateral PNH. These findings have clinical implications with respect to the medical and surgical interventions of PNH-related epilepsy. © 2017 EAN.

The critical role of the external carotid artery in cerebral perfusion of patients with total occlusion of the internal carotid artery.

PubMed

Dalainas, I; Avgerinos, E D; Daskalopoulos, M E; Papapetrou, A; Papasideris, C P; Katsikas, V; Xiromeritis, K; Moulakakis, K; Gianakopoulos, T; Liapis, C D

2012-02-01

The ipsilateral external carotid artery (ECA) can potentially provide an important collateral pathway for cerebral blood flow in the presence of occlusion or severe stenosis of the internal carotid artery (ICA), recovering up to 15% of the middle cerebral arterial flow. The aim of the study is to elucidate the role of ECA in cerebral flow of patients with total ICA occlusion. Retrospective study of prospectively collected data of 139 patients with total ICA occlusions. The patients were divided to symptomatic and asymptomatic and were categorized in four subgroups according to the stenosis rates: A) ipsilateral ECA<70% and contralateral internal carotid artery stenosis <70%; B) ipsilateral ECA stenosis <70% and contralateral internal carotid artery stenosis ≥70%; C) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis <70%; D) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis ≥75%. Fifty eight (41.7%) patients were asymptomatic. The highest rate (48.2%) of asymptomatic patients was in Group A. Among patients with strokes, the highest rate belonged in groups C and D (44.4% and 50% respectively) where ipsilateral ECA stenosis was ≥70% irrespectively of the contralateral ICA patency. Ipsilateral external carotid artery stenosis ≥70% proved to be and independent risk factor for symptom presentation (P=0.013). The study reveals the significant role of ECA patency in cerebral flow in patients with ICA occlusion.

Blood-Brain Barrier Alterations Provide Evidence of Subacute Diaschisis in an Ischemic Stroke Rat Model

PubMed Central

Garbuzova-Davis, Svitlana; Rodrigues, Maria C. O.; Hernandez-Ontiveros, Diana G.; Tajiri, Naoki; Frisina-Deyo, Aric; Boffeli, Sean M.; Abraham, Jerry V.; Pabon, Mibel; Wagner, Andrew; Ishikawa, Hiroto; Shinozuka, Kazutaka; Haller, Edward; Sanberg, Paul R.; Kaneko, Yuji; Borlongan, Cesario V.

2013-01-01

Background Comprehensive stroke studies reveal diaschisis, a loss of function due to pathological deficits in brain areas remote from initial ischemic lesion. However, blood-brain barrier (BBB) competence in subacute diaschisis is uncertain. The present study investigated subacute diaschisis in a focal ischemic stroke rat model. Specific focuses were BBB integrity and related pathogenic processes in contralateral brain areas. Methodology/Principal Findings In ipsilateral hemisphere 7 days after transient middle cerebral artery occlusion (tMCAO), significant BBB alterations characterized by large Evans Blue (EB) parenchymal extravasation, autophagosome accumulation, increased reactive astrocytes and activated microglia, demyelinization, and neuronal damage were detected in the striatum, motor and somatosensory cortices. Vascular damage identified by ultrastuctural and immunohistochemical analyses also occurred in the contralateral hemisphere. In contralateral striatum and motor cortex, major ultrastructural BBB changes included: swollen and vacuolated endothelial cells containing numerous autophagosomes, pericyte degeneration, and perivascular edema. Additionally, prominent EB extravasation, increased endothelial autophagosome formation, rampant astrogliosis, activated microglia, widespread neuronal pyknosis and decreased myelin were observed in contralateral striatum, and motor and somatosensory cortices. Conclusions/Significance These results demonstrate focal ischemic stroke-induced pathological disturbances in ipsilateral, as well as in contralateral brain areas, which were shown to be closely associated with BBB breakdown in remote brain microvessels and endothelial autophagosome accumulation. This microvascular damage in subacute phase likely revealed ischemic diaschisis and should be considered in development of treatment strategies for stroke. PMID:23675488

Survival and contralateral breast cancer in CHEK2 1100delC breast cancer patients: impact of adjuvant chemotherapy.

PubMed

Kriege, M; Hollestelle, A; Jager, A; Huijts, P E A; Berns, E M; Sieuwerts, A M; Meijer-van Gelder, M E; Collée, J M; Devilee, P; Hooning, M J; Martens, J W M; Seynaeve, C

2014-08-26

We assessed the sensitivity to adjuvant chemotherapy in cell cycle checkpoint kinase 2 (CHEK2) vs non-CHEK2 breast cancer patients by comparing the contralateral breast cancer incidence and distant disease-free and breast cancer-specific survival between both groups, stratified for adjuvant chemotherapy. One Dutch hereditary non-BRCA1/2 breast cancer patient cohort (n=1220) and two Dutch cohorts unselected for family history (n=1014 and n=2488, respectively) were genotyped for CHEK2 1100delC. Hazard ratios for contralateral breast cancer, distant disease-free and breast cancer-specific death for mutation carriers vs noncarriers were calculated using the Cox proportional hazard method, stratified for adjuvant chemotherapy. The CHEK2 mutation carriers (n=193) had an increased incidence of contralateral breast cancer (multivariate hazard ratio 3.97, 95% confidence interval 2.59-6.07). Distant disease-free and breast cancer-specific survival were similar in the first 6 years in mutation carriers compared with noncarriers, but diverted as of 6 years after breast cancer diagnosis (multivariate hazard ratios and 95% confidence intervals 2.65 (1.79-3.93) and 2.05 (1.41-2.99), respectively). No significant interaction between CHEK2 and adjuvant chemotherapy was observed. The CHEK2 1100delC-associated breast cancer is associated with a higher contralateral breast cancer rate as well as worse survival measures beyond 6 years after diagnosis. No differential sensitivity to adjuvant chemotherapy was observed in CHEK2 patients.

Separating the contributions of olivocochlear and middle ear muscle reflexes in modulation of distortion product otoacoustic emission levels.

PubMed

Wolter, Nikolaus E; Harrison, Robert V; James, Adrian L

2014-01-01

Mediated by the medial olivocochlear system (MOCS), distortion product otoacoustic emission (DPOAE) levels are reduced by presentation of contralateral acoustic stimuli. Such acoustic signals can also evoke a middle ear muscle reflex (MEMR) that also attenuates recorded DPOAE levels. Our aim is to clearly differentiate these two inhibitory mechanisms and to analyze each separately, perhaps allowing the development of novel tests of hearing function. DPOAE were recorded in real time from chinchillas with normal auditory brainstem response thresholds and middle ear function. Amplitude reduction and its onset latency caused by contralateral presentation of intermittent narrow-band noise (NBN) were measured. Stapedius and tensor tympani muscle tendons were divided without disturbing the ossicular chain, and DPOAE testing was repeated. Peak reduction of (2f1 - f2) DPOAE levels occurred when the center frequency of contralateral NBN approximated the primary tone f2, indicating an f2-frequency-specific response. For a 4.5-kHz centered NBN, DPOAE (f2 = 4.4 kHz) inhibition was 0.1 dB (p < 0.001). This response remained present after tendon division, consistent with an MOCS origin. Low-frequency NBN (center frequency: 0.5 kHz) reduced otoacoustic emission levels (0.1 dB, p < 0.001) across a wide range of DPOAE frequencies. This low-frequency response was abolished by division of the middle ear muscle tendons, clearly indicating MEMR involvement. Following middle ear muscle tendon division, DPOAE inhibition by contralateral stimuli approximating the primary tone f2 persists, whereas responses evoked by lower contralateral frequencies are abolished. This distinguishes the different roles of the MOCS (f2 frequency specific) and MEMR (low frequency only) in contralateral modulation of DPOAE. This analysis helps clarify the pathways involved in an objective test that might have clinical benefit in the testing of neonates.

Contralateral migration of oculomotor neurons is regulated by Slit/Robo signaling.

PubMed

Bjorke, Brielle; Shoja-Taheri, Farnaz; Kim, Minkyung; Robinson, G Eric; Fontelonga, Tatiana; Kim, Kyung-Tai; Song, Mi-Ryoung; Mastick, Grant S

2016-10-22

Oculomotor neurons develop initially like typical motor neurons, projecting axons out of the ventral midbrain to their ipsilateral targets, the extraocular muscles. However, in all vertebrates, after the oculomotor nerve (nIII) has reached the extraocular muscle primordia, the cell bodies that innervate the superior rectus migrate to join the contralateral nucleus. This motor neuron migration represents a unique strategy to form a contralateral motor projection. Whether migration is guided by diffusible cues remains unknown. We examined the role of Slit chemorepellent signals in contralateral oculomotor migration by analyzing mutant mouse embryos. We found that the ventral midbrain expresses high levels of both Slit1 and 2, and that oculomotor neurons express the repellent Slit receptors Robo1 and Robo2. Therefore, Slit signals are in a position to influence the migration of oculomotor neurons. In Slit 1/2 or Robo1/2 double mutant embryos, motor neuron cell bodies migrated into the ventral midbrain on E10.5, three days prior to normal migration. These early migrating neurons had leading projections into and across the floor plate. In contrast to the double mutants, embryos which were mutant for single Slit or Robo genes did not have premature migration or outgrowth on E10.5, demonstrating a cooperative requirement of Slit1 and 2, as well as Robo1 and 2. To test how Slit/Robo midline repulsion is modulated, we found that the normal migration did not require the receptors Robo3 and CXCR4, or the chemoattractant, Netrin 1. The signal to initiate contralateral migration is likely autonomous to the midbrain because oculomotor neurons migrate in embryos that lack either nerve outgrowth or extraocular muscles, or in cultured midbrains that lacked peripheral tissue. Overall, our results demonstrate that a migratory subset of motor neurons respond to floor plate-derived Slit repulsion to properly control the timing of contralateral migration.

Screening for carcinoma in situ in the contralateral testicle in patients with testicular cancer: a population-based study.

PubMed

Kier, M G G; Lauritsen, J; Almstrup, K; Mortensen, M S; Toft, B G; Rajpert-De Meyts, E; Skakkebaek, N E; Rørth, M; von der Maase, H; Agerbaek, M; Holm, N V; Andersen, K K; Dalton, S O; Johansen, C; Daugaard, G

2015-04-01

Screening programmes for contralateral carcinoma in situ (CIS) testis in patients with unilateral germ-cell cancer (GCC) have never been evaluated. We investigated the effect of screening for contralateral CIS in a large nation-wide, population-based study. A contralateral single-site biopsy was offered to 4130 patients in whom GCC had been diagnosed in 1984-2007 (screened cohort); 462 patients in whom GCC was diagnosed in 1984-1988 comprised the unscreened cohort. Cases with CIS were offered radiotherapy. Initially CIS-negative biopsies in patients with metachronous GCC were revised according to today's standards. Risk for metachronous GCC was estimated using cumulative incidence and the Cox proportional hazards model. In the screened cohort, contralateral CIS was found in 181 (4.4%) patients. The cumulative incidence of metachronous GCC after 20 years was 1.9% in the screened cohort and 3.1% in the unscreened cohort (P = 0.097), hazard ratio (HR) for the unscreened cohort: 1.59 (P = 0.144). Expert revision with contemporary methodology of CIS-negative biopsy samples from patients with metachronous cancer revealed CIS in 17 out of 45 (38%) cases. Decreased risks for metachronous GCC were related to older age at diagnosis (HR 0.52 per 10 years, P < 0.001) and chemotherapy (HR 0.35, P = 0.002). Limitations include the small number of patients in the unscreened cohort and the retrospective study design. Our evaluation of a national population-based screening programme for contralateral CIS in patients with testicular cancer showed no significant difference in the risk for metachronous GCC between a screened and an unscreened cohort. Single-site biopsy including modern immunohistochemistry does not identify all cases of CIS. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism.

PubMed

Shariq, Omair A; Bancos, Irina; Cronin, Patricia A; Farley, David R; Richards, Melanie L; Thompson, Geoffrey B; Young, William F; McKenzie, Travis J

2018-01-01

We aimed to determine whether a greater degree of contralateral suppression of aldosterone secretion at adrenal venous sampling predicted the development of postoperative hyperkalemia after unilateral adrenalectomy for primary aldosteronism. A retrospective analysis of patients undergoing unilateral adrenalectomy for primary aldosteronism between 2004-2015 was performed. Clinical and biochemical parameters of patients who developed hyperkalemia (≥5.2 mmol/L) after unilateral adreanlectomy were compared with those who remained normokalemic. The contralateral suppression index was defined as the aldosterone-to-cortisol ratio from the nondominant adrenal vein divided by the aldosterone-to-cortisol ratio from the external iliac vein. Of 192 patients who met criteria for inclusion, 12 (6.3%) developed hyperkalemia (median serum potassium 5.5 mmol/L, range 5.2-6.2 mmol/L), with a median time to onset of 13.5 days (range 7-55 days). Five patients had transiently increased serum potassium concentrations that normalized spontaneously. Four patients received mineralocorticoid replacement therapy with fludrocortisone. On univariate analysis, hyperkalemic patients had slightly greater preoperative serum creatinine levels (1.2 vs 1.0 mg/dL, P = .01), higher postoperative creatinine (1.3 vs 1.0 mg/dL, P = .02), lesser median contralateral suppression index (0.14 vs 0.27, P = .03), and larger adenomas (1.9 vs 1.4 cm, P = .02). On multivariable logistic regression, the contralateral suppression index remained the only significant predictor of postoperative hyperkalemia (P = .04) with an optimal cut-off of <0.47. Hyperkalemia after unilateral adrenalectomy for primary aldosteronism is uncommon and usually transient, but may require mineralocorticoid supplementation. Patients with a contralateral suppression index of <0.47 require meticulous follow-up and monitoring of serum potassium concentrations after unilateral adrenalectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Quantification of Contralateral Breast Dose and Risk Estimate of Radiation-Induced Contralateral Breast Cancer Among Young Women Using Tangential Fields and Different Modes of Breathing

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

Zurl, Brigitte, E-mail: brigitte.zurl@klinikum-graz.at; Stranzl, Heidi; Winkler, Peter

2013-02-01

Purpose: Whole breast irradiation with deep-inspiration breath-hold (DIBH) technique among left-sided breast cancer patients significantly reduces cardiac irradiation; however, a potential disadvantage is increased incidental irradiation of the contralateral breast. Methods and Materials: Contralateral breast dose (CBD) was calculated by comparing 400 treatment plans of 200 left-sided breast cancer patients whose tangential fields had been planned on gated and nongated CT data sets. Various anatomic and field parameters were analyzed for their impact on CBD. For a subgroup of patients (aged {<=}45 years) second cancer risk in the contralateral breast (CB) was modeled by applying the linear quadratic model, compoundmore » models, and compound models considering dose-volume information (DVH). Results: The mean CBD was significantly higher in DIBH with 0.69 Gy compared with 0.65 Gy in normal breathing (P=.01). The greatest impact on CBD was due to a shift of the inner field margin toward the CB in DIBH (mean 0.4 cm; range, 0-2), followed by field size in magnitude. Calculation with different risk models for CBC revealed values of excess relative risk/Gy ranging from 0.48-0.65 vs 0.46-0.61 for DIBH vs normal breathing, respectively. Conclusion: Contralateral breast dose, although within a low dose range, was mildly but significantly increased in 200 treatment plans generated under gated conditions, predominately due to a shift in the medial field margin. Risk modeling for CBC among women aged {<=}45 years also pointed to a higher risk when comparing DIBH with normal breathing. This risk, however, was substantially lower in the model considering DVH information. We think that clinical decisions should not be affected by this small increase in CBD with DIBH because DIBH is effective in reducing the dose to the heart in all patients.« less

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

Xu, H; Cape Breton Cancer Centre, Sydney, NS

Purpose: To perform the comparison of dose distributions and dosevolume- histograms generated by VMAT and conventional field-in-field technique for left-sided breast and chestwall cancers; to determine whether VMAT offers more dosimetric benefits than does the field-in-field technique. Methods: All VMAT and field-in-filed plans were produced in Eclipse(version 10). Five plans were generated for left-sided breast and leftsided chestwall with supraclavicular nodes, respectively. A clockwise arc (CW) and a counter-clockwise arc (CCW) were used with start and stop angles being 310o±10o and 140o±10o. Collimator angles were 30o for CW and 330o for CCW. The conformity index (CI) is the ratio ofmore » V95% over PTV. The homogeneity index (HI) is the ratio of the difference between D2% and D98% over the prescribed dose. The V5, as an indicator of low dose bath to organs-at-risk, was used for ipsilateral lung, heart, contralateral lung, and contralateral breast. The V20, as an indicator of radiation pneumonitis, was used for ipsilateral lung. Results: Breast/chestwall VMAT delivers much higher low dose bath to ipsilateral lung, contralateral lung and contralateral breast/chestwall for both intact breast and chestwall with nodes. V5 for heart is increased in VMAT plans. V20 for ipsilateral lung is lower in VMAT plans. PTV coverage is similar for both techniques. For one particular chestwall patient with supraclavicular and internal mammary nodes, VMAT offers superior dose coverage of PTVs with slightly more low-dose-wash to heart, contralateral lung and contralateral breast. Conclusion: This study indicates that there is generally no benefit using VMAT for left-sided intact breast, due to large low-dose-bath (5Gy) to normal tissues with insignificant improvement in PTV coverage. Dosimetric benefits will be seen in VMAT plans for some chestwall patients with large size, and/or internal mammary nodes, etc. Whether a chestwall patient is treated with VMAT should be carefully analyzed on an individual basis.« less

Subchronic MK-801 treatment and post-weaning social isolation in rats: differential effects on locomotor activity and hippocampal long-term potentiation.

PubMed

Ashby, Donovan M; Habib, Diala; Dringenberg, Hans C; Reynolds, James N; Beninger, Richard J

2010-09-01

Subchronic NMDA receptor antagonist treatment and post-weaning social isolation are two animal models of schizophrenia symptoms. However, behavioral and physiological changes following a combination of these two procedures have not been investigated. Thus, we examined effects of a novel, "double hit" model combining these two treatments, comparing them to standard models involving only NMDA antagonist treatment or social isolation. Male, Sprague-Dawley rats were either group-housed or maintained in social isolation (starting at postnatal day [PD] 21 and continuing throughout the study). Each housing condition was further subdivided into two groups, receiving either subchronic treatment with either saline or MK-801 (0.5mg/kg, i.p., 2xday for seven days starting at PD 56). Post-weaning social isolation increased locomotor activity (assessed at PD 70) in response to a novel environment and an acute amphetamine injection, while subchronic MK-801 increased only amphetamine induced locomotor activity. Subsequent electrophysiological experiments (under urethane anesthesia) assessing changes in plasticity of hippocampal synapses showed that subchronic MK-801 treatment resulted in an increase in long-term potentiation in area CA1 in response to high frequency stimulation of the contralateral CA3 area, while housing condition had no effect. No other changes in hippocampal electrophysiology (input-output curves, paired-pulse facilitation) were observed. These data are the first to demonstrate an enhancement in hippocampal long-term plasticity in vivo following subchronic MK-801 administration, an effect that may be related to the well-characterized changes in glutamatergic and GABAergic systems seen after subchronic NMDA receptor blockade. That lack of additive or synergistic effects in the "double hit model" suggests that combining isolation and subchronic MK-801 treatment does not necessarily produce greater behavioral or physiological dysfunction than that seen with either treatment alone. Copyright 2010 Elsevier B.V. All rights reserved.

Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma.

PubMed

Eom, Ki Seong; Kim, Tae Young; Park, Jong Tae

2009-04-01

We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. A computed tomography scan conducted on postoperative day 3 demonstrated an acute epidural haematoma over the contralateral frontoparietal convexity. Craniotomy and haematoma evacuation were immediately performed. The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.

Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy.

PubMed

Disler, D G; McCauley, T R; Kelman, C G; Fuchs, M D; Ratner, L M; Wirth, C R; Hospodar, P P

1996-07-01

The sensitivity of fat-suppressed three-dimensional spoiled gradient-echo (SPGR) images was compared with that of standard MR images for detecting hyaline cartilage defects of the knee, using arthroscopy as the standard of reference. We assessed 114 consecutive patients for hyaline cartilage defects of the knee with both standard MR imaging sequences and a sagittal fat-suppressed three-dimensional SPGR sequence. Of these patients, 48 with meniscal or ligament injury, or persistent symptoms, underwent subsequent arthroscopy. The standard MR images and SPGR images of these 48 patients were then retrospectively analyzed for articular defects in a blinded fashion by two independent observers. Sensitivity, specificity, and intraobserver and interobserver agreement were determined for the different imaging techniques. One fourth of the patients who went on to arthroscopy were shown to have isolated hyaline cartilage lesions that were clinically confused with meniscal tears and that were missed on the standard MR images. When looking at all surfaces combined for each reader, the SPGR imaging sequence had a significantly higher sensitivity than the standard MR imaging sequences for detecting hyaline cartilage defects (75-85% versus 29-38%, p < .001 for each comparison). When looking at individual surfaces for each reader, significant differences in sensitivity were shown for each surface except the trochlear and lateral tibial surfaces. We found no difference in specificity (97% versus 97%, p > .99). We also found that combined evaluation of standard MR and SPGR images gave no added diagnostic advantage (sensitivity, 86%; specificity, 97%; p > .42). Except for the lateral tibial surface, the study achieved excellent reproducibility among readings and between readers. Fat-suppressed three-dimensional SPGR imaging is more sensitive than standard MR imaging for the detection of hyaline cartilage defects of the knee.

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.

The role of oscillatory brain activity in object processing and figure-ground segmentation in human vision.

PubMed

Kinsey, K; Anderson, S J; Hadjipapas, A; Holliday, I E

2011-03-01

The perception of an object as a single entity within a visual scene requires that its features are bound together and segregated from the background and/or other objects. Here, we used magnetoencephalography (MEG) to assess the hypothesis that coherent percepts may arise from the synchronized high frequency (gamma) activity between neurons that code features of the same object. We also assessed the role of low frequency (alpha, beta) activity in object processing. The target stimulus (i.e. object) was a small patch of a concentric grating of 3c/°, viewed eccentrically. The background stimulus was either a blank field or a concentric grating of 3c/° periodicity, viewed centrally. With patterned backgrounds, the target stimulus emerged--through rotation about its own centre--as a circular subsection of the background. Data were acquired using a 275-channel whole-head MEG system and analyzed using Synthetic Aperture Magnetometry (SAM), which allows one to generate images of task-related cortical oscillatory power changes within specific frequency bands. Significant oscillatory activity across a broad range of frequencies was evident at the V1/V2 border, and subsequent analyses were based on a virtual electrode at this location. When the target was presented in isolation, we observed that: (i) contralateral stimulation yielded a sustained power increase in gamma activity; and (ii) both contra- and ipsilateral stimulation yielded near identical transient power changes in alpha (and beta) activity. When the target was presented against a patterned background, we observed that: (i) contralateral stimulation yielded an increase in high-gamma (>55 Hz) power together with a decrease in low-gamma (40-55 Hz) power; and (ii) both contra- and ipsilateral stimulation yielded a transient decrease in alpha (and beta) activity, though the reduction tended to be greatest for contralateral stimulation. The opposing power changes across different regions of the gamma spectrum with 'figure/ground' stimulation suggest a possible dual role for gamma rhythms in visual object coding, and provide general support of the binding-by-synchronization hypothesis. As the power changes in alpha and beta activity were largely independent of the spatial location of the target, however, we conclude that their role in object processing may relate principally to changes in visual attention. Copyright © 2010 Elsevier B.V. All rights reserved.

Structural correlates of impaired working memory in hippocampal sclerosis.

PubMed

Winston, Gavin P; Stretton, Jason; Sidhu, Meneka K; Symms, Mark R; Thompson, Pamela J; Duncan, John S

2013-07-01

Temporal lobe epilepsy (TLE) has been considered to impair long-term memory, whilst not affecting working memory, but recent evidence suggests that working memory is compromised. Functional MRI (fMRI) studies demonstrate that working memory involves a bilateral frontoparietal network the activation of which is disrupted in hippocampal sclerosis (HS). A specific role of the hippocampus to deactivate during working memory has been proposed with this mechanism faulty in patients with HS. Structural correlates of disrupted working memory in HS have not been explored. We studied 54 individuals with medically refractory TLE and unilateral HS (29 left) and 28 healthy controls. Subjects underwent 3T structural MRI, a visuospatial n-back fMRI paradigm and diffusion tensor imaging (DTI). Working memory capacity assessed by three span tasks (digit span backwards, gesture span, motor sequences) was combined with performance in the visuospatial paradigm to give a global working memory measure. Gray and white matter changes were investigated using voxel-based morphometry and voxel-based analysis of DTI, respectively. Individuals with left or right HS performed less well than healthy controls on all measures of working memory. fMRI demonstrated a bilateral frontoparietal network during the working memory task with reduced activation of the right parietal lobe in both patient groups. In left HS, gray matter loss was seen in the ipsilateral hippocampus and parietal lobe, with maintenance of the gray matter volume of the contralateral parietal lobe associated with better performance. White matter integrity within the frontoparietal network, in particular the superior longitudinal fasciculus and cingulum, and the contralateral temporal lobe, was associated with working memory performance. In right HS, gray matter loss was also seen in the ipsilateral hippocampus and parietal lobe. Working memory performance correlated with the gray matter volume of both frontal lobes and white matter integrity within the frontoparietal network and contralateral temporal lobe. Our data provide further evidence that working memory is disrupted in HS and impaired integrity of both gray and white matter is seen in functionally relevant areas. We suggest this forms the structural basis of the impairment of working memory, indicating widespread and functionally significant structural changes in patients with apparently isolated HS. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Structural correlates of impaired working memory in hippocampal sclerosis

PubMed Central

Winston, Gavin P; Stretton, Jason; Sidhu, Meneka K; Symms, Mark R; Thompson, Pamela J; Duncan, John S

2013-01-01

Purpose: Temporal lobe epilepsy (TLE) has been considered to impair long-term memory, whilst not affecting working memory, but recent evidence suggests that working memory is compromised. Functional MRI (fMRI) studies demonstrate that working memory involves a bilateral frontoparietal network the activation of which is disrupted in hippocampal sclerosis (HS). A specific role of the hippocampus to deactivate during working memory has been proposed with this mechanism faulty in patients with HS. Structural correlates of disrupted working memory in HS have not been explored. Methods: We studied 54 individuals with medically refractory TLE and unilateral HS (29 left) and 28 healthy controls. Subjects underwent 3T structural MRI, a visuospatial n-back fMRI paradigm and diffusion tensor imaging (DTI). Working memory capacity assessed by three span tasks (digit span backwards, gesture span, motor sequences) was combined with performance in the visuospatial paradigm to give a global working memory measure. Gray and white matter changes were investigated using voxel-based morphometry and voxel-based analysis of DTI, respectively. Key Findings: Individuals with left or right HS performed less well than healthy controls on all measures of working memory. fMRI demonstrated a bilateral frontoparietal network during the working memory task with reduced activation of the right parietal lobe in both patient groups. In left HS, gray matter loss was seen in the ipsilateral hippocampus and parietal lobe, with maintenance of the gray matter volume of the contralateral parietal lobe associated with better performance. White matter integrity within the frontoparietal network, in particular the superior longitudinal fasciculus and cingulum, and the contralateral temporal lobe, was associated with working memory performance. In right HS, gray matter loss was also seen in the ipsilateral hippocampus and parietal lobe. Working memory performance correlated with the gray matter volume of both frontal lobes and white matter integrity within the frontoparietal network and contralateral temporal lobe. Significance: Our data provide further evidence that working memory is disrupted in HS and impaired integrity of both gray and white matter is seen in functionally relevant areas. We suggest this forms the structural basis of the impairment of working memory, indicating widespread and functionally significant structural changes in patients with apparently isolated HS. PMID:23614459

Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases.

PubMed

Schlumberger, Michael; Schuster, Philipp; Schulz, Martin; Immendörfer, Micha; Mayer, Philipp; Bartholomä, Jochen; Richter, Jörg

2017-05-01

To determine incidence and risk factors for traumatic graft rupture following primary and revision anterior cruciate ligament (ACL) reconstruction. All cases of isolated ACL reconstructions (primary or revision) performed at our institution between January 2007 and December 2010 were included. From this group of 2467 primary reconstructions (32.4 ± 12.2 years) and 448 revision reconstructions (33.0 ± 10.4 years), we identified all patients who underwent revision ACL reconstruction following traumatic graft rupture in further course and all patients who underwent contralateral primary ACL reconstruction until January 2014. Age, gender, time from index procedure and graft diameter (for hamstring autografts) were analysed in terms of being a potential risk factor for graft rupture. Within a follow-up period of 5.0 ± 1.1 years (3.0-7.0), a total of 82 traumatic graft ruptures were identified, resulting in an incidence of 2.8 %. Seventy-three cases were seen following primary reconstructions (3.0 %), and nine cases following revision reconstructions (2.0 %), respectively (n.s.). Age younger than 25 years was identified as a risk factor for both groups (p = 0.001 and p = 0.008; odds ratio 6.0 and 6.4, respectively). In primary reconstruction, male patients had a higher risk of graft rupture compared with females (3.7 vs. 1.6 %; p = 0.005), and the first year after index procedure was associated with a higher risk of graft rupture compared with the following (p < 0.001). Graft diameter did not influence the risk of graft rupture. Incidence of contralateral ACL rupture was 3.1 %, which was not different to the incidence of graft rupture ipsilaterally (n.s.). No statistically significant differences were seen between graft rupture incidence of primary and revision ACL reconstructions. Young age (<25 years) and short time to the index procedure (especially within the first year) were confirmed as risk factors for graft rupture in both groups. Male gender was a risk factor for primary reconstructions. Graft diameter had no influence on graft rupture rates. No difference in incidence of graft rupture compared to ACL rupture on the contralateral side was apparent. Retrospective case series, Level IV.

Analysis of linear electrode array EMG for assessment of hemiparetic biceps brachii muscles.

PubMed

Yao, Bo; Zhang, Xu; Li, Sheng; Li, Xiaoyan; Chen, Xiang; Klein, Cliff S; Zhou, Ping

2015-01-01

This study presents a frequency analysis of surface electromyogram (EMG) signals acquired by a linear electrode array from the biceps brachii muscles bilaterally in 14 hemiparetic stroke subjects. For different levels of isometric contraction ranging from 10 to 80% of the maximum voluntary contraction (MVC), the power spectra of 19 bipolar surface EMG channels arranged proximally to distally along the muscle fibers were examined in both paretic and contralateral muscles. It was found that across all stroke subjects, the median frequency (MF) and the mean power frequency (MPF), averaged from different surface EMG channels, were significantly smaller in the paretic muscle compared to the contralateral muscle at each of the matched percent MVC contractions. The muscle fiber conduction velocity (MFCV) was significantly slower in the paretic muscle than in the contralateral muscle. No significant correlation between the averaged MF, MPF, or MFCV vs. torque was found in both paretic and contralateral muscles. However, there was a significant positive correlation between the global MFCV and MF. Examination of individual EMG channels showed that electrodes closest to the estimated muscle innervation zones produced surface EMG signals with significantly higher MF and MPF than more proximal or distal locations in both paretic and contralateral sides. These findings suggest complex central and peripheral neuromuscular alterations (such as selective loss of large motor units, disordered control of motor units, increased motor unit synchronization, and atrophy of muscle fibers, etc.) which can collectively influence the surface EMG signals. The frequency difference with regard to the innervation zone also confirms the relevance of electrode position in surface EMG analysis.

Multichannel fiber-based diffuse reflectance spectroscopy for the rat brain exposed to a laser-induced shock wave: comparison between ipsi- and contralateral hemispheres

NASA Astrophysics Data System (ADS)

Miyaki, Mai; Kawauchi, Satoko; Okuda, Wataru; Nawashiro, Hiroshi; Takemura, Toshiya; Sato, Shunichi; Nishidate, Izumi

2015-03-01

Due to considerable increase in the terrorism using explosive devices, blast-induced traumatic brain injury (bTBI) receives much attention worldwide. However, little is known about the pathology and mechanism of bTBI. In our previous study, we found that cortical spreading depolarization (CSD) occurred in the hemisphere exposed to a laser- induced shock wave (LISW), which was followed by long-lasting hypoxemia-oligemia. However, there is no information on the events occurred in the contralateral hemisphere. In this study, we performed multichannel fiber-based diffuse reflectance spectroscopy for the rat brain exposed to an LISW and compared the results for the ipsilateral and contralateral hemispheres. A pair of optical fibers was put on the both exposed right and left parietal bone; white light was delivered to the brain through source fibers and diffuse reflectance signals were collected with detection fibers for both hemispheres. An LISW was applied to the left (ipsilateral) hemisphere. By analyzing reflectance signals, we evaluated occurrence of CSD, blood volume and oxygen saturation for both hemispheres. In the ipsilateral hemispheres, we observed the occurrence of CSD and long-lasting hypoxemia-oligemia in all rats examined (n=8), as observed in our previous study. In the contralateral hemisphere, on the other hand, no occurrence of CSD was observed, but we observed oligemia in 7 of 8 rats and hypoxemia in 1 of 8 rats, suggesting a mechanism to cause hypoxemia or oligemia or both that is (are) not directly associated with CSD in the contralateral hemisphere.

Decreased oxygen saturation in asymmetrically prominent cortical veins in patients with cerebral ischemic stroke.

PubMed

Xia, Shuang; Utriainen, David; Tang, Jin; Kou, Zhifeng; Zheng, Gang; Wang, Xuesong; Shen, Wen; Haacke, E Mark; Lu, Guangming

2014-12-01

Decreased oxygen saturation in asymmetrically prominent cortical veins (APCV) seen in ischemic stroke has been hypothesized to correlate with an increase of de-oxygenated hemoglobin. Our goal is to quantify magnetic susceptibility to define APCV by establishing a cutoff above which the deoxyhemoglobin levels are considered abnormal. A retrospective study was conducted on 26 patients with acute ischemic stroke in one cerebral hemisphere that exhibited APCV with 30 age- and sex-matched healthy controls. Quantitative susceptibility mapping (QSM) was used to calculate the magnetic susceptibility of the cortical veins. A paired t-test was used to compare the susceptibility of the cortical veins in the left and right hemispheres for healthy controls as well as in the contralateral hemisphere for stroke patients with APCV. The change in oxygen saturation in the APCV relative to the contralateral side was calculated after thresholding the susceptibility using the mean plus two standard deviations of the contralateral side for each individual. The thresholded susceptibility value of the APCVs in the stroke hemisphere was 254±48 ppb which was significantly higher (p<0.05) than that in the contralateral hemisphere (123±12 ppb) and in healthy controls (125±8 ppb). There was a decrease of oxygen saturation in the APCV ranging from 16% to 44% relative to the veins of the contralateral hemisphere. In conclusion, APCV seen in SWI correspond to reduced levels of oxygen saturation and these abnormal veins can be identified using a susceptibility threshold on the QSM data. Copyright © 2014 Elsevier Inc. All rights reserved.

Magnetic resonance imaging demonstrates compartmental muscle mechanisms of human vertical fusional vergence

PubMed Central

Clark, Robert A.

2015-01-01

Vertical fusional vergence (VFV) normally compensates for slight vertical heterophorias. We employed magnetic resonance imaging to clarify extraocular muscle contributions to VFV induced by monocular two-prism diopter (1.15°) base-up prism in 14 normal adults. Fusion during prism viewing requires monocular infraduction. Scans were repeated without prism, and with prism shifted contralaterally. Contractility indicated by morphometric indexes was separately analyzed in medial and lateral vertical rectus and superior oblique (SO) putative compartments, and superior and inferior horizontal rectus extraocular muscle putative compartments, but in the whole inferior oblique (IO). Images confirmed appropriate VFV that was implemented by the inferior rectus (IR) medial compartment contracting ipsilateral and relaxing contralateral to prism. There was no significant contractility in the IR lateral compartment. The superior but not inferior lateral rectus (LR) compartment contracted significantly in the prism viewing eye, but not contralateral to prism. The IO contracted ipsilateral but not contralateral to the prism. In the infraducting eye, the SO medial compartment relaxed significantly, while the lateral compartment was unchanged; contralateral to prism, the SO lateral compartment contracted, while the medial compartment was unchanged. There was no contractility in the superior or medial rectus muscles in either eye. There was no globe retraction. We conclude that the vertical component of VFV is primarily implemented by IR medial compartment contraction. Since appropriate vertical rotation is not directly implemented, or is opposed, by associated differential LR and SO compartmental activity, and IO contraction, these actions probably implement a torsional component of VFV. PMID:25589593

Anterior transarticular C1-C2 fixation with contralateral screw insertion: a report of two cases and technical note.

PubMed

Lvov, Ivan; Grin, Andrey; Kaykov, Aleksandr; Smirnov, Vladimir; Krylov, Vladimir

2017-08-08

Anterior transarticular fixation of the C1-C2 vertebrae is a well-known technique that involves screw insertion through the body of the C2 vertebra into the lateral masses of the atlas through an anterior transcervical approach. Meanwhile, contralateral screw insertion has been previously described only in anatomical studies. We describe two case reports of the clinical application of this new technique. In Case 1, the patient was diagnosed with an unstable C1 fracture. The clinical features of the case did not allow for any type of posterior atlantoaxial fusion, Halo immobilization, or routine anterior fixation using the Reindl and Koller techniques. The possible manner of screw insertion into the anterior third of the right lateral mass was via a contralateral trajectory, which was performed in this case. Case 2 involved a patient with neglected posteriorly dislocated dens fracture who could not lie in the prone position due to concomitant cardiac pathology. Reduction of atlantoaxial dislocation was insufficient, even after scar tissue resection at the fracture, while transdental fusion was not possible. Considering the success of the previous case, atlantoaxial fixation was performed through the small approach, using the Reindl technique and contralateral screw insertion. These two cases demonstrate the potential of anterior transarticular fixation of C1-C2 vertebrae in cases where posterior atlantoaxial fusion is not achievable. This type of fixation can be performed through a single approach if one screw is inserted using the Reindl technique and another is inserted via a contralateral trajectory.

Bilateral Activity-Dependent Interactions in the Developing Corticospinal System

PubMed Central

Friel, Kathleen M.; Martin, John H.

2009-01-01

Activity-dependent competition between the corticospinal (CS) systems in each hemisphere drives postnatal development of motor skills and stable CS tract connections with contralateral spinal motor circuits. Unilateral restriction of motor cortex (M1) activity during an early postnatal critical period impairs contralateral visually guided movements later in development and in maturity. Silenced M1 develops aberrant connections with the contralateral spinal cord whereas the initially active M1, in the other hemisphere, develops bilateral connections. In this study, we determined whether the aberrant pattern of CS tract terminations and motor impairments produced by early postnatal M1 activity restriction could be abrogated by reducing activity-dependent synaptic competition from the initially active M1 later in development. We first inactivated M1 unilaterally between postnatal weeks 5–7. We next inactivated M1 on the other side from weeks 7–11 (alternate inactivation), to reduce the competitive advantage that this side may have over the initially inactivated side. Alternate inactivation redirected aberrant contralateral CS tract terminations from the initially silenced M1 to their normal spinal territories and reduced the density of aberrant ipsilateral terminations from the initially active side. Normal movement endpoint control during visually guided locomotion was fully restored. This reorganization of CS terminals reveals an unsuspected late plasticity after the critical period for establishing the pattern of CS terminations in the spinal cord. Our findings show that robust bilateral interactions between the developing CS systems on each side are important for achieving balance between contralateral and ipsilateral CS tract connections and visuomotor control. PMID:17928450

Motor activation in patients with Pantothenate-Kinase Associated Neurodegeneration: a functional magnetic resonance imaging study.

PubMed

Stoeter, P; Rodriguez-Raecke, R; Vilchez, C; Perez-Then, E; Speckter, H; Oviedo, J; Roa-Sanchez, P

2012-11-01

In a variety of dystonias, functional magnetic resonance imaging has shown deviations of cortical and basal ganglia activations within the motor network, which might cause the movement disturbances. Because these investigations have never been performed in secondary dystonia due to Pantothenate-Kinase Associated Neurodegeneration, we report our results in a small group of such patients from the Dominican Republic. Functional magnetic resonance imaging was carried out in 7 patients with a genetically confirmed mutation of the PANK2 gene and a non-affected control group (matched pairs) using an event-related motor activation paradigm (hand movements). Compared to the control group (p ≤ 0.01), patients showed a larger amount of activated voxels starting in the contralateral cerebellum and contralateral premotor cortex 2 s before the actual hand movement. Whereas these "hyperactivations" gradually diminished over time, activations in the contralateral primary motor cortex and the supplementary motor area peaked during the next second and those of the contralateral putamen at the time of the actual hand movement. In a multiple regression analysis, all these areas correlated positively with the degree of dystonia of the contralateral arm as judged by the Burke-Fahn-Marsden-scale (p ≤ 0.001). As in other forms of dystonia, the increased activations of the motor system found in our patients could be related to the origin of the dystonic movements. Because in this condition the primary lesion affects the pallidum, a defect of the feed-back control mechanism between basal ganglia and cortex might be the responsible factor. © 2012 Elsevier Ltd. All rights reserved.

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90.

PubMed

Teo, Jin-Yao; Allen, John C; Ng, David C; Choo, Su-Pin; Tai, David W M; Chang, Jason P E; Cheah, Foong-Khoon; Chow, Pierce K H; Goh, Brian K P

2016-01-01

Curative liver resection is the treatment of choice for both primary and secondary liver malignancies. However, an inadequate future liver remnant (FLR) frequently precludes successful surgery. Portal vein embolization is the gold-standard modality for inducing hypertrophy of the FLR. In recent times, unilobar Yttrium-90 selective internal radiation therapy (SIRT) has been reported to induce hypertrophy of the contralateral, untreated liver lobe. The aim of this study is to review the current literature reporting on contralateral liver hypertrophy induced by unilobar SIRT. A systematic review of the English-language literature between 2000 and 2014 was performed using the search terms "Yttrium 90" OR "selective internal radiation therapy" OR "radioembolization" AND "hypertrophy". Seven studies, reporting on 312 patients, were included. Two hundred and eighty four patients (91.0%) received treatment to the right lobe. Two hundred and fifteen patients had hepatocellular carcinoma (HCC), 12 had intrahepatic cholangiocarcinoma, and 85 had liver metastases from mixed primaries. Y90 SIRT resulted in contralateral liver hypertrophy which ranged from 26 to 47% at 44 days-9 months. All studies were retrospective in nature, and heterogeneous, with substantial variations relative to pathology treated, underlying liver disease, dosage and delivery of Y90, number of treatment sessions and time to measurement of hypertrophy. Unilobar Y90 SIRT results in significant hypertrophy of the contralateral liver lobe. The rate of hypertrophy seems to be slower than that achieved by other methods. Copyright © 2015 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training.

PubMed

Gao, Ying; Shi, Jian-guo; Ye, Hong; Liu, Zhi-rong; Zheng, Long-bao; Ni, Zhi-ming; Fan, Liang-quan; Wang, Jian; Hou, Zhen-hai

2014-11-01

This study aims to investigate the effects of sudden load changes (expected and unexpected imbalance) on the activity of muscles of the lumbar spine and their central motor control strategy in military personnel with or without chronic low back pain (LBP). Bilateral sudden imbalance was examined (2 × 2 factorial design). The 117th PLA Hospital, Hangzhou, China Twenty-one male subjects with lower back pain and 21 male healthy control subjects were active members of the Nanjing Military Region land forces. Independent variables: LBP vs. healthy controls and imbalance anticipation (expected and unexpected imbalance). rapid reaction time (RRT) and intensity of rapid reaction (IRR) of bilateral lumbar (L3-L4) erector spinae (ES), lumbar (L5-S1) multifidus (MF), and abdominal external oblique muscles. Results Under expected or unexpected sudden imbalance conditions, subjects with LBP demonstrated significantly greater IRR than healthy controls in ipsilateral and contralateral ES and MF, respectively (P < 0.05 for all). IRR of contralateral ES was significantly larger than that of the ipsilateral ES. A significant group effect of RRT of both ipsilateral and contralateral ES muscles and a significant time expectation effect on RRT of contralateral MF muscles were also observed. RRT of the contralateral ES muscles was significantly lower than that of the ipsilateral ES muscles (P < 0.001). Sudden imbalance prolonged RRT of selected trunk muscles in patients with chronic LBP. The activation amplitude increased. The results may provide a theoretical basis for a study on the pathogenesis of chronic LBP.

Protective effect of sildenafil citrate on contralateral testis injury after unilateral testicular torsion/detorsion.

PubMed

Yíldíz, Hamit; Durmus, Ali Said; Simşek, Halil; Yaman, Mine

2011-01-01

This study was designed to investigate prevention of contralateral testicular injury with sildenafil citrate after unilateral testicular torsion/detorsion. Thirty-seven adult male rats were divided into four groups: sham operated (group 1, n = 7), torsion/detorsion + saline (group 2, n = 10), torsion/detorsion + 0.7 mg of sildenafil citrate (group 3, n = 10) and torsion/detorsion + 1.4 mg of sildenafil citrate (group 4, n = 10). Unilateral testicular torsion was created by rotating the right testis 720º in a clockwise direction for 2 h in other groups, except for group 1, which was served as sham group. After torsion (2 h) and detorsion (2 h) periods, rats were killed. The level of reduced glutathion (GSH) (p < 0.05) and the activities of catalase (p < 0.01) and glutathione peroxidase (p < 0.05) in the contralateral testis from group 2 were significantly lower and nitric oxide (NO) (p < 0.05) level in the contralateral testis were significantly higher than those of group 1. Administration of low-dose sildenafil citrate (group 3) prevented the increases in malondialdehyde and NO levels and decreases in glutathione peroxidase activities and GSH values induced by testicular torsion. However, administration of high-dose sildenafil citrate (group 4) had no effect on these testicular parameters (p > 0.05). Histopathological changes were detected in groups 2, 3 and 4. These results suggest that biochemically and histologically torsion/detorsion injury occurs in the contralateral testis following 2-h torsion and 2-h detorsion and that administration of low-dose sildenafil citrate before detorsion prevents ischemia/reperfusion cellular damage in testicular tissue.

Objective assessment of the compensatory effect of clinical hind limb lameness in horses: 37 cases (2011-2014).

PubMed

Maliye, Sylvia; Marshall, John F

2016-10-15

OBJECTIVE To characterize and describe the compensatory load redistribution that results from unilateral hind limb lameness in horses. DESIGN Retrospective case series. ANIMALS 37 client-owned horses. PROCEDURES Medical records were reviewed to identify horses with unilateral hind limb lameness that responded positively (by objective assessment) to diagnostic local anesthesia during lameness evaluation and that were evaluated before and after diagnostic local anesthesia with an inertial sensor-based lameness diagnosis system. Horses were grouped as having hind limb lameness only, hind limb and ipsilateral forelimb lameness, or hind limb and contralateral forelimb lameness. Measures of head and pelvic movement asymmetry before (baseline) and after diagnostic local anesthesia were compared. The effect of group on baseline pelvic movement asymmetry variables was analyzed statistically. RESULTS Maximum pelvic height significantly decreased from the baseline value after diagnostic local anesthesia in each of the 3 lameness groups and in all horses combined. Minimum pelvic height significantly decreased after the procedure in all groups except the hind limb and contralateral forelimb lameness group. Head movement asymmetry was significantly decreased after diagnostic local anesthesia for horses with hind limb and ipsilateral forelimb lameness and for all horses combined, but not for those with hind limb lameness only or those with hind limb and contralateral forelimb lameness. CONCLUSIONS AND CLINICAL RELEVANCE Results supported that hind limb lameness can cause compensatory load redistribution evidenced as ipsilateral forelimb lameness. In this population of horses, contralateral forelimb lameness was not compensatory and likely reflected true lameness. Further studies are needed to investigate the source of the contralateral forelimb lameness in such horses.

Evaluation of anticollagen type I antibody titers in synovial fluid of both stifle joints and the left shoulder joint of dogs with unilateral cranial cruciate disease.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Cox, Eric

2007-03-01

To evaluate anticollagen type I antibodies in synovial fluid of the affected stifle joint, the contralateral stifle joint, and the left shoulder joint of dogs with unilateral cranial cruciate ligament (CrCL) rupture during an extended period of 12 to 18 months. 13 client-owned dogs with CrCL rupture and 2 sham-operated dogs. All dogs were examined and arthrocentesis of all 3 joints was performed every 6 months after surgery. Synovial fluid samples were tested for anticollagen type I antibodies by use of an ELISA. Dogs with partial CrCL rupture had higher antibody titers than dogs with complete rupture. Six of 13 dogs ruptured the contralateral CrCL during the study, whereby higher antibody titers were found for the stifle joints than for the shoulder joint. Seronegative dogs or dogs with extremely low antibody titers and 2 dogs with high antibody titers did not sustain a CrCL rupture in the contralateral stifle joint. In most dogs that had a CrCL rupture of the contralateral stifle joint, a distinct antibody titer gradient toward the stifle joints was detected, suggesting that there was a local inflammatory process in these joints. However, only a small number of sham-operated dogs were used to calculate the cutoff values used to determine the anticollagen type I antibody titers in these patients. Synovial fluid antibodies against collagen type I alone do not initiate CrCL rupture because not all dogs with high antibody titers sustained a CrCL rupture in the contralateral stifle joint.

Contralateral Noise Stimulation Delays P300 Latency in School-Aged Children.

PubMed

Ubiali, Thalita; Sanfins, Milaine Dominici; Borges, Leticia Reis; Colella-Santos, Maria Francisca

2016-01-01

The auditory cortex modulates auditory afferents through the olivocochlear system, which innervates the outer hair cells and the afferent neurons under the inner hair cells in the cochlea. Most of the studies that investigated the efferent activity in humans focused on evaluating the suppression of the otoacoustic emissions by stimulating the contralateral ear with noise, which assesses the activation of the medial olivocochlear bundle. The neurophysiology and the mechanisms involving efferent activity on higher regions of the auditory pathway, however, are still unknown. Also, the lack of studies investigating the effects of noise on human auditory cortex, especially in peadiatric population, points to the need for recording the late auditory potentials in noise conditions. Assessing the auditory efferents in schoolaged children is highly important due to some of its attributed functions such as selective attention and signal detection in noise, which are important abilities related to the development of language and academic skills. For this reason, the aim of the present study was to evaluate the effects of noise on P300 responses of children with normal hearing. P300 was recorded in 27 children aged from 8 to 14 years with normal hearing in two conditions: with and whitout contralateral white noise stimulation. P300 latencies were significantly longer at the presence of contralateral noise. No significant changes were observed for the amplitude values. Contralateral white noise stimulation delayed P300 latency in a group of school-aged children with normal hearing. These results suggest a possible influence of the medial olivocochlear activation on P300 responses under noise condition.

Dose-dependent effect of mammographic breast density on the risk of contralateral breast cancer.

PubMed

Chowdhury, Marzana; Euhus, David; O'Donnell, Maureen; Onega, Tracy; Choudhary, Pankaj K; Biswas, Swati

2018-07-01

Increased mammographic breast density is a significant risk factor for breast cancer. It is not clear if it is also a risk factor for the development of contralateral breast cancer. The data were obtained from Breast Cancer Surveillance Consortium and included women diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 18 and 88 and years 1995 and 2009. Each case of contralateral breast cancer was matched with three controls based on year of first breast cancer diagnosis, race, and length of follow-up. A total of 847 cases and 2541 controls were included. The risk factors included in the study were mammographic breast density, age of first breast cancer diagnosis, family history of breast cancer, anti-estrogen treatment, hormone replacement therapy, menopausal status, and estrogen receptor status, all from the time of first breast cancer diagnosis. Both univariate analysis and multivariate conditional logistic regression analysis were performed. In the final multivariate model, breast density, family history of breast cancer, and anti-estrogen treatment remained significant with p values less than 0.01. Increasing breast density had a dose-dependent effect on the risk of contralateral breast cancer. Relative to 'almost entirely fat' category of breast density, the adjusted odds ratios (and p values) in the multivariate analysis for 'scattered density,' 'heterogeneously dense,' and 'extremely dense' categories were 1.65 (0.036), 2.10 (0.002), and 2.32 (0.001), respectively. Breast density is an independent and significant risk factor for development of contralateral breast cancer. This risk factor should contribute to clinical decision making.

Survival and contralateral breast cancer in CHEK2 1100delC breast cancer patients: impact of adjuvant chemotherapy

PubMed Central

Kriege, M; Hollestelle, A; Jager, A; Huijts, P E A; Berns, E M; Sieuwerts, A M; Meijer-van Gelder, M E; Collée, J M; Devilee, P; Hooning, M J; Martens, J W M; Seynaeve, C

2014-01-01

Background: We assessed the sensitivity to adjuvant chemotherapy in cell cycle checkpoint kinase 2 (CHEK2) vs non-CHEK2 breast cancer patients by comparing the contralateral breast cancer incidence and distant disease-free and breast cancer-specific survival between both groups, stratified for adjuvant chemotherapy. Methods: One Dutch hereditary non-BRCA1/2 breast cancer patient cohort (n=1220) and two Dutch cohorts unselected for family history (n=1014 and n=2488, respectively) were genotyped for CHEK2 1100delC. Hazard ratios for contralateral breast cancer, distant disease-free and breast cancer-specific death for mutation carriers vs noncarriers were calculated using the Cox proportional hazard method, stratified for adjuvant chemotherapy. Results: The CHEK2 mutation carriers (n=193) had an increased incidence of contralateral breast cancer (multivariate hazard ratio 3.97, 95% confidence interval 2.59–6.07). Distant disease-free and breast cancer-specific survival were similar in the first 6 years in mutation carriers compared with noncarriers, but diverted as of 6 years after breast cancer diagnosis (multivariate hazard ratios and 95% confidence intervals 2.65 (1.79–3.93) and 2.05 (1.41–2.99), respectively). No significant interaction between CHEK2 and adjuvant chemotherapy was observed. Conclusions: The CHEK2 1100delC-associated breast cancer is associated with a higher contralateral breast cancer rate as well as worse survival measures beyond 6 years after diagnosis. No differential sensitivity to adjuvant chemotherapy was observed in CHEK2 patients. PMID:24918820

Contralaterally Controlled Functional Electrical Stimulation for Stroke Rehabilitation

PubMed Central

Knutson, Jayme S.; Harley, Mary Y.; Hisel, Terri Z.; Makowski, Nathaniel S.; Fu, Michael J.; Chae, John

2012-01-01

Contralaterally controlled functional electrical stimulation (CCFES) is an innovative method of delivering neuromuscular electrical stimulation for rehabilitation of paretic limbs after stroke. It is being studied to evaluate its efficacy in improving recovery of arm and hand function and ankle dorsiflexion in chronic and subacute stroke patients. The initial studies provide preliminary evidence supporting the efficacy of CCFES. PMID:23365893

Contribution of a Contralateral Hearing Aid to Perception of Consonant Voicing, Intonation, and Emotional State in Adult Cochlear Implantees

ERIC Educational Resources Information Center

Most, Tova; Gaon-Sivan, Gal; Shpak, Talma; Luntz, Michal

2012-01-01

Binaural hearing in cochlear implant (CI) users can be achieved either by bilateral implantation or bimodally with a contralateral hearing aid (HA). Binaural-bimodal hearing has the advantage of complementing the high-frequency electric information from the CI by low-frequency acoustic information from the HA. We examined the contribution of a…

The benefit of image guidance for the contralateral interhemispheric approach to the lateral ventricle.

PubMed

Fronda, Chiara; Miller, Dorothea; Kappus, Christoph; Bertalanffy, Helmut; Sure, Ulrich

2008-06-01

Recently, neurosurgeons have increasingly faced small intracerebral lesions in asymptomatic or minimally symptomatic patients. Here, we evaluated a series of four patients with nearly asymptomatic intraventricular tumors close to the corpus callosum that had been treated with the aid of an image-guided transcallosal approach. Four consecutive patients suffering from left intra- and paraventricular tumors were operated on via a contralateral interhemispheric transcallosal approach with the aid of neuronavigation. Our image-guided system directed: (1) the skin incision, (2) the interhemispheric dissection, and (3) the incision of the corpus callosum. Using the image-guided contralateral interhemispheric transcallosal approach to the left ventricle all lesions have been completely resected without the risk of damage to the dominant hemisphere. The callosal incision was kept as limited as possible (1.2-2.1cm) depending on the size of the tumor. No postoperative neurological or neuropsychological deficit was observed in our series. Neuronavigation facilitates a safe and targeted contralateral interhemispheric transcallosal approach to the dominant hemisphere's lateral ventricle. Our technique minimizes the risk of damage to the dominant hemisphere and requires only a limited opening of the corpus callosum, which might decrease the risk of neuropsychological morbidity.

Anatomical physiology of spatial extinction.

PubMed

Ciçek, Metehan; Gitelman, Darren; Hurley, Robert S E; Nobre, Anna; Mesulam, Marsel

2007-12-01

Neurologically intact volunteers participated in a functional magnetic resonance imaging experiment that simulated the unilateral (focal) and bilateral (global) stimulations used to elicit extinction in patients with hemispatial neglect. In peristriate areas, attentional modulations were selectively sensitive to contralaterally directed attention. A higher level of mapping was observed in the intraparietal sulcus (IPS), inferior parietal lobule (IPL), and inferior frontal gyrus (IFG). In these areas, there was no distinction between contralateral and ipsilateral focal attention, and the need to distribute attention globally led to greater activity than either focal condition. These physiological characteristics were symmetrically distributed in the IPS and IFG, suggesting that the effects of unilateral lesions in these 2 areas can be compensated by the contralateral hemisphere. In the IPL, the greater activation by the bilateral attentional mode was seen only in the right hemisphere. Its contralateral counterpart displayed equivalent activations when attention was distributed to the right, to the left, or bilaterally. Within the context of this experiment, the IPL of the right hemisphere emerged as the one area where unilateral lesions can cause the most uncompensated and selective impairment of global attention (without interfering with unilateral attention to either side), giving rise to the phenomenon of extinction.

Hemispheric differences of motor execution: a near-infrared spectroscopy study.

PubMed

Helmich, Ingo; Rein, Robert; Niermann, Nico; Lausberg, Hedda

2013-01-01

Distal movements of the limbs are predominantly controlled by the contralateral hemisphere. However, functional neuroimaging studies do not unequivocally demonstrate a lateralization of the cerebral activation during hand movements. While some studies show a predominant activation of the contralateral hemisphere, other studies provide evidence for a symmetrically distributed bihemispheric activation. However, the divergent results may also be due to methodological shortcomings. Therefore, the present study using functional near-infrared spectroscopy examines cerebral activation in both hemispheres during motor actions of the right and left hands. Twenty participants performed a flexion/extension task with the right- or left-hand thumb. Cerebral oxygenation changes were recorded from 48 channels over the primary motor, pre-motor, supplementary motor, primary somatosensory cortex, subcentral area, and the supramarginal gyrus of each hemisphere. A consistent increase of cerebral oxygenation was found for oxygenated and for total hemoglobin in the hemisphere contralateral to the moving hand, regardless of the laterality. These findings are in line with previous data from localization [1-3] and brain imaging studies [4-6]. The present data support the proposition that there is no hemispheric specialization for simple distal motor tasks. Both hemispheres are equally activated during movement of the contralateral upper limb.

Endoscopic contralateral transmaxillary approach for pterygoid process osteotomy in total maxillectomy: A technical case report.

PubMed

Hanazawa, Toyoyuki; Yamasaki, Kazuki; Chazono, Hideaki; Okamoto, Yoshitaka

2018-06-01

An approach for total maxillectomy with endoscopic transection of the pterygoid process via the contralateral maxillary sinus is described. In total maxillectomy, the resection of the pterygoid process of the sphenoid is a key step for successful resection. However, a conventional craniofacial approach requires extensive incision in the face, elevation of the lateral cheek flap. Even after elevation of the lateral cheek flap, visualization of this region is not good. An endoscopic approach through the contralateral maxillary sinus improved visualization of the pterygoid process, and osteotomy using a diamond-drilling bar was successfully performed. This technique has the potential to widen the indication for total maxillectomy in malignant neoplasms of the maxillary sinus. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of prazosin on skin microcirculation as assessed by laser Doppler flowmetry.

PubMed Central

Khan, F; Struthers, A D; Spence, V A

1988-01-01

1. Laser Doppler flowmetry was used in six normal volunteers to record changes in fingertip skin blood flow after the administration of prazosin to block postsynaptic alpha 1-adrenoceptors. 2. Prazosin (0.5 mg orally) did not alter systolic or diastolic blood pressure or heart rate. 3. Prazosin did significantly increase basal skin blood flow 2 h after its administration but this effect was no longer evident after contralateral hand warming. Prazosin markedly reduced the skin vasoconstrictor response to deep inspiration and to contralateral hand cooling. 4. This study suggests that postsynaptic alpha 1-adrenoceptors are involved in maintaining skin vasoconstrictor tone at rest and are also involved in the rapid skin vasoconstriction seen in response to a deep inspiration and to contralateral hand cooling. PMID:2846022

Ruptured ectopic pregnancy with contralateral adnexal torsion after spontaneous conception.

PubMed

DiLuigi, Andrea J; Maier, Donald B; Benadiva, Claudio A

2008-11-01

To describe a case of ruptured ectopic pregnancy and contralateral adnexal torsion after spontaneous conception. Case report. Tertiary university medical center. A 23-year-old multiparous female with severe bilateral pelvic pain and a positive pregnancy test. Operative laparoscopy with detorsion of left adnexa, drainage of left ovarian hemorrhagic corpus luteum cyst, right salpingectomy, and dilation and curettage. Laparoscopy revealed a 5 cm hemorrhagic corpus luteum cyst of the left ovary, torsion of the left ovary and fallopian tube, and a ruptured right ampullary ectopic pregnancy. Normal perfusion of left ovary and fallopian tube after detorsion, resolution of left ovarian hemorrhagic corpus luteum cyst, patent left fallopian tube with chromopertubation, and successful removal of ectopic pregnancy. This is a unique case of adnexal torsion and contralateral ectopic pregnancy occurring after spontaneous conception.

Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.

PubMed

Cho, Bum-Joo; Kim, Ji-Soo; Hwang, Jeong-Min

2013-12-01

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.

Surround Inhibition in the Primary Motor Cortex is Task-specifically Modulated in Non-professional Musicians but not in Healthy Controls During Real Piano Playing.

PubMed

Márquez, Gonzalo; Keller, Martin; Lundbye-Jensen, Jesper; Taube, Wolfgang

2018-03-01

Research has indicated that at the onset of a finger movement, unwanted contractions of adjacent muscles are prevented by inhibiting the cortical areas representing these muscles. This so-called surround inhibition (SI) seems relevant for the performance of selective finger movements but may not be necessary for tasks involving functional coupling between different finger muscles. Therefore, the present study compared SI between isolated finger movement and complex selective finger movements while playing a three-finger sequence on the piano in nine non-professional musicians and 10 untrained control participants. Transcranial magnetic stimulation (TMS) was applied to the contralateral motor cortex to assess SI in the first dorsal interosseous (FDI), abductor pollicis brevis (APB) and abductor digiti minimi (ADM) during the movement preparation and the late phasic phases. The results reveal stronger SI during the preparation phase than during the phasic phase (30.6% vs. 10.7%; P < 0.05) in the isolated-finger condition in both musicians and controls. Results also show higher SI in musicians during the preparation phase of the isolated finger condition compared to the preparation phase of the three-finger sequence (40% vs. 15%; P < 0.05). However, the control group did not show this task-specific modulation of SI (isolated: 25% vs. sequence: 25%; P > 0.05). Thus, musicians were able to modulate SI between conditions whereas control participants revealed constant levels of SI. Therefore, it may be assumed that long-term training as observed in skilled musicians is accompanied by task-specific effects on SI modulation potentially relating to the ability to perform selective and complex finger movements. Copyright © 2018 IBRO. Published by Elsevier Ltd. All rights reserved.

Accelerated functional recovery after skeletal muscle ischemia-reperfusion injury using freshly isolated bone marrow cells.

PubMed

Corona, Benjamin T; Rathbone, Christopher R

2014-05-01

Relatively little information exists regarding the usefulness of bone marrow-derived cells for skeletal muscle ischemia-reperfusion injury (I/R), especially when compared with I/R that occurs in other tissues. The objectives of this study were to evaluate the ability of freshly isolated bone marrow cells to home to injured skeletal muscle and to determine their effects on muscle regeneration. Freshly isolated lineage-depleted bone marrow cells (Lin(-) BMCs) were injected intravenously 2 d after I/R. Bioluminescent imaging was used to evaluate cell localization for up to 28 d after injury. Muscle function, the percentage of fibers with centrally located nuclei, and the capillary-to-fiber ratio were evaluated 14 d after delivery of either saline (Saline) or saline containing Lin(-) BMCs (Lin(-) BMCs). Bioluminescence was higher in the injured leg than the contralateral control leg for up to 7 d after injection (P < 0.05) suggestive of cell homing to the injured skeletal muscle. Fourteen days after injury, there was a significant improvement in maximal tetanic torque (40% versus 22% deficit; P < 0.05), a faster rate of force production (+dP/dt) (123.6 versus 94.5 Nmm/S; P < 0.05), and a reduction in the percentage of fibers containing centrally located nuclei (40 versus 17%; P < 0.05), but no change in the capillary-to-fiber ratio in the Lin(-) BMC as compared with the Saline group. The homing of freshly isolated BMCs to injured skeletal muscle after I/R is associated with an increase in functional outcomes. Published by Elsevier Inc.

Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report.

PubMed

Yilmaz, Ali; Kizilay, Zahir; Ozkul, Ayca; Çirak, Bayram

2016-03-15

The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood. Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner. Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.

Combined SCI and TBI: Recovery of forelimb function after unilateral cervical spinal cord injury (SCI) is retarded by contralateral traumatic brain injury (TBI), and ipsilateral TBI balances the effects of SCI on paw placement

PubMed Central

Inoue, Tomoo; Lin, Amity; Ma, Xiaokui; McKenna, Stephen L.; Creasey, Graham H.; Manley, Geoffrey T.; Ferguson, Adam R.; Bresnahan, Jacqueline C.; Beattie, Michael S.

2015-01-01

A significant proportion (estimates range from 16–74%) of patients with spinal cord injury (SCI) have concomitant traumatic brain injury (TBI), and the combination often produces difficulties in planning and implementing rehabilitation strategies and drug therapies. For example, many of the drugs used to treat SCI may interfere with cognitive rehabilitation, and conversely drugs that are used to control seizures in TBI patients may undermine locomotor recovery after SCI. The current paper presents an experimental animal model for combined SCI and TBI to help drive mechanistic studies of dual diagnosis. Rats received a unilateral SCI (75 kdyn) at C5 vertebral level, a unilateral TBI (2.0 mm depth, 4.0 m/s velocity impact on the forelimb sensori-motor cortex), or both SCI + TBI. TBI was placed either contralateral or ipsilateral to the SCI. Behavioral recovery was examined using paw placement in a cylinder, grooming, open field locomotion, and the IBB cereal eating test. Over 6 weeks, in the paw placement test, SCI + contralateral TBI produced a profound deficit that failed to recover, but SCI + ipsilateral TBI increased the relative use of the paw on the SCI side. In the grooming test, SCI + contralateral TBI produced worse recovery than either lesion alone even though contralateral TBI alone produced no observable deficit. In the IBB forelimb test, SCI + contralateral TBI revealed a severe deficit that recovered in 3 weeks. For open field locomotion, SCI alone or in combination with TBI resulted in an initial deficit that recovered in 2 weeks. Thus, TBI and SCI affected forelimb function differently depending upon the test, reflecting different neural substrates underlying, for example, exploratory paw placement and stereotyped grooming. Concurrent SCI and TBI had significantly different effects on outcomes and recovery, depending upon laterality of the two lesions. Recovery of function after cervical SCI was retarded by the addition of a moderate TBI in the contralateral hemisphere in all tests, but forepaw placements were relatively increased by an ipsilateral TBI relative to SCI alone, perhaps due to the dual competing injuries influencing the use of both forelimbs. These findings emphasize the complexity of recovery from combined CNS injuries, and the possible role of plasticity and laterality in rehabilitation, and provide a start towards a useful preclinical model for evaluating effective therapies for combine SCI and TBI. PMID:23770071

Combined SCI and TBI: recovery of forelimb function after unilateral cervical spinal cord injury (SCI) is retarded by contralateral traumatic brain injury (TBI), and ipsilateral TBI balances the effects of SCI on paw placement.

PubMed

Inoue, Tomoo; Lin, Amity; Ma, Xiaokui; McKenna, Stephen L; Creasey, Graham H; Manley, Geoffrey T; Ferguson, Adam R; Bresnahan, Jacqueline C; Beattie, Michael S

2013-10-01

A significant proportion (estimates range from 16 to 74%) of patients with spinal cord injury (SCI) have concomitant traumatic brain injury (TBI), and the combination often produces difficulties in planning and implementing rehabilitation strategies and drug therapies. For example, many of the drugs used to treat SCI may interfere with cognitive rehabilitation, and conversely drugs that are used to control seizures in TBI patients may undermine locomotor recovery after SCI. The current paper presents an experimental animal model for combined SCI and TBI to help drive mechanistic studies of dual diagnosis. Rats received a unilateral SCI (75 kdyn) at C5 vertebral level, a unilateral TBI (2.0 mm depth, 4.0 m/s velocity impact on the forelimb sensori-motor cortex), or both SCI+TBI. TBI was placed either contralateral or ipsilateral to the SCI. Behavioral recovery was examined using paw placement in a cylinder, grooming, open field locomotion, and the IBB cereal eating test. Over 6weeks, in the paw placement test, SCI+contralateral TBI produced a profound deficit that failed to recover, but SCI+ipsilateral TBI increased the relative use of the paw on the SCI side. In the grooming test, SCI+contralateral TBI produced worse recovery than either lesion alone even though contralateral TBI alone produced no observable deficit. In the IBB forelimb test, SCI+contralateral TBI revealed a severe deficit that recovered in 3 weeks. For open field locomotion, SCI alone or in combination with TBI resulted in an initial deficit that recovered in 2 weeks. Thus, TBI and SCI affected forelimb function differently depending upon the test, reflecting different neural substrates underlying, for example, exploratory paw placement and stereotyped grooming. Concurrent SCI and TBI had significantly different effects on outcomes and recovery, depending upon laterality of the two lesions. Recovery of function after cervical SCI was retarded by the addition of a moderate TBI in the contralateral hemisphere in all tests, but forepaw placements were relatively increased by an ipsilateral TBI relative to SCI alone, perhaps due to the dual competing injuries influencing the use of both forelimbs. These findings emphasize the complexity of recovery from combined CNS injuries, and the possible role of plasticity and laterality in rehabilitation, and provide a start towards a useful preclinical model for evaluating effective therapies for combine SCI and TBI. Copyright © 2013 Elsevier Inc. All rights reserved.

Getting a Grip on Memory: Unilateral Hand Clenching Alters Episodic Recall

DTIC Science & Technology

2013-04-24

States of America Abstract Unilateral hand clenching increases neuronal activity in the frontal lobe of the contralateral hemisphere. Such hand clenching...Simple clenching of one versus the other hand increases the neuronal activity of the frontal lobe in the opposite (contralateral) hemisphere [1], [2...hemispheres are thought to be differentially involved in many functions, including language , emotion, spatial processing, and local/global informa

[Glomerular changes in the contralateral kidney in the rat with experimental hydronephrosis].

PubMed

Castillo Bernabéu, R; Gázquez Ortiz, A; Bonillo Morales, A; Sierra Planas, M A; Ocaña Losa, J M; Romanos Lezcano, A

1985-10-31

We have studied under optic and electronmicroscopes the alterations of glomeruli in contralateral kidneys of rats with experimental hydronephrosis. Forty-eight Wistar rats, divided into two groups (control and experimental) were used. They were sacrificed 3, 6, 9 and 12 days after ureteral obstruction. There was a slight hypertrophy of glomeruli and hiperplasia of other components accompanied by a increased development of podocytes.

[The morphological features of the nervous and vascular components of communication systems in the cervix uteri].

PubMed

Dorosevich, A E; Bekhtereva, I A; Sudilovskaia, V V

2009-01-01

The investigation has indicated the presence of adrenergic and cholinergic autonomic nerve terminals (ANT) in the tissues of squamous cell carcinomas of the cervix uteri in a tumor growth area and contralaterally. Heterogeneity of the local neuromediator background in the tumor growth area and contralaterally may be explained, by studying the specific features of the cell microenvironment of ANT.

Single-session tDCS over the dominant hemisphere affects contralateral spectral EEG power, but does not enhance neurofeedback-guided event-related desynchronization of the non-dominant hemisphere's sensorimotor rhythm.

PubMed

Mondini, Valeria; Mangia, Anna Lisa; Cappello, Angelo

2018-01-01

Transcranial direct current stimulation (tDCS) and neurofeedback-guided motor imagery (MI) have attracted considerable interest in neurorehabilitation, given their ability to influence neuroplasticity. As tDCS has been shown to modulate event-related desynchronization (ERD), the neural signature of motor imagery detected for neurofeedback, a combination of the techniques was recently proposed. One limitation of this approach is that the area targeted for stimulation is the same from which the signal for neurofeedback is acquired. As tDCS may interfere with proximal electroencephalographic (EEG) electrodes, in this study our aim was to test whether contralateral tDCS could have interhemispheric effects on the spectral power of the unstimulated hemisphere, possibly mediated by transcallosal connection, and whether such effects could be used to enhance ERD magnitudes. A contralateral stimulation approach would indeed facilitate co-registration, as the stimulation electrode would be far from the recording sites. Twenty right-handed healthy volunteers (aged 21 to 32) participated in the study: ten assigned to cathodal, ten to anodal versus sham stimulation. We applied stimulation over the dominant (left) hemisphere, and assessed ERD and spectral power over the non-dominant (right) hemisphere. The effect of tDCS was evaluated over time. Spectral power was assessed in theta, alpha and beta bands, under both rest and MI conditions, while ERD was evaluated in alpha and beta bands. Two main findings emerged: (1) contralateral alpha-ERD was reduced after anodal (p = 0.0147), but not enhanced after cathodal tDCS; (2) both stimulations had remote effects on the spectral power of the contralateral hemisphere, particularly in theta and alpha (significant differences in the topographical t-value maps). The absence of contralateral cathodal ERD enhancement suggests that the protocol is not applicable in the context of MI training. Nevertheless, ERD results of anodal and spectral power results of both stimulations complement recent findings on the distant tDCS effects between functionally related areas.

Single-session tDCS over the dominant hemisphere affects contralateral spectral EEG power, but does not enhance neurofeedback-guided event-related desynchronization of the non-dominant hemisphere's sensorimotor rhythm

PubMed Central

Mangia, Anna Lisa; Cappello, Angelo

2018-01-01

Background and objective Transcranial direct current stimulation (tDCS) and neurofeedback-guided motor imagery (MI) have attracted considerable interest in neurorehabilitation, given their ability to influence neuroplasticity. As tDCS has been shown to modulate event-related desynchronization (ERD), the neural signature of motor imagery detected for neurofeedback, a combination of the techniques was recently proposed. One limitation of this approach is that the area targeted for stimulation is the same from which the signal for neurofeedback is acquired. As tDCS may interfere with proximal electroencephalographic (EEG) electrodes, in this study our aim was to test whether contralateral tDCS could have interhemispheric effects on the spectral power of the unstimulated hemisphere, possibly mediated by transcallosal connection, and whether such effects could be used to enhance ERD magnitudes. A contralateral stimulation approach would indeed facilitate co-registration, as the stimulation electrode would be far from the recording sites. Methods Twenty right-handed healthy volunteers (aged 21 to 32) participated in the study: ten assigned to cathodal, ten to anodal versus sham stimulation. We applied stimulation over the dominant (left) hemisphere, and assessed ERD and spectral power over the non-dominant (right) hemisphere. The effect of tDCS was evaluated over time. Spectral power was assessed in theta, alpha and beta bands, under both rest and MI conditions, while ERD was evaluated in alpha and beta bands. Results Two main findings emerged: (1) contralateral alpha-ERD was reduced after anodal (p = 0.0147), but not enhanced after cathodal tDCS; (2) both stimulations had remote effects on the spectral power of the contralateral hemisphere, particularly in theta and alpha (significant differences in the topographical t-value maps). Conclusion The absence of contralateral cathodal ERD enhancement suggests that the protocol is not applicable in the context of MI training. Nevertheless, ERD results of anodal and spectral power results of both stimulations complement recent findings on the distant tDCS effects between functionally related areas. PMID:29513682

SU-F-T-195: Systematic Constraining of Contralateral Parotid Gland Led to Improved Dosimetric Outcomes for Multi-Field Optimization with Scanning Beam Proton Therapy: Promising Results From a Pilot Study in Patients with Base of Tongue Carcinoma

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

Wu, R; Liu, A; Poenisch, F

Purpose: Treatment planning for Intensity Modulated Proton Therapy (IMPT) for head and neck cancer is time-consuming due to the large number of organs-at-risk (OAR) to be considered. As there are many competing objectives and also wide range of acceptable OAR constraints, the final approved plan may not be most optimal for the given structures. We evaluated the dose reduction to the contralateral parotid by implementing standardized constraints during optimization for scanning beam proton therapy planning. Methods: Twenty-four (24) consecutive patients previously treated for base of tongue carcinoma were retrospectively selected. The doses were 70Gy, 63Gy and 57Gy (SIB in 33more » fractions) for high-, intermediate-, and standard-risk clinical target volumes (CTV), respectively; the treatment included bilateral neck. Scanning beams using MFO with standardized bilateral anterior oblique and PA fields were applied. New plans where then developed and optimized by employing additional contralateral parotid constraints at multiple defined dose levels. Using a step-wise iterative process, the volume-based constraints at each level were then further reduced until known target coverages were compromised. The newly developed plans were then compared to the original clinically approved plans using paired student t-testing. Results: All 24 newly optimized treatment plans maintained initial plan quality as compared to the approved plans, and the 98% prescription dose coverage to the CTV’s were not compromised. Representative DVH comparison is shown in FIGURE 1. The contralateral parotid doses were reduced at all levels of interest when systematic constraints were applied to V10, V20, V30 and V40Gy (All P<0.0001; TABLE 1). Overall, the mean contralateral parotid doses were reduced by 2.26 Gy on average, a ∼13% relative improvement. Conclusion: Applying systematic and volume-based contralateral parotid constraints for IMPT planning significantly reduced the dose at all dosimetric levels for patients with base of tongue cancer.« less

Contralateral suppression of transient otoacoustic emissions and sentence recognition in noise in young adults.

PubMed

Stuart, Andrew; Butler, Alyson K

2012-10-01

One purported role of the medial olivocochlear (MOC) efferent system is to reduce the effects of masking noise. MOC system functioning can be evaluated noninvasively in humans through contralateral suppression of otoacoustic emissions. It has been suggested that the strength of the MOC efferent activity should be positively associated with listening performance in noise. The objective of the study was to further explore this notion by examining contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) and sentence recognition in two noises with normal hearing young adults. A repeated measures multivariate quasi-experimental design was employed. Thirty-two normal hearing young adult females participated. Reception thresholds for sentences (RTSs) were determined monaurally and binaurally in quiet and in competing continuous and interrupted noises. Both noises had an identical power spectrum and differed only in their temporal continuity. "Release from masking" was computed by subtracting RTS signal-to-noise ratios in interrupted from continuous noise. TEOAEs were evoked with 80 dB peSPL click stimuli. To examine contralateral suppression, TEOAEs were evaluated with 60 dB peSPL click stimuli with and without a contralateral 65 dB SPL white noise suppressor. A binaural advantage was observed for RTSs in quiet and noise (p < .0001) while there was no difference between ears (p >.05). In noise, performance was superior in the interrupted noise (i.e., RTSs were lower vs. continuous noise; p < .0001). There were no statistically significant differences in TEOAE levels between ears (p >.05). There was also no significant difference in the amount of suppression between ears (p = .41). There were no significant correlations or predictive linear relations between the amount of TEOAE suppression and any indices of sentence recognition in noise (i.e., RTS signal-to-noise ratios and release from masking; p > .05). The findings are not consistent with the notion that increased medial olivocochlear efferent feedback, as assessed via contralateral suppression of TEOAEs, is associated with improved speech perception in continuous and interrupted noise. American Academy of Audiology.

Impact of Node Negative Target Volume Delineation on Contralateral Parotid Gland Dose Sparing Using IMRT in Head and Neck Cancer.

PubMed

Magnuson, William J; Urban, Erich; Bayliss, R Adam; Harari, Paul M

2015-06-01

There is considerable practice variation in treatment of the node negative (N0) contralateral neck in patients with head and neck cancer. In this study, we examined the impact of N0 neck target delineation volume on radiation dose to the contralateral parotid gland. Following institutional review board approval, 12 patients with head and neck cancer were studied. All had indications for treatment of the N0 neck, such as midline base of tongue or soft palate extension or advanced ipsilateral nodal disease. The N0 neck volumes were created using the Radiation Therapy Oncology Group head and neck contouring atlas. The physician-drawn N0 neck clinical target volume (CTV) was expanded by 25% to 200% to generate volume variation, followed by a 3-mm planning target volume (PTV) expansion. Surrounding organs at risk were contoured and complete intensity-modulated radiation therapy plans were generated for each N0 volume expansion. The median N0 target volume drawn by the radiation oncologist measured 93 cm(3) (range 71-145). Volumetric expansion of the N0 CTV by 25% to 200% increased the resultant mean dose to the contralateral parotid gland by 1.4 to 8.5 Gray (Gy). For example, a 4.1-mm increase in the N0 neck CTV translated to a 2.0-Gy dose increase to the parotid, 7.4 mm to a 4.5 Gy dose increase, and 12.5 mm to an 8.5 Gy dose increase, respectively. The treatment volume designated for the N0 neck has profound impact on resultant dose to the contralateral parotid gland. Variations of up to 15 mm are routine across physicians in target contouring, reflecting individual preference and training expertise. Depending on the availability of immobilization and image guidance techniques, experts commonly recommend 3 to 10 mm margin expansions to generate the PTV. Careful attention to the original volume of the N0 neck CTV, as well as expansion margins, is important in achieving effective contralateral gland sparing to reduce the resultant xerostomia and dysguesia that may ensue after radiotherapy. © The Author(s) 2014.

SU-D-204-04: Correlations Between Dosimetric Indices and Follow-Up Data for Salivary Glands Six Months After Radiation Therapy for Head and Neck Cancer

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

Chera, B; Price, A; Kostich, M

Purpose: To investigate the correlation between different dosimetric indices of salivary glands (as separate or combined structures) to patient-reported dry mouth 6 months post radiotherapy using the novel patient reported outcome version of the CTCAE (PRO-CTCAE). Methods: Forty-three patients with oropharyngeal squamous cell carcinoma were treated on a prospective multi-institutional study. All patients received de-intensified 60 Gy intensity modulated radiotherapy. Dosimetric constraints were used for the salivary glands (e.g. mean dose to the contralateral-parotid < 26 Gy). We investigated correlations of individual patient dosimetric data of the parotid and submandibular glands (as separate or combined structures) to their self-reported 6more » month post-treatment dry mouth responses. Moderate dry mouth responses were most prevalent and were used as the clinical endpoint indicating response. The correlation of Dmean, Dmax and a range of dosevolume (VD) points were assessed through the area under the Receiver Operating Characteristic curve (ROC) and Odds Ratios (OR). Results: Patients reporting non/mild dry mouth response (N=22) had average Dmean = 19.6 ± 6.2Gy to the contralateral-parotid compared to an average Dmean = 28.0 ± 8.3Gy and an AUC = 0.758 for the patients reporting moderate/severe/very severe dry mouth (N=21). Analysis of the range of VD’s for patients who had reported dry mouth showed that for the contralateral-parotid the indices V18 through V22 had the highest area under the curves (AUC) (0.762 – 0.772) compared to a more traditional dosimetric index V30, which had an AUC = 0.732. The highest AUC was observed for the combination of contralateral parotid and contralateral submandibular glands, for which V16 through V28 had AUC = 0.801 – 0.834. Conclusion: Patients who report moderate/severe/very severe dry mouth 6 months post radiotherapy had on average higher Dmean. The V16-V28 of the combination of the contralateral glands showed the highest correlation with the clinical endpoint.« less

Three-dimensional in vivo patellofemoral kinematics and contact area of anterior cruciate ligament-deficient and -reconstructed subjects using magnetic resonance imaging.

PubMed

Shin, Choongsoo S; Carpenter, R Dana; Majumdar, Sharmila; Ma, C Benjamin

2009-11-01

The purpose of this study was to test whether (1) the 3-dimensional in vivo patellofemoral kinematics and patellofemoral contact area of anterior cruciate ligament (ACL)-deficient knees are different from those of normal, contralateral knees and (2) ACL reconstruction restores in vivo patellofemoral kinematics and contact area. Ten ACL-deficient knees and twelve ACL-reconstructed knees, as well as the contralateral uninjured knees, were tested. Magnetic resonance imaging was performed at full extension and 40 degrees of flexion under simulated partial weight-bearing conditions. Six-degrees of freedom patellofemoral kinematics, patellofemoral contact area, and contact location were analyzed by use of magnetic resonance image-based 3-dimensional patellofemoral knee models. The patella in the ACL-deficient knees underwent significantly more lateral tilt during flexion (P < .05) and tended to translate more laterally (P = .083) than the patella in contralateral knees. After ACL reconstruction, no kinematic parameters were significantly different from those in contralateral knees. The patellofemoral contact areas of ACL-deficient knees at both the extended and flexed positions (37 +/- 22 mm(2) and 357 +/- 53 mm(2), respectively) were significantly smaller than those of contralateral knees (78 +/- 45 mm(2) and 437 +/- 119 mm(2), respectively) (P < .05). After reconstruction, the patellofemoral contact area of ACL-reconstructed knees in the extended position (86 +/- 41 mm(2)) was significantly larger (P < .05) than that of contralateral knees (50 +/- 34 mm(2)), but no difference was detected in the flexed position. Reproducibility of all patellofemoral kinematic parameters, contact centroid translation, and contact area showed coefficients of variation of less than 6.8%. ACL injuries alter patellofemoral kinematics including patellar tilt and patellar lateral translation, but ACL reconstruction with hamstring or allograft restores altered patellar tilt. ACL injuries reduce the patellofemoral contact area at both the extended and flexed positions, but ACL reconstruction enlarges the patellofemoral contact area at extension and restores the normal contact area at low angles of flexion. Level III, case-control study.

Progressive contralateral hippocampal atrophy following surgery for medically refractory temporal lobe epilepsy.

PubMed

Elliott, Cameron A; Gross, Donald W; Wheatley, B Matt; Beaulieu, Christian; Sankar, Tejas

2016-09-01

Determine the extent and time course of volumetric changes in the contralateral hippocampus following surgery for medically refractory temporal lobe epilepsy (TLE). Serial T1-weighted MRI brain scans were obtained in 26 TLE patients pre- and post-temporal lobe epilepsy surgery as well as in 12 control subjects of similar age. Patients underwent either anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH). Blinded, manual hippocampal volumetry (head, body, and tail) was performed in two groups: 1) two scan group [ATL (n=6); SAH (n=10)], imaged pre-surgery and on average at 5.4 years post-surgery; and 2) longitudinal group [ATL (n=8); SAH (n=2)] imaged pre-surgery and on post-operative day 1, 2, 3, 6, 60, 120 and a delayed time point (average 2.4 years). In the two scan group, there was atrophy by 12% of the unresected contralateral hippocampus (p<0.001), with atrophy being most pronounced (27%) in the hippocampal body (p<0.001) with no significant differences seen for the hippocampal head or tail. In the longitudinal group, significant atrophy was also observed for the whole hippocampus and the body with atrophy seen as early as post-operative day #1 which progressed significantly over the first post-operative week (1.3%/day and 3.0%./day, respectively) before stabilizing over the long-term to a 13% reduction in total volume. There was no significant difference in atrophy compared by surgical approach (ATL vs. SAH; p=0.94) or side (p=0.31); however, atrophy was significantly more pronounced in patients with ongoing post-operative seizures (hippocampal body, p=0.019; whole hippocampus, p=0.048). There were no detectable post-operative neuropsychological deficits attributable to contralateral hippocampal atrophy. Significant contralateral hippocampal atrophy occurs following TLE surgery, which begins immediately and progresses over the first post-operative week. The observation that seizure free patients had significantly less atrophy of the contralateral hippocampus after surgery suggests the possibility of an early post-operative imaging marker to predict surgical outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

Carotid artery stiffness in patients with symptomatic carotid artery disease with contralateral asymptomatic carotid artery disease and in patients with bilateral asymptomatic carotid artery disease: a cine phase-contrast carotid MR study.

PubMed

Sadat, Umar; Usman, Ammara; Howarth, Simon P S; Tang, Tjun Y; Alam, Fahreyar; Graves, Martin J; Gillard, Jonathan H

2014-04-01

Atherosclerosis is a systemic inflammatory disease that may affect multiple arterial beds simultaneously. Vascular distensibility is increasingly used in the clinical assessment of patients with atherosclerotic disease. In this study, we assess distensibility of symptomatic atherosclerotic carotid artery and of contralateral asymptomatic side. We also investigate the distensibility of bilaterally asymptomatic atherosclerotic carotid arteries using cine phase-contrast carotid magnetic resonance (MR) imaging. Nineteen patients with bilateral carotid artery disease underwent cine phase-contrast carotid imaging on a 1.5 T MR system. Ten patients had ipsilateral symptomatic carotid artery disease and contralateral asymptomatic stenosis. Nine additional patients with bilateral asymptomatic carotid artery disease constituted historical control group. Cine phase-contrast MR imaging acquired at the common carotid artery, maximum luminal stenosis, and internal carotid artery was used to determine carotid distensibility bilaterally for carotid arteries in both patient groups. Symptomatic carotid arteries were found to be significantly less distensible (mean distensibility coefficient [DC] 35.4 ± 6.12 × 10(-3)/kPa) than the contralateral asymptomatic vessels (mean DC 54.4 ± 7.88 × 10(-3)/kPa, P = .03) at the level of the common carotid artery. A similar trend of high distensibility for asymptomatic side in the area of maximum stenosis and the internal carotid artery was seen, but it was not found to be statistically significant. Plaque burden was comparable between the 2 groups at all locations. DC was comparable for patients with bilateral asymptomatic carotid artery stenoses. Distensibility of bilaterally asymptomatic carotid arteries was greater than that of asymptomatic carotid artery contralateral to the symptomatic side. Symptomatic carotid artery is stiffer than the contralateral asymptomatic side, despite comparable plaque burden. Patients with bilateral asymptomatic carotid artery disease have comparable stiffness. Larger studies are warranted to further investigate the findings of this MR study. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization.

PubMed

Garlipp, Benjamin; de Baere, Thierry; Damm, Robert; Irmscher, Romy; van Buskirk, Mark; Stübs, Patrick; Deschamps, Frederic; Meyer, Frank; Seidensticker, Ricarda; Mohnike, Konrad; Pech, Maciej; Amthauer, Holger; Lippert, Hans; Ricke, Jens; Seidensticker, Max

2014-05-01

In patients with liver malignancies potentially amenable to curative extended right hepatectomy but insufficient size of the future liver remnant (FLR), portal vein embolization (PVE) of the tumor-bearing liver is used to induce contralateral liver hypertrophy but leaves the tumor untreated. Radioembolization (RE) treats the tumor in the embolized lobe along with contralateral hypertrophy induction. We performed a matched-pair analysis to compare the capacity for hypertrophy induction of these two modalities. Patients with right-hepatic secondary liver malignancies with no or negligible left-hepatic tumor involvement who were treated by right-lobar PVE (n = 141) or RE (n = 35) at two centers were matched for criteria known to influence liver regeneration following PVE: 1) baseline FLR/Total liver volume ratio (<25 versus ≥ 25%); 2) prior platinum-containing systemic chemotherapy; 3) embolization of segments 5-8 versus 4-8; and 4) baseline platelet count (<200 versus ≥ 200 Gpt/L).The primary endpoint was relative change in FLR volume from baseline to follow-up. Twenty-six matched pairs were identified. FLR volume increase from baseline to follow-up (median 33 [24-56] days after PVE or 46 [27-79] days after RE) was significant in both groups but PVE produced significantly more FLR hypertrophy than RE (61.5 versus 29%, P < 0.001). Time between treatment and follow-up was not correlated with the degree of contralateral hypertrophy achieved in both groups. Although group differences in patient history and treatment setting were present and some bias cannot be excluded, this was minimized by the matched-pair design, as remaining group differences after matching were found to have no significant influence on contralateral hypertrophy development. PVE induces significantly more contralateral hypertrophy than RE with therapeutic (nonlobectomy) doses. However, contralateral hypertrophy induced by RE is substantial and RE minimizes the risk of tumor progression in the treated lobe, possibly making it a suitable modality for selected patients. © 2014 by the American Association for the Study of Liver Diseases.

Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center.

PubMed

Roberts, Amanda; Sandhu, Lakhbir; Cil, Tulin D; Hofer, Stefan O P; Zhong, Toni

2016-06-10

To examine trends of contralateral prophylactic mastectomy (CPM) rates at a Canadian academic breast cancer center. A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy (UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010 were included. Patients who underwent CPM on the same day as UM were isolated to create two distinct cohorts. Patient and procedure characteristics were compared across groups using R software (version 3.1.0). The percentage of CPMs per year was determined. The Cochrane-Armitage test was used to assess the trend of CPMs over time. A P value of < 0.05 was considered significant. A total of 811 women met the inclusions/exclusion criteria; 759 (93.6%) underwent UM alone and 52 (6.4%) underwent UM with immediate CPM. The absolute number of procedures (UM and UM + CPM) increased over time, from 83 in 2004 to 147 in 2010 reflecting an increase in mastectomy volume. Annual CPM rates did not increase over time (P = 0.7) and varied between 2.6% to 10.7%. Family history of breast cancer [OR 3.6 (1.8-7.3)] and immediate reconstruction [10.0 (5.2-19.3)] were both significantly associated with CPM. Women who underwent CPM were younger (median age CPM 49 years vs UM 52 years, P < 0.0001) but age less than 50 years was not statistically associated with increased rates of CPM. CPM rates from 2004 to 2010 at a high-volume Canadian breast cancer center did not increase over time, in contrast to trends observed in the United States.

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants

PubMed Central

Gao, Kai-ming; Hu, Jing-jing; Lao, Jie; Zhao, Xin

2018-01-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033). PMID:29623932

Role of Active Listening and Listening Effort on Contralateral Suppression of Transient Evoked Otoacousic Emissions.

PubMed

Kalaiah, Mohan Kumar; Theruvan, Nikhitha B; Kumar, Kaushlendra; Bhat, Jayashree S

2017-04-01

The present study aimed to investigate the effect of active listening and listening effort on the contralateral suppression of transient evoked otoacoustic emissions (CSTEOAEs). Twenty eight young adults participated in the study. Transient evoked otoacoustic emissions (TEOAEs) were recorded using 'linear' clicks at 60 dB peSPL, in three contralateral noise conditions. In condition 1, TEOAEs were obtained in the presence of white noise in the contralateral ear. While, in condition 2, speech was embedded into white noise at +3, -3, and -9 dB signal-to-noise ratio (SNR) and delivered to the contralateral ear. The SNR was varied to investigate the effect of listening effort on the CSTEOAE. In condition 3, speech was played backwards and embedded into white noise at -3 dB SNR. The conditions 1 and 3 served as passive listening condition and the condition 2 served as active listening condition. In active listening condition, the participants categorized the words in to two groups (e.g., animal and vehicle). CSTEOAE was found to be largest in the presence of white noise, and the amount of CSTEOAE was not significantly different between active and passive listening conditions (condition 2 and 3). Listening effort had an effect on the CSTEOAE, the amount of suppression increased with listening effort, when SNR was decreased from +3 dB to -3 dB. However, when the SNR was further reduced to -9 dB, there was no further increase in the amount of CSTEOAE, instead there was a reduction in the amount of suppression. The findings of the present study show that listening effort might affect CSTEOAE.

Role of Active Listening and Listening Effort on Contralateral Suppression of Transient Evoked Otoacousic Emissions

PubMed Central

Theruvan, Nikhitha B; Kumar, Kaushlendra; Bhat, Jayashree S

2017-01-01

Background and Objectives The present study aimed to investigate the effect of active listening and listening effort on the contralateral suppression of transient evoked otoacoustic emissions (CSTEOAEs). Subjects and Methods Twenty eight young adults participated in the study. Transient evoked otoacoustic emissions (TEOAEs) were recorded using ‘linear’ clicks at 60 dB peSPL, in three contralateral noise conditions. In condition 1, TEOAEs were obtained in the presence of white noise in the contralateral ear. While, in condition 2, speech was embedded into white noise at +3, −3, and −9 dB signal-to-noise ratio (SNR) and delivered to the contralateral ear. The SNR was varied to investigate the effect of listening effort on the CSTEOAE. In condition 3, speech was played backwards and embedded into white noise at −3 dB SNR. The conditions 1 and 3 served as passive listening condition and the condition 2 served as active listening condition. In active listening condition, the participants categorized the words in to two groups (e.g., animal and vehicle). Results CSTEOAE was found to be largest in the presence of white noise, and the amount of CSTEOAE was not significantly different between active and passive listening conditions (condition 2 and 3). Listening effort had an effect on the CSTEOAE, the amount of suppression increased with listening effort, when SNR was decreased from +3 dB to −3 dB. However, when the SNR was further reduced to −9 dB, there was no further increase in the amount of CSTEOAE, instead there was a reduction in the amount of suppression. Conclusions The findings of the present study show that listening effort might affect CSTEOAE. PMID:28417101

Analysis of Surgical Freedom Variation Across the Basilar Artery Bifurcation: Towards a Deeper Insight Into Approach Selection for Basilar Apex Aneurysms.

PubMed

Tayebi Meybodi, Ali; Benet, Arnau; Rodriguez Rubio, Roberto; Yousef, Sonia; Lawton, Michael T

2018-03-03

The orbitozygomatic approach is generally advocated over the pterional approach for basilar apex aneurysms. However, the impact of the extensions of the pterional approach on the obtained maneuverability over multiple vascular targets (relevant to basilar apex surgery) has not been studied before. To analyze the patterns of surgical freedom change across the basilar bifurcation between the pterional, orbitopterional, and orbitozygomatic approaches. Surgical freedom was assessed for 3 vascular targets important in basilar apex aneurysm surgery (ipsilateral and contralateral P1-P2 junctions, and basilar apex), and compared between the pterional, orbitopterional, and orbitozygomatic approaches in 10 cadaveric specimens. Transitioning from the pterional to orbitopterional approach, the surgical freedom increased significantly at all 3 targets (P < .05). However, the gain in surgical freedom declined progressively from the most superficial target (60% for ipsilateral P1-P2 junction) to the deepest target (35% for contralateral P1-P2 junction). Conversely, transitioning from the orbitopterional to the orbitozygomatic approach, the gain in surgical freedom was minimal for the ipsilateral P1-P2 and basilar apex (<4%), but increased dramatically to 19% at the contralateral P1-P2 junction. The orbitopterional approach provides a remarkable increase in surgical maneuverability compared to the pterional approach for the basilar apex target and the relevant adjacent arterial targets. However, compared to the orbitopterional, the orbitozygomatic approach adds little maneuverability except for the deepest target (ie, contralateral P1-P2 junction). Therefore, the orbitozygomatic approach may be most efficacious with larger basilar apex aneurysms limiting the control over of the contralateral P1 PCA.

Different functional reorganization of motor cortex after transfer of the contralateral C7 to different recipient nerves in young rats with total brachial plexus root avulsion.

PubMed

Pan, Feng; Wei, Hai-feng; Chen, Liang; Gu, Yu-dong

2012-12-07

Clinically, contralateral C7 transfer is used for nerve reconstruction in brachial plexus injuries. Postoperatively, synchronous motions at the donor limb are noteworthy. This study studied if different recipient nerves influenced transhemispheric functional reorganization of motor cortex after this procedure. 90 young rats with total root avulsion of the brachial plexus were divided into groups 1-3 of contralateral C7 transfer to anterior division of the upper trunk, to both the musculocutaneous and median nerves, and to the median nerve, respectively. After reinnervation of target muscles, number of sites for forelimb representations in bilateral motor cortices was determined by intracortical microstimulation at 1.5, 3, 6, 9, and 12 months postoperatively. At nine months, transhemispheric reorganization of nerves neurotized by contralateral C7 was fulfilled in four of six rats in group 1, one of six in group 2 and none in group 3, respectively; at 12 months, that was fulfilled in five of six in group 1, four of six in groups 2 and 3, respectively. Logistic regression analysis showed that rate of fulfilled transhemispheric reorganization in group 1 was 12.19 times that in group 3 (95% CI 0.006-0.651, p=0.032). At 12 months, number of sites for hindlimb representations which had encroached upon original forelimb representations on the uninjured side was statistically more in group 3 than in group 2 (t=9.5, p<0.0001). It is concluded that contralateral C7 transfer to upper trunk or to both the musculocutaneous and median nerves induces faster transhemispheric functional reorganization of motor cortex than that to median nerve alone in rats. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Use-Dependent Dendritic Regrowth Is Limited after Unilateral Controlled Cortical Impact to the Forelimb Sensorimotor Cortex

PubMed Central

Jones, Theresa A.; Liput, Daniel J.; Maresh, Erin L.; Donlan, Nicole; Parikh, Toral J.; Marlowe, Dana

2012-01-01

Abstract Compensatory neural plasticity occurs in both hemispheres following unilateral cortical damage incurred by seizures, stroke, and focal lesions. Plasticity is thought to play a role in recovery of function, and is important for the utility of rehabilitation strategies. Such effects have not been well described in models of traumatic brain injury (TBI). We examined changes in immunoreactivity for neural structural and plasticity-relevant proteins in the area surrounding a controlled cortical impact (CCI) to the forelimb sensorimotor cortex (FL-SMC), and in the contralateral homotopic cortex over time (3–28 days). CCI resulted in considerable motor deficits in the forelimb contralateral to injury, and increased reliance on the ipsilateral forelimb. The density of dendritic processes, visualized with immunostaining for microtubule-associated protein-2 (MAP-2), were bilaterally decreased at all time points. Synaptophysin (SYN) immunoreactivity increased transiently in the injured hemisphere, but this reflected an atypical labeling pattern, and it was unchanged in the contralateral hemisphere compared to uninjured controls. The lack of compensatory neuronal structural plasticity in the contralateral homotopic cortex, despite behavioral asymmetries, is in contrast to previous findings in stroke models. In the cortex surrounding the injury (but not the contralateral cortex), decreases in dendrites were accompanied by neurodegeneration, as indicated by Fluoro-Jade B (FJB) staining, and increased expression of the growth-inhibitory protein Nogo-A. These studies indicate that, following unilateral CCI, the cortex undergoes neuronal structural degradation in both hemispheres out to 28 days post-injury, which may be indicative of compromised compensatory plasticity. This is likely to be an important consideration in designing therapeutic strategies aimed at enhancing plasticity following TBI. PMID:22352953

Carotid Artery Stenting and Blood-Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis.

PubMed

Szarmach, Arkadiusz; Halena, Grzegorz; Kaszubowski, Mariusz; Piskunowicz, Maciej; Studniarek, Michal; Lass, Piotr; Szurowska, Edyta; Winklewski, Pawel J

2017-05-08

Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (-9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT -16.09%, TTP -7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT -14.65%, TTP -7.46%) sides. PS decreased by almost half: ipsilateral -48.11%, contralateral -45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.

Is NAA reduction in normal contralateral cerebral tissue in stroke patients dependent on underlying risk factors?

PubMed

Walker, P M; Ben Salem, D; Giroud, M; Brunotte, F

2006-05-01

This retrospective study investigated the dependence of N-acetyl aspartate (NAA) ratios on risk factors for cerebral vasculopathy such as sex, age, hypertension, diabetes mellitus, carotid stenosis, and dyslipidaemia, which may have affected brain vessels and induced metabolic brain abnormalities prior to stroke. We hypothesise that in stroke patients metabolic alterations in the apparently normal contralateral brain are dependent on the presence or not of such risk factors. Fifty nine patients (31 male, 28 female: 58.8+/-16.1 years old) with cortical middle cerebral artery (MCA) territory infarction were included. Long echo time chemical shift imaging spectroscopy was carried out on a Siemens 1.5 T Magnetom Vision scanner using a multi-voxel PRESS technique. Metabolite ratios (NAA/choline, NAA/creatine, lactate/choline, etc) were studied using uni- and multivariate analyses with respect to common risk factors. The influence of age, stroke lesion size, and time since stroke was studied using a linear regression approach. Age, sex, and hypertension all appeared to individually influence metabolite ratios, although only hypertension was significant after multivariate analysis. In both basal ganglia and periventricular white matter regions in apparently normal contralateral brain, the NAA/choline ratio was significantly lower in hypertensive (1.37+/-0.16 and 1.50+/-0.19, respectively) than in normotensive patients (1.72+/-0.19 and 1.85+/-0.15, respectively). Regarding MCA infarction, contralateral tissue remote from the lesion behaves abnormally in the presence of hypertension, the NAA ratios in hypertensive patients being significantly lower. These data suggest that hypertension may compromise the use of contralateral tissue data as a reference for comparison with ischaemic tissue.

Decreasing an Offloading Device's Size and Offsetting Its Imposed Limb Length Discrepancy Lead to Improved Comfort and Gait.

PubMed

Crews, Ryan T; Candela, Joseph

2018-04-17

Patient adherence is a challenge in offloading diabetic foot ulcers (DFUs) with removable cast walkers (RCWs). The size and weight of an RCW, changes to gait, and imposed limb length discrepancies may all discourage adherence. This study sought to determine whether RCW size and provision of a contralateral limb lift affected users' comfort and gait. Twenty-five individuals at risk for DFUs completed several 20-m walking trials under five footwear conditions: bilateral standardized shoes, a knee-high RCW with shoe with or without an external shoe lift contralaterally, and an ankle-high RCW with shoe with or without an external shoe lift contralaterally. Perceived comfort ratings were assessed through the use of visual analog scales. Spatial and temporal parameters of gait were captured by an instrumented walkway, and plantar pressure was measured and recorded using pedobarographic insoles. The bilateral shoes condition was reported to be most comfortable; both RCW conditions without the lift were significantly less comfortable ( P < 0.01). In contrast to the ankle-high RCW, the knee-high RCW resulted in significantly slower walking (5.6%; P < 0.01) but greater offloading in multiple forefoot regions of the offloaded foot (6.8-8.1%; P < 0.01). Use of the contralateral shoe lift resulted in significantly less variability in walking velocity (52.8%; P < 0.01) and reduced stance time for the offloaded foot (2.6%; P = 0.01), but it also reduced offloading in multiple forefoot regions of the offloaded foot (3.7-6.0%; P < 0.01). Improved comfort and gait were associated with the ankle-high RCW and contralateral limb lift. Providing this combination to patients with active DFUs may increase offloading adherence and subsequently improve healing. © 2018 by the American Diabetes Association.

Hop Distance Symmetry Does Not Indicate Normal Landing Biomechanics in Adolescent Athletes With Recent Anterior Cruciate Ligament Reconstruction.

PubMed

Wren, Tishya A L; Mueske, Nicole M; Brophy, Christopher H; Pace, J Lee; Katzel, Mia J; Edison, Bianca R; VandenBerg, Curtis D; Zaslow, Tracy L

2018-03-30

Study Design Retrospective cohort. Background Return to sport (RTS) protocols after anterior cruciate ligament reconstruction (ACLR) often include assessment of hop distance symmetry. However, it is unclear if movement deficits are present regardless of hop symmetry. Objectives To assess biomechanics and symmetry of adolescent athletes following ACLR during a single leg hop for distance. Methods Forty-six patients with ACLR (5-12 months post-surgery; 27 female; age 15.6, SD 1.7 years) were classified as asymmetric (operative limb hop distance <90% of non-operative limb; n=17) or symmetric (n=29). Lower extremity biomechanics were compared among operative and contralateral limbs and 24 symmetric controls (12 female; age 14.7, SD 1.5 years) using ANOVA. Results Compared to controls, asymmetric patients hopped a shorter distance on their operative limb (P<0.001), while symmetric patients hopped an intermediate distance on both sides (P≥0.12). During landing, operative limbs, regardless of hop distance, exhibited lower knee flexion moments compared to controls and the contralateral side (P≤0.04) with lower knee energy absorption than the contralateral side (P≤0.006). During take-off, both symmetric and asymmetric patients had less hip extension and smaller ankle range of motion on the operative side compared with controls (P≤0.05). Asymmetric patients also had lower hip range of motion on the operative, compared with the contralateral, side (P=0.001). Conclusion Both symmetric and asymmetric patients offloaded the operative knee; symmetric patients achieved symmetry in part by hopping a shorter distance on the contralateral side. Therefore, hop distance symmetry may not be an adequate test of single limb function and RTS readiness. Level of Evidence 2b. J Orthop Sports Phys Ther, Epub 30 Mar 2018. doi:10.2519/jospt.2018.7817.

Cross-education of muscular strength following unilateral resistance training: a meta-analysis.

PubMed

Manca, A; Dragone, D; Dvir, Z; Deriu, Franca

2017-11-01

Cross-education (CE) of strength is a well-known phenomenon whereby exercise of one limb can induce strength gains in the contralateral untrained limb. The only available meta-analyses on CE, which date back to a decade ago, estimated a modest 7.8% increase in contralateral strength following unilateral training. However, in recent years new evidences have outlined larger contralateral gains, which deserve to be systematically evaluated. Therefore, the aim of this meta-analysis was to appraise current data on CE and determine its overall magnitude of effect. Five databases were searched from inception to December 2016. All randomized controlled trials focusing on unilateral resistance training were carefully checked by two reviewers who also assessed the eligibility of the identified trials and extracted data independently. The risk of bias was assessed using the Cochrane Risk-of-Bias tool. Thirty-one studies entered the meta-analysis. Data from 785 subjects were pooled and subgroup analyses by body region (upper/lower limb) and type of training (isometric/concentric/eccentric/isotonic-dynamic) were performed. The pooled estimate of CE was a significant 11.9% contralateral increase (95% CI 9.1-14.8; p < 0.00001; upper limb: + 9.4%, p < 0.00001; lower limb: + 16.4%, p < 0.00001). Significant CE effects were induced by isometric (8.2%; p = 0.0003), concentric (11.3%; p < 0.00001), eccentric (17.7%; p = 0.003) and isotonic-dynamic training (15.9%; p < 0.00001), although a high risk of bias was detected across the studies. Unilateral resistance training induces significant contraction type-dependent gains in the contralateral untrained limb. Methodological issues in the included studies are outlined to provide guidance for a reliable quantification of CE in future studies.

The central pattern generator underlying swimming in Dendronotus iris: a simple half-center network oscillator with a twist.

PubMed

Sakurai, Akira; Katz, Paul S

2016-10-01

The nudibranch mollusc, Dendronotus iris, swims by rhythmically flexing its body from left to right. We identified a bilaterally represented interneuron, Si3, that provides strong excitatory drive to the previously identified Si2, forming a half-center oscillator, which functions as the central pattern generator (CPG) underlying swimming. As with Si2, Si3 inhibited its contralateral counterpart and exhibited rhythmic bursts in left-right alternation during the swim motor pattern. Si3 burst almost synchronously with the contralateral Si2 and was coactive with the efferent impulse activity in the contralateral body wall nerve. Perturbation of bursting in either Si3 or Si2 by current injection halted or phase-shifted the swim motor pattern, suggesting that they are both critical CPG members. Neither Si2 nor Si3 exhibited endogenous bursting properties when activated alone; activation of all four neurons was necessary to initiate and maintain the swim motor pattern. Si3 made a strong excitatory synapse onto the contralateral Si2 to which it is also electrically coupled. When Si3 was firing tonically but not exhibiting bursting, artificial enhancement of the Si3-to-Si2 synapse using dynamic clamp caused all four neurons to burst. In contrast, negation of the Si3-to-Si2 synapse by dynamic clamp blocked ongoing swim motor patterns. Together, these results suggest that the Dendronotus swim CPG is organized as a "twisted" half-center oscillator in which each "half" is composed of two excitatory-coupled neurons from both sides of the brain, each of which inhibits its contralateral counterpart. Consisting of only four neurons, this is perhaps the simplest known network oscillator for locomotion. Copyright © 2016 the American Physiological Society.

Adaptation of muscles of the lumbar spine to sudden imbalance in patients with lower back pain caused by military training

PubMed Central

Gao, Ying; Shi, Jian-guo; Ye, Hong; Liu, Zhi-rong; Zheng, Long-bao; Ni, Zhi-ming; Fan, Liang-quan; Wang, Jian; Hou, Zhen-hai

2014-01-01

Objective This study aims to investigate the effects of sudden load changes (expected and unexpected imbalance) on the activity of muscles of the lumbar spine and their central motor control strategy in military personnel with or without chronic low back pain (LBP). Design Bilateral sudden imbalance was examined (2 × 2 factorial design). Setting The 117th PLA Hospital, Hangzhou, China Participants Twenty-one male subjects with lower back pain and 21 male healthy control subjects were active members of the Nanjing Military Region land forces. Outcome measures Independent variables: LBP vs. healthy controls and imbalance anticipation (expected and unexpected imbalance). Dependent variables: rapid reaction time (RRT) and intensity of rapid reaction (IRR) of bilateral lumbar (L3–L4) erector spinae (ES), lumbar (L5–S1) multifidus (MF), and abdominal external oblique muscles. Results Under expected or unexpected sudden imbalance conditions, subjects with LBP demonstrated significantly greater IRR than healthy controls in ipsilateral and contralateral ES and MF, respectively (P < 0.05 for all). IRR of contralateral ES was significantly larger than that of the ipsilateral ES. A significant group effect of RRT of both ipsilateral and contralateral ES muscles and a significant time expectation effect on RRT of contralateral MF muscles were also observed. RRT of the contralateral ES muscles was significantly lower than that of the ipsilateral ES muscles (P < 0.001). Conclusions Sudden imbalance prolonged RRT of selected trunk muscles in patients with chronic LBP. The activation amplitude increased. The results may provide a theoretical basis for a study on the pathogenesis of chronic LBP. PMID:24621023

Area- and band-specific representations of hand movements by local field potentials in caudal cingulate motor area and supplementary motor area of monkeys

PubMed Central

Yokoyama, Osamu; Nakayama, Yoshihisa

2016-01-01

The caudal cingulate motor area (CMAc) and the supplementary motor area (SMA) play important roles in movement execution. The present study examined the neural mechanisms underlying these roles by investigating local field potentials (LFPs) from these areas while monkeys pressed buttons with either their left or right hand. During hand movement, power increases in the high-gamma (80–120 Hz) and theta (3–8 Hz) bands and a power decrease in the beta (12–30 Hz) band were observed in both the CMAc and SMA. High-gamma and beta activity in the SMA predominantly represented contralateral hand movements, whereas activity in the CMAc preferentially represented movement of either hand. Theta activity in both brain regions most frequently reflected movement of either hand, but a contralateral hand bias was more evident in the SMA than in the CMAc. An analysis of the relationships of the laterality representations between the high-gamma and theta bands at each recording site revealed that, irrespective of the hand preference for the theta band, the high-gamma band in the SMA preferentially represented contralateral hand movement, whereas the high-gamma band in the CMAc represented movement of either hand. These findings suggest that the input-output relationships for ipsilateral and contralateral hand movements in the CMAc and SMA differ in terms of their functionality. The CMAc may transform the input signals representing general aspects of movement into commands to perform movements with either hand, whereas the SMA may transform the input signals into commands to perform movement with the contralateral hand. PMID:26792884

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: A retrospective study of 73 participants.

PubMed

Gao, Kai-Ming; Hu, Jing-Jing; Lao, Jie; Zhao, Xin

2018-03-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C 7 -transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C 7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C 7 transfer (33 cases) than for those who received partial contralateral C 7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C 7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033).

Cytokine mRNA expression in synovial fluid of affected and contralateral stifle joints and the left shoulder joint in dogs with unilateral disease of the stifle joint.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Duchateau, Luc; Cox, Eric

2007-09-01

To examine mRNA expression of cytokines in synovial fluid (SF) cells from dogs with cranial cruciate ligament (CrCL) rupture and medial patellar luxation (MPL) and determine mRNA expression for 3 joints (affected stifle, unaffected contralateral stifle, and left shoulder joints) in dogs with unilateral CrCL rupture. 29 stifle joints with CrCL rupture (29 dogs), 8 stifle joints with MPL (7 dogs), and 24 normal stifle joints (16 clinically normal dogs). Immediately before reconstructive surgery, SF was aspirated from the cruciate-deficient stifle joint or stifle joint with MPL. Fourteen of 29 dogs had unilateral CrCL rupture; SF was also aspirated from the unaffected contralateral stifle joint and left shoulder joint. Those 14 dogs were examined 6 and 12 months after reconstructive surgery. Total RNA was extracted from SF cells and reverse transcription-PCR assay was performed to obtain cDNA. Canine-specific cytokine mRNA expression was determined by use of a real-time PCR assay. Interleukin (IL)-8 and -10 and interferon-gamma expression differed significantly between dogs with arthropathies and dogs with normal stifle joints. For the 14 dogs with unilateral CrCL rupture, a significant difference was found for IL-8 expression. Before reconstructive surgery, IL-8 expression differed significantly between the affected stifle joint and left shoulder joint or contralateral stifle joint. Six months after surgery, IL-8 expression was significantly increased in the unaffected contralateral stifle joint, compared with the shoulder joint. No conclusions can be made regarding the role of the examined cytokines in initiation of CrCL disease.

Use-dependent dendritic regrowth is limited after unilateral controlled cortical impact to the forelimb sensorimotor cortex.

PubMed

Jones, Theresa A; Liput, Daniel J; Maresh, Erin L; Donlan, Nicole; Parikh, Toral J; Marlowe, Dana; Kozlowski, Dorothy A

2012-05-01

Compensatory neural plasticity occurs in both hemispheres following unilateral cortical damage incurred by seizures, stroke, and focal lesions. Plasticity is thought to play a role in recovery of function, and is important for the utility of rehabilitation strategies. Such effects have not been well described in models of traumatic brain injury (TBI). We examined changes in immunoreactivity for neural structural and plasticity-relevant proteins in the area surrounding a controlled cortical impact (CCI) to the forelimb sensorimotor cortex (FL-SMC), and in the contralateral homotopic cortex over time (3-28 days). CCI resulted in considerable motor deficits in the forelimb contralateral to injury, and increased reliance on the ipsilateral forelimb. The density of dendritic processes, visualized with immunostaining for microtubule-associated protein-2 (MAP-2), were bilaterally decreased at all time points. Synaptophysin (SYN) immunoreactivity increased transiently in the injured hemisphere, but this reflected an atypical labeling pattern, and it was unchanged in the contralateral hemisphere compared to uninjured controls. The lack of compensatory neuronal structural plasticity in the contralateral homotopic cortex, despite behavioral asymmetries, is in contrast to previous findings in stroke models. In the cortex surrounding the injury (but not the contralateral cortex), decreases in dendrites were accompanied by neurodegeneration, as indicated by Fluoro-Jade B (FJB) staining, and increased expression of the growth-inhibitory protein Nogo-A. These studies indicate that, following unilateral CCI, the cortex undergoes neuronal structural degradation in both hemispheres out to 28 days post-injury, which may be indicative of compromised compensatory plasticity. This is likely to be an important consideration in designing therapeutic strategies aimed at enhancing plasticity following TBI.

GABA-mediated changes in inter-hemispheric beta frequency activity in early-stage Parkinson’s disease

PubMed Central

Hall, S.D.; Prokic, E.J.; McAllister, C.J.; Ronnqvist, K.C.; Williams, A.C.; Yamawaki, N.; Witton, C.; Woodhall, G.L.; Stanford, I.M.

2014-01-01

In Parkinson’s disease (PD), elevated beta (15–35 Hz) power in subcortical motor networks is widely believed to promote aspects of PD symptomatology, moreover, a reduction in beta power and coherence accompanies symptomatic improvement following effective treatment with l-DOPA. Previous studies have reported symptomatic improvements that correlate with changes in cortical network activity following GABAA receptor modulation. In this study we have used whole-head magnetoencephalography to characterize neuronal network activity, at rest and during visually cued finger abductions, in unilaterally symptomatic PD and age-matched control participants. Recordings were then repeated following administration of sub-sedative doses of the hypnotic drug zolpidem (0.05 mg/kg), which binds to the benzodiazepine site of the GABAA receptor. A beamforming based ‘virtual electrode’ approach was used to reconstruct oscillatory power in the primary motor cortex (M1), contralateral and ipsilateral to symptom presentation in PD patients or dominant hand in control participants. In PD patients, contralateral M1 showed significantly greater beta power than ipsilateral M1. Following zolpidem administration contralateral beta power was significantly reduced while ipsilateral beta power was significantly increased resulting in a hemispheric power ratio that approached parity. Furthermore, there was highly significant correlation between hemispheric beta power ratio and Unified Parkinson’s Disease Rating Scale (UPDRS). The changes in contralateral and ipsilateral beta power were reflected in pre-movement beta desynchronization and the late post-movement beta rebound. However, the absolute level of movement-related beta desynchronization was not altered. These results show that low-dose zolpidem not only reduces contralateral beta but also increases ipsilateral beta, while rebalancing the dynamic range of M1 network oscillations between the two hemispheres. These changes appear to underlie the symptomatic improvements afforded by low-dose zolpidem. PMID:25261686

Quantitative Analysis of Geometry and Lateral Symmetry of Proximal Middle Cerebral Artery.

PubMed

Peter, Roman; Emmer, Bart J; van Es, Adriaan C G M; van Walsum, Theo

2017-10-01

The purpose of our work is to quantitatively assess clinically relevant geometric properties of proximal middle cerebral arteries (pMCA), to investigate the degree of their lateral symmetry, and to evaluate whether the pMCA can be modeled by using state-of-the-art deformable image registration of the ipsi- and contralateral hemispheres. Individual pMCA segments were identified, quantified, and statistically evaluated on a set of 55 publicly available magnetic resonance angiography time-of-flight images. Rigid and deformable image registrations were used for geometric alignment of the ipsi- and contralateral hemispheres. Lateral symmetry of relevant geometric properties was evaluated before and after the image registration. No significant lateral differences regarding tortuosity and diameters of contralateral M1 segments of pMCA were identified. Regarding the length of M1 segment, 44% of all subjects could be considered laterally symmetrical. Dominant M2 segment was identified in 30% of men and 9% of women in both brain hemispheres. Deformable image registration performed significantly better (P < .01) than rigid registration with regard to distances between the ipsi- and the contralateral centerlines of M1 segments (1.5 ± 1.1 mm versus 2.8 ± 1.2 mm respectively) and between the M1 and the anterior cerebral artery (ACA) branching points (1.6 ± 1.4 mm after deformable registration). Although natural lateral variation of the length of M1 may not allow for sufficient modeling of the complete pMCA, deformable image registration of the contralateral brain hemisphere to the ipsilateral hemisphere is feasible for localization of ACA-M1 branching point and for modeling 71 ± 23% of M1 segment. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

External root resorption during orthodontic treatment in root-filled teeth and contralateral teeth with vital pulp: A clinical study of contributing factors.

PubMed

Lee, Yun Ju; Lee, Tae Yeon

2016-01-01

There is a lack of research to support the belief that root canal treatment can be considered for stopping or decreasing external apical root resorption (EARR). There is conflicting evidence as to whether root-filled teeth are more or less likely to experience EARR after orthodontic treatment. The purpose of this study was to compare the degree of EARR of root-filled teeth with that of contralateral teeth with vital pulp after fixed orthodontic treatment. The study sample consisted of 35 patients aged 25.23 ± 4.92 years who had at least 1 root-filled tooth before orthodontic treatment. Digital panoramic radiographs of each patient taken before and after orthodontic treatment were used to measure the EARR. The Student t test for matched pairs and the Pearson correlation analysis were applied. The mean EARR values were 0.22 (0.14, 0.35) for root-filled teeth and 0.87 (0.59, 1.31) for contralateral teeth with vital pulp, indicating significantly less EARR for root-filled teeth compared with the contralateral teeth with vital pulp after orthodontic treatment. EARR was influenced by the patient's age, treatment duration, treatment type, and periapical pathosis, but not by tooth type and sex. Root-filled teeth appear to be associated with significantly less EARR than are contralateral teeth with vital pulp. This study suggests that the possible complication of EARR in root-filled teeth may not be an important consideration in orthodontic treatment planning, and root canal treatment can be considered for stopping or decreasing EARR when severe EARR occurs during orthodontic treatment. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Using motor behavior during an early critical period to restore skilled limb movement after damage to the corticospinal motor system during development

PubMed Central

Friel, KM; Chakrabarty, S; H-C, Kuo; Martin, JH

2012-01-01

This study investigated requirements for restoring motor function after corticospinal (CS) system damage during early postnatal development. Activity-dependent competition between the CS tracts (CST) of the two hemispheres is imperative for normal development. Blocking primary motor cortex (M1) activity unilaterally during a critical period (postnatal weeks-PW-5–7) produces permanent contralateral motor skill impairments, loss of M1 motor map, aberrant CS terminations, and decreases in CST presynaptic sites and spinal cholinergic interneuron numbers. To repair these motor systems impairments and restore function, we manipulated motor experience in three groups of cats after this CST injury produced by inactivation. One group wore a jacket restraining the limb ipsilateral to inactivation, forcing use of the contralateral, impaired, limb, for the month following M1 inactivation (PW8–13; “Restraint Alone”). A second group wore the restraint during PW8–13, and was also trained for 1 h/day in a reaching task with the contralateral forelimb (“Early Training”). To test the efficacy of intervention during adolescence, a third group wore the restraint and received reach training during PW20–24 (“Delayed Training”). Early training restored CST connections and the M1 motor map; increased cholinergic spinal interneurons numbers on the contralateral, relative to ipsilateral, side; and abrogated limb control impairments. Delayed training restored CST connectivity and the M1 motor map, but not contralateral spinal cholinergic cell counts or motor performance. Restraint alone only restored CST connectivity. Our findings stress the need to reestablish the integrated functions of the CS system at multiple hierarchical levels in restoring skilled motor function after developmental injury. PMID:22764234

Examination of Poststroke Alteration in Motor Unit Firing Behavior Using High-Density Surface EMG Decomposition.

PubMed

Li, Xiaoyan; Holobar, Ales; Gazzoni, Marco; Merletti, Roberto; Rymer, William Zev; Zhou, Ping

2015-05-01

Recent advances in high-density surface electromyogram (EMG) decomposition have made it a feasible task to discriminate single motor unit activity from surface EMG interference patterns, thus providing a noninvasive approach for examination of motor unit control properties. In the current study, we applied high-density surface EMG recording and decomposition techniques to assess motor unit firing behavior alterations poststroke. Surface EMG signals were collected using a 64-channel 2-D electrode array from the paretic and contralateral first dorsal interosseous (FDI) muscles of nine hemiparetic stroke subjects at different isometric discrete contraction levels between 2 to 10 N with a 2 N increment step. Motor unit firing rates were extracted through decomposition of the high-density surface EMG signals and compared between paretic and contralateral muscles. Across the nine tested subjects, paretic FDI muscles showed decreased motor unit firing rates compared with contralateral muscles at different contraction levels. Regression analysis indicated a linear relation between the mean motor unit firing rate and the muscle contraction level for both paretic and contralateral muscles (p < 0.001), with the former demonstrating a lower increment rate (0.32 pulses per second (pps)/N) compared with the latter (0.67 pps/N). The coefficient of variation (averaged over the contraction levels) of the motor unit firing rates for the paretic muscles (0.21 ± 0.012) was significantly higher than for the contralateral muscles (0.17 ± 0.014) (p < 0.05). This study provides direct evidence of motor unit firing behavior alterations poststroke using surface EMG, which can be an important factor contributing to hemiparetic muscle weakness.

Examination of Post-stroke Alteration in Motor Unit Firing Behavior Using High Density Surface EMG Decomposition

PubMed Central

Li, Xiaoyan; Holobar, Aleš; Gazzoni, Marco; Merletti, Roberto; Rymer, William Z.; Zhou, Ping

2014-01-01

Recent advances in high density surface electromyogram (EMG) decomposition have made it a feasible task to discriminate single motor unit activity from surface EMG interference patterns, thus providing a noninvasive approach for examination of motor unit control properties. In the current study we applied high density surface EMG recording and decomposition techniques to assess motor unit firing behavior alterations post-stroke. Surface EMG signals were collected using a 64-channel 2-dimensional electrode array from the paretic and contralateral first dorsal interosseous (FDI) muscles of nine hemiparetic stroke subjects at different isometric discrete contraction levels between 2 N to 10 N with a 2 N increment step. Motor unit firing rates were extracted through decomposition of the high density surface EMG signals, and compared between paretic and contralateral muscles. Across the nine tested subjects, paretic FDI muscles showed decreased motor unit firing rates compared with contralateral muscles at different contraction levels. Regression analysis indicated a linear relation between the mean motor unit firing rate and the muscle contraction level for both paretic and contralateral muscles (p < 0.001), with the former demonstrating a lower increment rate (0.32 pulses per second (pps)/N) compared with the latter (0.67 pps/N). The coefficient of variation (CoV, averaged over the contraction levels) of the motor unit firing rates for the paretic muscles (0.21 ± 0.012) was significantly higher than for the contralateral muscles (0.17 ± 0.014) (p < 0.05). This study provides direct evidence of motor unit firing behavior alterations post-stroke using surface EMG, which can be an important factor contributing to hemiparetic muscle weakness. PMID:25389239

Evaluation of contralateral kidney, liver and lung after extracorporeal shock wave lithotripsy in rabbits.

PubMed

Senyucel, M F; Boybeyi, O; Ayva, S; Aslan, M K; Soyer, T; Demet, A I; Kısa, U; Basar, M; Cakmak, M A

2013-10-01

An experimental study was carried out to evaluate the effects of extracorporeal shock wave lithotripsy (ESWL) on contralateral kidney, liver and lung by histopathological and biochemical methods. Twelve New Zealand rabbits were allocated to two groups (n = 6). Tissues of control group (CG, n = 6) were harvested without any intervention. In ESWL group (EG), right kidneys were exposed to 3,000 shock waves at 14 kV energy using electro-hydraulic type ESWL device three times every other day. Both kidneys, liver, and right lobe of lung tissues in EG were harvested on seventh day. Kidneys were examined histopathologically for presence of glomerular and tubular injury, interstitial edema, congestion, inflammation and fibrosis. Livers were examined for hepatocyte vacuolization, congestion, portal inflammation and fibrosis. Lung tissues were examined for loss of normal structure, emphysema, interstitial congestion-edema, prominent alveolar septal vessels, interstitial inflammation, intra-alveolar hemorrhage, intraluminal hemorrhage, peribronchial edema, congestion, inflammation in bronchial wall and epithelial desquamation. Biochemical analysis of tissue samples was performed for oxidative injury markers. Histopathological evaluations revealed that tubular injury was found in both shocked and contralateral kidneys (p < 0.05). EG showed higher grades of portal fibrosis in liver and higher grades of peribronchial congestion in lung when compared to CG (p < 0.05). Biochemical evaluations of both kidneys showed that malondialdehyde levels were higher in EG than in CG (p < 0.05). ESWL causes histopathologic alterations both in shocked and contralateral kidneys. Extrarenal tissues such as liver and lung can be affected by shock waves histopathologically and oxidative injury of contralateral kidney may occur acutely after ESWL.

Evaluation of root and alveolar bone development of unilateral osseous impacted immature maxillary central incisors after the closed-eruption technique.

PubMed

Shi, Xiangru; Xie, Xiaoyan; Quan, Junkang; Wang, Xiaozhe; Sun, Xiangyu; Zhang, Chenying; Zheng, Shuguo

2015-10-01

In this study, we evaluated root and alveolar bone development in unilateral osseous impacted immature maxillary central incisors by cone-beam computed tomography before and after closed-eruption treatment, in comparison with naturally erupted contralateral immature maxillary central incisors. The study included 30 patients, 20 boys and 10 girls, with a mean age of 8.44 ± 1.20 years (range, 6.5-11.2 years). After treatment, the root lengths of both the impacted maxillary central incisors (10.66 ± 2.10 mm) and the contralateral maxillary central incisors (11.04 ± 1.76 mm) were significantly greater than their pretreatment values (6.67 ± 1.94 and 9.02 ± 2.13 mm, respectively). The root canal widths of the incisors decreased significantly after treatment. From the posttreatment cone-beam computed tomography images, the ratio of exposed root length to total root length and the thickness of the alveolar bone at 1 mm under the alveolar crest and at the apex were calculated to evaluate alveolar bone development. Impacted immature maxillary central incisors differed significantly from contralateral immature maxillary central incisors in labial exposed root length, labial ratio to total root length, and lingual alveolar crest. Clinical crown height was higher (statistically but not clinically) for the impacted incisors (9.87 mm) than for the contralateral incisors (9.37 mm). Impacted immature incisors grew to the same stage as did erupted contralateral incisors after closed-eruption treatment. Both incisor types had some alveolar bone loss, and thin alveolar bone surrounded the roots. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Effects of slow repetitive transcranial magnetic stimulation in patients with corticobasal syndrome.

PubMed

Civardi, Carlo; Pisano, Fabrizio; Delconte, Carmen; Collini, Alessandra; Monaco, Francesco

2015-06-01

Corticobasal syndrome is characterized by asymmetric cortical sensorimotor dysfunction and parkinsonism; an altered cortical excitability has been reported. We explored with transcranial magnetic stimulation the motor cortical excitability in corticobasal syndrome, and the effects of slow repetitive transcranial magnetic stimulation. With transcranial magnetic stimulation, we studied two corticobasal syndrome patients. We determined bilaterally from the first dorsal interosseous muscle: relaxed threshold, and contralateral and ipsilateral silent period. We also evaluated the contralateral silent period after active/sham slow repetitive transcranial magnetic stimulation on the most affected side. At T0 the silent period was bilaterally short. On the most affected side, active slow repetitive transcranial magnetic stimulation induced a short lasting prolongation of the contralateral silent period. In corticobasal syndrome, transcranial magnetic stimulation showed a reduction cortical inhibitory phenomenon potentially reversed transiently by slow repetitive transcranial magnetic stimulation.

Spatial analysis of muscular activations in stroke survivors.

PubMed

Rasool, Ghulam; Afsharipour, Babak; Suresh, Nina L; Xiaogang Hu; Rymer, William Zev

2015-01-01

We investigated the spatial patterns of electrical activity in stroke-affected muscles using the high density surface electromyogram (sEMG) grids. We acquired 128-channel sEMG signals from the impaired as well as contralateral Biceps Brachii (BB) muscles of stroke survivors and from healthy participants at various force levels from 20 to 60% of maximum voluntary contraction in an isometric non-fatiguing recording protocol. We found the spatial sEMG pattern to be consistent across force levels in healthy and stroke subjects. However, once compared across sides (left vs right in healthy and impaired vs. contralateral in stroke) we found stroke-affected sides to be significantly different in distribution pattern of sEMG from the contralateral side. The sEMG activity areas were significantly shrunk on the affected sides indicating muscle atrophy due to stroke.

Neocortical temporal FDG-PET hypometabolism correlates with temporal lobe atrophy in hippocampal sclerosis associated with microscopic cortical dysplasia.

PubMed

Diehl, Beate; LaPresto, Eric; Najm, Imad; Raja, Shanker; Rona, Sabine; Babb, Thomas; Ying, Zhong; Bingaman, William; Lüders, Hans O; Ruggieri, Paul

2003-04-01

Medically intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS), with or without cortical dysplasia (CD), is associated with atrophy of the hippocampal formation and regional fluorodeoxyglucose positron-emission tomography (FDG-PET) hypometabolism. The relation between areas of functional and structural abnormalities is not well understood. We investigate the relation between FDG-PET metabolism and temporal lobe (TL) and hippocampal atrophy in patients with histologically proven isolated HS and HS associated with CD. Twenty-three patients underwent en bloc resection of the mesial and anterolateral neocortical structures. Ten patients were diagnosed with isolated HS; 13 patients had associated microscopic CD. Temporal lobe volumes (TLVs) and hippocampal volumes were measured. Magnetic resonance imaging (MRI) and PET were co-registered, and regions of interest (ROIs) determined as gray matter of the mesial, lateral, and anterior temporal lobe. All patients (HS with or without CD) had significant ipsilateral PET hypometabolism in all three regions studied (p < 0.0001). In patients with isolated HS, the most prominent hypometabolism was in the anterior and mesial temporal lobe, whereas in dual pathology, it was in the lateral temporal lobe. TLVs and hippocampal volumes were significantly smaller on the epileptogenic side (p < 0.05). The PET asymmetries ipsilateral/contralateral to the epileptogenic zone and TLV asymmetries correlated significantly for the anterior and lateral temporal lobes (p < 0.05) in the HS+CD group, but not in the isolated HS group. Mesial temporal hypometabolism was not significantly different between the two groups. Temporal neocortical microscopic CD with concurrent HS is associated with more prominent lateral temporal metabolic dysfunction compared with isolated HS in TL atrophy. Further studies are needed to confirm these findings and correlate the PET hypometabolic patterns with outcome data in patients operated on for HS with or without CD.

Skin thickening as unique pathologic sign of an inflammatory breast cancer: a case report and review of the literature.

PubMed

Ballesio, L; D'Ambrosio, I; Ravazzolo, N; Angeletti, M; Di Pastena, F; Tardioli, S; Lodise, P; Marini, M

2011-01-01

We report the case of a 42-year-old woman with inflammatory cancer of the right breast treated with neoadjuvant chemotherapy, surgery, additional chemotherapy, and consolidative radiotherapy (RT), that has metastatized to the chest wall and presented a resumption of disease on the contralateral breast. Magnetic Resonance (MR), performed after the second phase's fourth round of additional chemotherapy, showed a modest reduction of scar metastases on the right and a contralateral anomalous skin thickening with high signal intensity in T2 weighted images (WI) with multiple mass-like enhancements located in a wide area of the central region at the union of higher quadrants. These findings were suggestive for resumption of contralateral disease; the biopsy confirmed an inflammatory breast cancer (IBC) infiltrating lobular type with high mitotic rate. A retrospective evaluation of the previous MR exam, performed 5 months before, was conducted: on the left side only a modest skin thickening was found as an early sign. A careful review of the literature has confirmed that skin thickening, increased density and clinical signs of inflammation are the most common findings in inflammatory cancer. We report the case of a patient affected by IBC whose unique early sign of resumption on the contralateral breast was skin thickening.

Transrectal Doppler sonography of uterine blood flow during the first two weeks after parturition in Simmenthal heifers

PubMed Central

Krüger, Lars; Leidl, Stephanie; Bollwein, Heinrich

2013-01-01

Transrectal Doppler sonography was used to evaluate uterine blood flow during the first two weeks after parturition in six primiparous Simmental cows. The uterine blood flow was evaluated on the day of parturition (Day 0), once daily from Days 1 to 8 and then every other day until Day 14. Blood flow was quantified by determining the diameter (D), the time-averaged maximum velocity (TAMV), the pulsatility index (PI) and the blood flow volume (BFV) of the uterine arteries ipsilateral and contralateral to the formerly pregnant uterine horn. During the first four days after calving D, TAMV and BFV declined (ipsilateral: TAMV 70%, BFV 87%, contralateral: D 47%, BFV 84%; p < 0.05), while PI increased (ipsilateral 158%, contralateral 100%; p < 0.05) distinctly. Between Days 4 and 14 only the ipsilateral D (12%) and the BFV of both arteries (ipsilateral 5%, contralateral 8%) decreased (p < 0.05). Blood flow variables were very strongly correlated with each other (r > ±0.75, p < 0.05), with negative correlations with PI and positive correlations with all other investigated factors. Overall, this study revealed characteristic changes in uterine perfusion during the first two weeks after parturition in cows that were pronounced during the first four days postpartum. PMID:23820167

Transrectal Doppler sonography of uterine blood flow during the first two weeks after parturition in Simmenthal heifers.

PubMed

Heppelmann, Maike; Krüger, Lars; Leidl, Stephanie; Bollwein, Heinrich

2013-01-01

Transrectal Doppler sonography was used to evaluate uterine blood flow during the first two weeks after parturition in six primiparous Simmental cows. The uterine blood flow was evaluated on the day of parturition (Day 0), once daily from Days 1 to 8 and then every other day until Day 14. Blood flow was quantified by determining the diameter (D), the time-averaged maximum velocity (TAMV), the pulsatility index (PI) and the blood flow volume (BFV) of the uterine arteries ipsilateral and contralateral to the formerly pregnant uterine horn. During the first four days after calving D, TAMV and BFV declined (ipsilateral: TAMV 70%, BFV 87%, contralateral: D 47%, BFV 84%; p < 0.05), while PI increased (ipsilateral 158%, contralateral 100%; p < 0.05) distinctly. Between Days 4 and 14 only the ipsilateral D (12%) and the BFV of both arteries (ipsilateral 5%, contralateral 8%) decreased (p < 0.05). Blood flow variables were very strongly correlated with each other (r > ±0.75, p < 0.05), with negative correlations with PI and positive correlations with all other investigated factors. Overall, this study revealed characteristic changes in uterine perfusion during the first two weeks after parturition in cows that were pronounced during the first four days postpartum.

The use of self-inflating hydrogel expanders in pediatric patients with congenital microphthalmia in China.

PubMed

Hou, Zhijia; Yang, Qiong; Chen, Tao; Hao, Lei; Li, Yang; Li, Dongmei

2012-10-01

To report the results of enlarging orbital volume in consecutive cases of severe congenital microphthalmia by means of solid hydrophilic tissue expanders. The medical records of consecutive patients with congenital microphthalmia who underwent the placement of a hydrogel expander were retrospectively reviewed. Main outcome measures were orbital tissue expansion, prosthetic retention, and patient family satisfaction. A total of 17 patients were included in the study. All patients were able to retain an ocular prosthesis. The horizontal palpebral length increased from 71.3% of the contralateral unaffected eye to 85.4% of the contralateral unaffected eye. The expansion of orbital volume was assessed in seven patients. The volume of the microphthalmic orbits was expanded from 74.7% of the contralateral unaffected orbits to 83.5% of the contralateral unaffected orbits. Aesthetic results were satisfactory to both physicians and patient families. The following complications were noted in two patients: inferior migration of a spherical expander occurred in one case; a hemispheric expander was removed by the patient in another case. Hydrogel implants can successfully expand the dimensions of the conjunctival sac and the orbit in cases of severe congenital microphthalmia. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Changes in Serial Optical Topography and TMS during Task Performance after Constraint-Induced Movement Therapy in Stroke: A Case Study

PubMed Central

Park, Si-Woon; Butler, Andrew J.; Cavalheiro, Vanessa; Alberts, Jay L.; Wolf, Steven L.

2013-01-01

The authors examined serial changes in optical topography in a stroke patient performing a functional task, as well as clinical and physiologic measures while undergoing constraint-induced therapy (CIT). A 73-year-old right hemiparetic patient, who had a subcortical stroke 4 months previously, received 2 weeks of CIT. During the therapy, daily optical topography imaging using near-infrared light was measured serially while the participant performed a functional key-turning task. Clinical outcome measures included the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and functional key grip test. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were also used to map cortical areas and hemodynamic brain responses, respectively. Optical topography measurement showed an overall decrease in oxy-hemoglobin concentration in both hemispheres as therapy progressed and the laterality index increased toward the contralateral hemisphere. An increased TMS motor map area was observed in the contralateral cortex following treatment. Posttreatment fMRI showed bilateral primary motor cortex activation, although slightly greater in the contralateral hemisphere, during affected hand movement. Clinical scores revealed marked improvement in functional activities. In one patient who suffered a stroke, 2 weeks of CIT led to improved function and cortical reorganization in the hemisphere contralateral to the affected hand. PMID:15228805

Effects of contralateral white noise stimulation on distortion product otoacoustic emissions in myasthenic patients.

PubMed

Di Girolamo, S; d'Ecclesia, A; Quaranta, N; Garozzo, A; Evoli, A; Paludetti, G

2001-12-01

Myasthenia gravis (MG) induces a reduction of transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) that reverses partially after administration of an acetylcholinesterase (AChE) inhibitor. In normal subjects a contralateral acoustic stimulation (CAS) produces an amplitude reduction of TEOAEs and DPOAEs. This effect, called contralateral suppression (CS), is mediated by the efferent auditory system. Twenty subjects affected by MG underwent DPOAE recording with and without contralateral white noise in a drug-free baseline period ('basal') and 1 h ('post') after administration of a reversible AChE inhibitor. In 'basal' condition CAS did not induce significant DPOAE amplitude changes but a paradoxical slight increase was observed. After drug administration, CAS produced a significant decrease of DPOAE amplitudes for middle frequencies (f(2) between 1306 and 2600 Hz). In normal controls CAS caused a significant decrease (P<0.001) for all frequencies. The amount of CS in controls and in the MG 'post' condition was not significantly different. The increased acetylcholine (ACh) availability following drug consumption seems to partially restore outer hair cell function and enhances their electromotility; a further influx of ACh due to CAS yields to restoration of the CS. These findings also suggest that DPOAEs may be useful in the diagnosis of MG and for monitoring the effectiveness of treatment.

Unilateral vs bilateral hip bone mineral density measurement for the diagnosis of osteoporosis.

PubMed

Ikegami, Shota; Kamimura, Mikio; Uchiyama, Shigeharu; Mukaiyama, Keijiro; Kato, Hiroyuki

2014-01-01

It has not been established whether unilateral or bilateral hip dual-energy X-ray absorptiometry (DXA) is preferable for the diagnosis of osteoporosis. We investigated the discordance in DXA measurements in bilateral hips to determine whether unilateral DXA is valid for osteoporosis diagnosis. The subjects were 2964 Japanese patients without a previous diagnosis of primary osteoporosis. We measured bilateral femoral bone mineral density (BMD) and calculated indices, related to the unilateral results, for predicting contralateral hip osteoporosis. A likelihood ratio (LR) of a negative test (LR [-]) of less than 0.2 was considered to exclude the diagnosis. In the normal spinal BMD group, the sensitivity of unilateral DXA for women was 27-73% and LR (-) was 0.28-0.73; the sensitivity for men was 0-50% and LR (-) was 0.51-1.00; the diagnosis of contralateral osteoporosis was not excluded. Sensitivity increased and LR (-) increased with worsening spinal BMD status; however, LR (-) did not meet the cutoff for exclusion. We could exclude unilateral hip osteoporosis, in women only, by performing contralateral femoral DXA; this necessitated lowering the T-score cutoff from -2.5 to -2.0. Unilateral femoral DXA is not useful for excluding the diagnosis of contralateral hip osteoporosis. Copyright © 2014 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Mental Practice Combined with Physical Practice to Enhance Hand Recovery in Stroke Patients

PubMed Central

Liu, Hua; Song, Lu-ping

2014-01-01

Objectives. To evaluate whether combining mental practice with physical practice training enhances hand function in patients with stroke. Methods. 10 for treatment and 10 for control were recruited for this pre/posttraining matched case control study. In the treatment group, subjects underwent combining mental practice with physical practice for four weeks. In the control group, subjects only participated in physical practice. Change of hand function and the number of activated voxels of the contralateral somatosensory motor cortex (SMC) acquired by functional magnetic resonance imaging were measured. Results. After training, the Action Research Arm Test score increased by 12.65 for treatment and by 5.20 for control. There was a significant difference in the Action Research Arm Test score between the two groups (P = 0.04). The activated voxels number of the contralateral SMC increased in both groups, but the activated voxels number in the contralateral SMC and the improvement of hand function for treatment were greater than for control. In the treatment group, the number of activated voxels of the contralateral SMC was positively correlated with better hand function scores. Conclusions. Combining mental practice with physical practice may be a more effective treatment strategy than physical training alone for hand recovery in stroke patients. PMID:25435713

Contralateral cerebello-thalamo-cortical pathways with prominent involvement of associative areas in humans in vivo.

PubMed

Palesi, Fulvia; Tournier, Jacques-Donald; Calamante, Fernando; Muhlert, Nils; Castellazzi, Gloria; Chard, Declan; D'Angelo, Egidio; Wheeler-Kingshott, Claudia A M

2015-11-01

In addition to motor functions, it has become clear that in humans the cerebellum plays a significant role in cognition too, through connections with associative areas in the cerebral cortex. Classical anatomy indicates that neo-cerebellar regions are connected with the contralateral cerebral cortex through the dentate nucleus, superior cerebellar peduncle, red nucleus and ventrolateral anterior nucleus of the thalamus. The anatomical existence of these connections has been demonstrated using virus retrograde transport techniques in monkeys and rats ex vivo. In this study, using advanced diffusion MRI tractography we show that it is possible to calculate streamlines to reconstruct the pathway connecting the cerebellar cortex with contralateral cerebral cortex in humans in vivo. Corresponding areas of the cerebellar and cerebral cortex encompassed similar proportion (about 80%) of the tract, suggesting that the majority of streamlines passing through the superior cerebellar peduncle connect the cerebellar hemispheres through the ventrolateral thalamus with contralateral associative areas. This result demonstrates that this kind of tractography is a useful tool to map connections between the cerebellum and the cerebral cortex and moreover could be used to support specific theories about the abnormal communication along these pathways in cognitive dysfunctions in pathologies ranging from dyslexia to autism.

Unilateral endonasal transcribriform approach with septal transposition for olfactory groove meningioma: can olfaction be preserved?

PubMed

Youssef, A Samy; Sampath, Raghuram; Freeman, Jacob L; Mattingly, Jameson K; Ramakrishnan, Vijay R

2016-10-01

Loss of olfaction has been considered inevitable in endoscopic endonasal resection of olfactory groove meningiomas. Olfaction preservation may be feasible through an endonasal unilateral transcribriform approach, with the option for expansion using septal transposition and contralateral preservation of the olfactory apparatus. An expanded unilateral endonasal transcribriform approach with septal transposition was performed in five cadaver heads. The approach was applied in a surgical case of a 24 × 26-mm olfactory groove meningioma originating from the right cribriform plate with partially intact olfaction. The surgical approach offered adequate exposure to the anterior skull base bilaterally. The nasal/septal mucosa was preserved on the contralateral side. Gross total resection of the meningioma was achieved with the successful preservation of the contralateral olfactory apparatus and preoperative olfaction. Six months later, the left nasal cavity showed no disruption of the mucosal lining and the right side was at the appropriate stage of healing for a harvested nasoseptal flap. One year later, the preoperative olfactory function was intact and favorably viewed by the patient. Objective testing of olfaction showed microsomia. Olfaction preservation may be feasible in the endoscopic endonasal resection of a unilateral olfactory groove meningioma through a unilateral transcribriform approach with septal transposition and preservation of the contralateral olfactory apparatus.

Computer-Aided Diagnostic (CAD) Scheme by Use of Contralateral Subtraction Technique

NASA Astrophysics Data System (ADS)

Nagashima, Hiroyuki; Harakawa, Tetsumi

We developed a computer-aided diagnostic (CAD) scheme for detection of subtle image findings of acute cerebral infarction in brain computed tomography (CT) by using a contralateral subtraction technique. In our computerized scheme, the lateral inclination of image was first corrected automatically by rotating and shifting. The contralateral subtraction image was then derived by subtraction of reversed image from original image. Initial candidates for acute cerebral infarctions were identified using the multiple-thresholding and image filtering techniques. As the 1st step for removing false positive candidates, fourteen image features were extracted in each of the initial candidates. Halfway candidates were detected by applying the rule-based test with these image features. At the 2nd step, five image features were extracted using the overlapping scale with halfway candidates in interest slice and upper/lower slice image. Finally, acute cerebral infarction candidates were detected by applying the rule-based test with five image features. The sensitivity in the detection for 74 training cases was 97.4% with 3.7 false positives per image. The performance of CAD scheme for 44 testing cases had an approximate result to training cases. Our CAD scheme using the contralateral subtraction technique can reveal suspected image findings of acute cerebral infarctions in CT images.

Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness.

PubMed

Honig, Asaf; Eliahou, Ruth; Auriel, Eitan

2017-02-15

We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness. None had pyramidal signs or increased limb tone. Speech, language, and cognitive performance were intact during admission examination. In all three patients, initial diffusion-weighted imaging (DWI) MRI showed small confined regions of restriction involving the posterolateral border of ACA territory; CT angiography was normal in one patient with a newly diagnosed atrial fibrillation but showed atherosclerotic vasculature with severe narrowing of the A3 segment of the ACA in two. Awareness of ACAI presenting as unilateral axial weakness is warranted. We suggest that optimal diagnostic management should include examination of axial tone. Ischemic involvement of distal ACA branches may herald a more extensive ACAI. Prompt diagnosis may enable thrombolysis or endovascular treatment, and blood pressure maintenance may allow adequate perfusion to damaged tissue. Copyright © 2016 Elsevier B.V. All rights reserved.

PubMed Central

SENNAROĞLU, G.; YÜCEL, E.; BELGIN, E.; MANCINI, P.

2015-01-01

SUMMARY The aim of this study was to investigate the amount of binaural squelch effect (BSE) and head shadow effect (HSE) in children who use unilateral cochlear implants (CI) and contralateral hearing aids (HA). The study group consisted of 19 CI recipient children who consistently wore a contralateral HA. Speech sounds were used to evaluate speech perception performance in noise. Testing was performed in three listening conditions: (1) bimodal listening with noise source on HA side; (2) CI only with noise source contralaterally (HA off); (3) CI only with noise source on the CI side. Statistical analysis revealed a significant difference between the three listening conditions and post hoc tests indicated significant differences for all pairwise comparisons (p < 0.001). The average BSE and HSE were 11.8% and 17.1% respectively. The majority of bimodal CI users showed BSE and HSE with significant speech perception improvement in the presence of noise. PMID:26824917

Analysis of electromyographic activity in spastic biceps brachii muscle following neural mobilization.

PubMed

Castilho, Jéssica; Ferreira, Luiz Alfredo Braun; Pereira, Wagner Menna; Neto, Hugo Pasini; Morelli, José Geraldo da Silva; Brandalize, Danielle; Kerppers, Ivo Ilvan; Oliveira, Claudia Santos

2012-07-01

Hypertonia is prevalent in anti-gravity muscles, such as the biceps brachii. Neural mobilization is one of the techniques currently used to reduce spasticity. The aim of the present study was to assess electromyographic (EMG) activity in spastic biceps brachii muscles before and after neural mobilization of the upper limb contralateral to the hemiplegia. Repeated pre-test and post-test EMG measurements were performed on six stroke victims with grade 1 or 2 spasticity (Modified Ashworth Scale). The Upper Limb Neurodynamic Test (ULNT1) was the mobilization technique employed. After neural mobilization contralateral to the lesion, electromyographic activity in the biceps brachii decreased by 17% and 11% for 90° flexion and complete extension of the elbow, respectively. However, the results were not statistically significant (p gt; 0.05). When performed using contralateral techniques, neural mobilization alters the electrical signal of spastic muscles. Copyright © 2011 Elsevier Ltd. All rights reserved.

Proteoglycan concentrations in healthy and diseased articular cartilage by Fourier transform infrared imaging and principal component regression

NASA Astrophysics Data System (ADS)

Yin, Jianhua; Xia, Yang

2014-12-01

Fourier transform infrared imaging (FTIRI) combining with principal component regression (PCR) analysis were used to determine the reduction of proteoglycan (PG) in articular cartilage after the transection of the anterior cruciate ligament (ACL). A number of canine knee cartilage sections were harvested from the meniscus-covered and meniscus-uncovered medial tibial locations from the control joints, the ACL joints at three time points after the surgery, and their contralateral joints. The PG loss in the ACL cartilage was related positively to the durations after the surgery. The PG loss in the contralateral knees was less than that of the ACL knees. The PG loss in the meniscus-covered cartilage was less than that of the meniscus-uncovered tissue in both ACL and contralateral knees. The quantitative mapping of PG loss could monitor the disease progression and repair processes in arthritis.

Benefits of awake uniportal pulmonary resection in a patient with a previous contralateral lobectomy

PubMed Central

Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Mafe, Juan Jose; Rivera, Maria Jesus; Roca, Joaquin; Baschwitz, Benno

2014-01-01

Surgical resection of a contralateral recurrence of non-small cell lung cancer (NSCLC) is indicated in patients without evidence of disseminated disease and considered functionally operable. General anesthesia and double-lumen intubation involves one lobe ventilation in a patient treated with a previous lobectomy, thus increasing the risks of ventilator-induced injuries and the morbidity. Awake procedures facilitate the surgery decreasing the anesthetic and surgical times, keeping the diaphragm motion and diminishing the ventilator-induced injuries into the remaining contralateral lobe. We present a 43-year-old woman with a previous left-lower lobectomy for a 3.1-cm mucinous adenocarcinoma 15 months before without nodal involvement, who presents a right-lower lobe 8-mm cavitated nodule, with evident radiological growth and fine-needle aspiration concordant with mucinous adenocarcinoma. We suggest an awake procedure with locoregional epidural anesthesia. PMID:25405168

Benefits of awake uniportal pulmonary resection in a patient with a previous contralateral lobectomy.

PubMed

Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Mafe, Juan Jose; Rivera, Maria Jesus; Roca, Joaquin; Baschwitz, Benno

2014-09-01

Surgical resection of a contralateral recurrence of non-small cell lung cancer (NSCLC) is indicated in patients without evidence of disseminated disease and considered functionally operable. General anesthesia and double-lumen intubation involves one lobe ventilation in a patient treated with a previous lobectomy, thus increasing the risks of ventilator-induced injuries and the morbidity. Awake procedures facilitate the surgery decreasing the anesthetic and surgical times, keeping the diaphragm motion and diminishing the ventilator-induced injuries into the remaining contralateral lobe. We present a 43-year-old woman with a previous left-lower lobectomy for a 3.1-cm mucinous adenocarcinoma 15 months before without nodal involvement, who presents a right-lower lobe 8-mm cavitated nodule, with evident radiological growth and fine-needle aspiration concordant with mucinous adenocarcinoma. We suggest an awake procedure with locoregional epidural anesthesia.

Abnormal functional motor lateralization in healthy siblings of patients with schizophrenia.

PubMed

Altamura, Mario; Fazio, Leonardo; De Salvia, Michela; Petito, Annamaria; Blasi, Giuseppe; Taurisano, Paolo; Romano, Raffaella; Gelao, Barbara; Bellomo, Antonello; Bertolino, Alessandro

2012-07-30

Earlier neuroimaging studies of motor function in schizophrenia have demonstrated reduced functional lateralization in the motor network during motor tasks. Here, we used event-related functional magnetic resonance imaging during a visually guided motor task in 18 clinically unaffected siblings of patients with schizophrenia and 24 matched controls to investigate if abnormal functional lateralization is related to genetic risk for this brain disorder. Whereas activity associated with motor task performance was mainly contralateral with only a marginal ipsilateral component in healthy participants, unaffected siblings had strong bilateral activity with significantly greater response in ipsilateral and contralateral premotor areas as well as in contralateral subcortical motor regions relative to controls. Reduced lateralization in siblings was also identified with a measure of laterality quotient. These findings suggest that abnormal functional lateralization of motor circuitry is related to genetic risk of schizophrenia. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Changes in Abundance of Oral Microbiota Associated with Oral Cancer

PubMed Central

Schmidt, Brian L.; Kuczynski, Justin; Bhattacharya, Aditi; Huey, Bing; Corby, Patricia M.; Queiroz, Erica L. S.; Nightingale, Kira; Kerr, A. Ross; DeLacure, Mark D.; Veeramachaneni, Ratna; Olshen, Adam B.; Albertson, Donna G.

2014-01-01

Individual bacteria and shifts in the composition of the microbiome have been associated with human diseases including cancer. To investigate changes in the microbiome associated with oral cancers, we profiled cancers and anatomically matched contralateral normal tissue from the same patient by sequencing 16S rDNA hypervariable region amplicons. In cancer samples from both a discovery and a subsequent confirmation cohort, abundance of Firmicutes (especially Streptococcus) and Actinobacteria (especially Rothia) was significantly decreased relative to contralateral normal samples from the same patient. Significant decreases in abundance of these phyla were observed for pre-cancers, but not when comparing samples from contralateral sites (tongue and floor of mouth) from healthy individuals. Weighted UniFrac principal coordinates analysis based on 12 taxa separated most cancers from other samples with greatest separation of node positive cases. These studies begin to develop a framework for exploiting the oral microbiome for monitoring oral cancer development, progression and recurrence. PMID:24887397

In Vivo Measurement of Glenohumeral Joint Contact Patterns

NASA Astrophysics Data System (ADS)

Bey, Michael J.; Kline, Stephanie K.; Zauel, Roger; Kolowich, Patricia A.; Lock, Terrence R.

2009-12-01

The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics.

Studies of the mechanism of contralateral polyuria after renal artery stenosis.

PubMed Central

Galvez, O G; Roberts, B W; Mishkind, M H; Bay, W H; Ferris, T F

1977-01-01

Acute renal artery stenosis in hydropenic dogs caused a contralateral increase in urine volume and free water clearance without change in glomerular filtration, renal blood flow, or osmolar clearance. The increase in urine volume was not dependent on the development of hypertension since it occurred in animals pretreated with trimethaphan but was dependent upon angiotensin since it was presented with angiotensin blockade with Saralasin. The effect was not caused by angiotensin inhibiting antidiuretic hormone release since the polyuria occurred in hypophysectomized animals receiving a constant infusion of 10 muU/kg per min of aqueous Pitressin. Since the rise in urine volume was associated with an increase in renal vein prostaglandin E concentration and was prevented by pretreatment with indomethacin (5 mg/kg) the results suggest that the rise in plasma angiotensin after renal artery stenosis causes an increase in contralateral prostaglandin E synthesis with resultant antagonism to antidiuretic hormone at the collecting tubule. PMID:845253

"Facilitated" amino acid transport is upregulated in brain tumors.

PubMed

Miyagawa, T; Oku, T; Uehara, H; Desai, R; Beattie, B; Tjuvajev, J; Blasberg, R

1998-05-01

The goal of this study was to determine the magnitude of "facilitated" amino acid transport across tumor and brain capillaries and to evaluate whether amino acid transporter expression is "upregulated" in tumor vessels compared to capillaries in contralateral brain tissue. Aminocyclopentane carboxylic acid (ACPC), a non-metabolized [14C]-labeled amino acid, and a reference molecule for passive vascular permeability, [67Ga]-gallium-diethylenetriaminepentaacetic acid (Ga-DTPA), were used in these studies. Two experimental rat gliomas were studied (C6 and RG2). Brain tissue was rapidly processed for double label quantitative autoradiography 10 minutes after intravenous injection of ACPC and Ga-DTPA. Parametric images of blood-to-brain transport (K1ACPC and K1Ga-DTPA, microL/min/g) produced from the autoradiograms and the histology were obtained from the same tissue section. These three images were registered in an image array processor; regions of interest in tumor and contralateral brain were defined on morphologic criteria (histology) and were transferred to the autoradiographic images to obtain mean values. The facilitated component of ACPC transport (deltaK1ACPC) was calculated from the K1ACPC and K1Ga-DTPA data, and paired comparisons between tumor and contralateral brain were performed. ACPC flux, K1ACPC, across normal brain capillaries (22.6 +/- 8.1 microL/g/min) was >200-fold greater than that of Ga-DTPA (0.09 +/- 0.04 microL/g/min), and this difference was largely (approximately 90%) due to facilitated ACPC transport. Substantially higher K1ACPC values compared to corresponding K1DTPA values were also measured in C6 and RG2 gliomas. The deltaK1ACPC values for C6 glioma were more than twice that of contralateral brain cortex. K1ACPC and deltaK1ACPC values for RG2 gliomas was not significantly higher than that of contralateral cortex, although a approximately 2-fold difference in facilitated transport is obtained after normalization for differences in capillary surface area between RG2 tumors and contralateral cortex. K1ACPC, deltaK1ACPC, and K DTPA were directly related to tumor cell density, were higher in regions of "impending" necrosis, and the tumor/contralateral brain ACPC radio-activity ratios (0 to 10 minutes) were very similar to that obtained with 0 to 60 minutes experiments. These results indicate that facilitated transport of ACPC is upregulated across C6 and RG2 glioma capillaries, and that tumors can induce upregulation of amino acid transporter expression in their supporting vasculature. They also suggest that early imaging (e.g., 0 to 20 minutes) with radiolabeled amino acids in a clinical setting may be optimal for defining brain tumors.

Acupuncture for lateral epicondylitis (tennis elbow): study protocol for a randomized, practitioner-assessor blinded, controlled pilot clinical trial.

PubMed

Shin, Kyung-Min; Kim, Joo-Hee; Lee, Seunghoon; Shin, Mi-Suk; Kim, Tae-Hun; Park, Hyo-Ju; Lee, Min-Hee; Hong, Kwon-Eui; Lee, Seungdeok; Choi, Sun-Mi

2013-06-14

Lateral epicondylitis is the most frequent cause of pain around the elbow joint. It causes pain in the region of the elbow joint and results in dysfunction of the elbow and deterioration of the quality of life. The purpose of this study is to compare the effects of ipsilateral acupuncture, contralateral acupuncture and sham acupuncture on lateral epicondylitis. Forty-five subjects with lateral epicondylitis will be randomized into three groups: the ipsilateral acupuncture group, contralateral acupuncture group and the sham acupuncture group. The inclusion criteria will be as follows: (1) age between 19 and 65 years with pain due to one-sided lateral epicondylitis that persisted for at least four weeks, (2) with tenderness on pressure limited to regions around the elbow joint, (3) complaining of pain during resistive extension of the middle finger or the wrist, (4) with average pain of NRS 4 or higher during the last one week at a screening visit and (5) voluntarily agree to this study and sign a written consent. Acupuncture treatment will be given 10 times in total for 4 weeks to all groups. Follow up observations will be conducted after the completion of the treatment, 8 weeks and 12 weeks after the random assignment. Ipsilateral acupuncture group and contralateral acupuncture group will receive acupuncture on LI4, TE5, LI10, LI11, LU5, LI12 and two Ashi points. The sham acupuncture group will receive treatment on acupuncture points not related to the lateral epicondylitis using a non-invasive method. The needles will be maintained for 20 minutes. The primary outcome will be differences in the visual analogue scale (VAS) for elbow pain between the groups. The secondary outcome will be differences in patient-rated tennis elbow evaluation (PRTEE), pain-free/maximum grip strength (Dynamometer), pressure pain threshold, clinically relevant improvement, patient global assessment, and the EQ-5D. The data will be analyzed with the paired t-test and ANCOVA (P <0.05). The results of this study will allow evaluation of contralateral acupuncture from two aspects. First, if the contralateral acupuncture shows the effects similar to ipsilateral acupuncture, this will establish clinical basis for contralateral acupuncture. Second, if the effects of contralateral acupuncture are not comparable to the effects of ipsilateral acupuncture, but are shown to be similar to the effects of the sham acupuncture, we can establish the basis for using the same acupoints of the unaffected side as a control in acupuncture clinical studies. This trial has been registered with the 'Clinical Research Information Service (CRIS)', Republic of Korea: KCT0000628.

Acupuncture for lateral epicondylitis (tennis elbow): study protocol for a randomized, practitioner-assessor blinded, controlled pilot clinical trial

PubMed Central

2013-01-01

Background Lateral epicondylitis is the most frequent cause of pain around the elbow joint. It causes pain in the region of the elbow joint and results in dysfunction of the elbow and deterioration of the quality of life. The purpose of this study is to compare the effects of ipsilateral acupuncture, contralateral acupuncture and sham acupuncture on lateral epicondylitis. Methods/design Forty-five subjects with lateral epicondylitis will be randomized into three groups: the ipsilateral acupuncture group, contralateral acupuncture group and the sham acupuncture group. The inclusion criteria will be as follows: (1) age between 19 and 65 years with pain due to one-sided lateral epicondylitis that persisted for at least four weeks, (2) with tenderness on pressure limited to regions around the elbow joint, (3) complaining of pain during resistive extension of the middle finger or the wrist, (4) with average pain of NRS 4 or higher during the last one week at a screening visit and (5) voluntarily agree to this study and sign a written consent. Acupuncture treatment will be given 10 times in total for 4 weeks to all groups. Follow up observations will be conducted after the completion of the treatment, 8 weeks and 12 weeks after the random assignment. Ipsilateral acupuncture group and contralateral acupuncture group will receive acupuncture on LI4, TE5, LI10, LI11, LU5, LI12 and two Ashi points. The sham acupuncture group will receive treatment on acupuncture points not related to the lateral epicondylitis using a non-invasive method. The needles will be maintained for 20 minutes. The primary outcome will be differences in the visual analogue scale (VAS) for elbow pain between the groups. The secondary outcome will be differences in patient-rated tennis elbow evaluation (PRTEE), pain-free/maximum grip strength (Dynamometer), pressure pain threshold, clinically relevant improvement, patient global assessment, and the EQ-5D. The data will be analyzed with the paired t-test and ANCOVA (P <0.05). Discussion The results of this study will allow evaluation of contralateral acupuncture from two aspects. First, if the contralateral acupuncture shows the effects similar to ipsilateral acupuncture, this will establish clinical basis for contralateral acupuncture. Second, if the effects of contralateral acupuncture are not comparable to the effects of ipsilateral acupuncture, but are shown to be similar to the effects of the sham acupuncture, we can establish the basis for using the same acupoints of the unaffected side as a control in acupuncture clinical studies. Trial registration This trial has been registered with the ‘Clinical Research Information Service (CRIS)’, Republic of Korea: KCT0000628. PMID:23768129

Electrophysiology of Extraocular Cranial Nerves: Oculomotor, Trochlear, and Abducens Nerve.

PubMed

Hariharan, Praveen; Balzer, Jeffery R; Anetakis, Katherine; Crammond, Donald J; Thirumala, Parthasarathy D

2018-01-01

The utility of extraocular cranial nerve electrophysiologic recordings lies primarily in the operating room during skull base surgeries. Surgical manipulation during skull base surgeries poses a risk of injury to multiple cranial nerves, including those innervating extraocular muscles. Because tumors distort normal anatomic relationships, it becomes particularly challenging to identify cranial nerve structures. Studies have reported the benefits of using intraoperative spontaneous electromyographic recordings and compound muscle action potentials evoked by electrical stimulation in preventing postoperative neurologic deficits. Apart from surgical applications, electromyography of extraocular muscles has also been used to guide botulinum toxin injections in patients with strabismus and as an adjuvant diagnostic test in myasthenia gravis. In this article, we briefly review the rationale, current available techniques to monitor extraocular cranial nerves, technical difficulties, clinical and surgical applications, as well as future directions for research.

Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children.

PubMed

Ahmed, H; Youssef, M K; Salem, E A; Fawzi, A M; Desoky, E A E; Eliwa, A M; Sakr, A M N; Shahin, A M S

2016-02-01

Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively. The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV. Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Comparison of the benefits of cochlear implantation versus contra-lateral routing of signal hearing aids in adult patients with single-sided deafness: study protocol for a prospective within-subject longitudinal trial.

PubMed

Kitterick, Pádraig T; O'Donoghue, Gerard M; Edmondson-Jones, Mark; Marshall, Andrew; Jeffs, Ellen; Craddock, Louise; Riley, Alison; Green, Kevin; O'Driscoll, Martin; Jiang, Dan; Nunn, Terry; Saeed, Shakeel; Aleksy, Wanda; Seeber, Bernhard U

2014-01-01

Individuals with a unilateral severe-to-profound hearing loss, or single-sided deafness, report difficulty with listening in many everyday situations despite having access to well-preserved acoustic hearing in one ear. The standard of care for single-sided deafness available on the UK National Health Service is a contra-lateral routing of signals hearing aid which transfers sounds from the impaired ear to the non-impaired ear. This hearing aid has been found to improve speech understanding in noise when the signal-to-noise ratio is more favourable at the impaired ear than the non-impaired ear. However, the indiscriminate routing of signals to a single ear can have detrimental effects when interfering sounds are located on the side of the impaired ear. Recent published evidence has suggested that cochlear implantation in individuals with a single-sided deafness can restore access to the binaural cues which underpin the ability to localise sounds and segregate speech from other interfering sounds. The current trial was designed to assess the efficacy of cochlear implantation compared to a contra-lateral routing of signals hearing aid in restoring binaural hearing in adults with acquired single-sided deafness. Patients are assessed at baseline and after receiving a contra-lateral routing of signals hearing aid. A cochlear implant is then provided to those patients who do not receive sufficient benefit from the hearing aid. This within-subject longitudinal design reflects the expected care pathway should cochlear implantation be provided for single-sided deafness on the UK National Health Service. The primary endpoints are measures of binaural hearing at baseline, after provision of a contra-lateral routing of signals hearing aid, and after cochlear implantation. Binaural hearing is assessed in terms of the accuracy with which sounds are localised and speech is perceived in background noise. The trial is also designed to measure the impact of the interventions on hearing- and health-related quality of life. This multi-centre trial was designed to provide evidence for the efficacy of cochlear implantation compared to the contra-lateral routing of signals. A purpose-built sound presentation system and established measurement techniques will provide reliable and precise measures of binaural hearing. Current Controlled Trials http://www.controlled-trials.com/ISRCTN33301739 (05/JUL/2013).

The Coordinated Noninvasive Studies (CNS) Project. Phase 1

DTIC Science & Technology

1991-12-01

may reveal functional asymmetries that represent the influence of two factors: 1) the "contralateral effect ," based on the side -of-space source of...asymmetries, where processing on that side of the CNS opposite the side of input is favored, and 2) an effect based J.L. Lauter [CNS Project/AFOSR 88-0352...extent that these exist over and above sidedness bias as well as side -of-space asymmetries -- since in these experiments, contralateral effects are

Granulosa cell tumor of the contralateral testis in a man with a history of cryptorchism.

PubMed

Guzzo, Thomas; Gerstein, Matthew; Mydlo, Jack H

2004-01-01

We report a case of adult-type testicular granulosa cell tumor in a 33-year-old man with a history of cryptorchism of the contralateral testis as well as Crohn's disease. The tumor was identified as a 1 x 1 x 1 cm mass on baseline ultrasound evaluation. CT evaluation of the patient revealed extensive mesenteric adenopathy, most likely secondary to his history of Crohn's disease. Copyright 2004 S. Karger AG, Basel

Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation.

PubMed

Mueller, M J; Strube, M J; Allen, B T

1997-04-01

To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA). Thirty patients with diabetes and TMA participated (mean age 62 +/- 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments. All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe. The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

Evaluation of mirrored muscle activity in patients with Complex Regional Pain Syndrome.

PubMed

Bank, Paulina J M; Peper, C Lieke E; Marinus, Johan; Beek, Peter J; van Hilten, Jacobus J

2014-10-01

Motor dysfunction in Complex Regional Pain Syndrome (CRPS) has been associated with bilateral changes in central motor processing, suggesting abnormal coupling between the affected and unaffected limb. We evaluated the occurrence of involuntary muscle activity in a limb during voluntary movements of the contralateral limb (i.e., mirror activity) in unilaterally affected patients to examine disinhibition of contralateral motor activity in CRPS. Mirror activity was examined during unimanual rhythmic flexion-extension movements of the wrist through in-depth analysis of electromyography recordings from the passive arm in 20 CRPS patients and 40 controls. The number of mirror-epochs was comparable for both arms in both CRPS patients and controls. Mirror-epochs in the affected arm of patients were comparable to those in controls. Mirror-epochs in the unaffected arm were shorter and showed less resemblance (in terms of rhythm and timing) to activity of the homologous muscle in the moving arm compared to mirror-epochs in controls. No evidence for disinhibition of contralateral motor activity was found during unimanual movement. Although motor dysfunction in CRPS has been associated with bilateral changes in cortical motor processing, the present findings argue against disinhibition of interhemispheric projections to homologous muscles in the contralateral limb during unimanual movement. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Radiographic Evaluation of Ankle Joint Stability After Calcaneofibular Ligament Elevation During Open Reduction and Internal Fixation of Calcaneus Fracture.

PubMed

Wang, Chien-Shun; Tzeng, Yun-Hsuan; Lin, Chun-Cheng; Huang, Ching-Kuei; Chang, Ming-Chau; Chiang, Chao-Ching

2016-09-01

The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability. Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively. The average degree of talar tilt on stress radiographs was 3.4 degrees (range, 0-12 degrees) on the operative side and 3.2 degrees (range, 0-14 degrees) on the contralateral side. The mean anterior drawer on stress radiographs of the CFL incised ankle was 6.1 mm (range, 2.4-11.8 mm) and on the contralateral ankle was 5.7 mm (range, 2.6-8.6 mm). There was no statistically significant difference of talar tilt and anterior drawer between the CFL incised side and the contralateral side (P = .658 and .302, respectively). The results suggest that sectioning of the CFL without any repair during ORIF of a calcaneal fracture does not have a negative effect on stability of the ankle. Repair of the CFL is, thus, probably not necessary following extended lateral approach for ORIF of calcaneal fractures. Level II, comparative study. © The Author(s) 2016.

The effects of ipsilateral, contralateral, and bilateral broadband noise on the mid-level hump in intensity discriminationa)

PubMed Central

Roverud, Elin; Strickland, Elizabeth A.

2015-01-01

Previous psychoacoustical and physiological studies indicate that the medial olivocochlear reflex (MOCR), a bilateral, sound-evoked reflex, may lead to improved sound intensity discrimination in background noise. The MOCR can decrease the range of basilar-membrane compression and can counteract effects of neural adaptation from background noise. However, the contribution of these processes to intensity discrimination is not well understood. This study examined the effect of ipsilateral, contralateral, and bilateral noise on the “mid-level hump.” The mid-level hump refers to intensity discrimination Weber fractions (WFs) measured for short-duration, high-frequency tones which are poorer at mid levels than at lower or higher levels. The mid-level hump WFs may reflect a limitation due to basilar-membrane compression, and thus may be decreased by the MOCR. The noise was either short (50 ms) or long (150 ms), with the long noise intended to elicit the sluggish MOCR. For a tone in quiet, mid-level hump WFs improved with ipsilateral noise for most listeners, but not with contralateral noise. For a tone in ipsilateral noise, WFs improved with contralateral noise for most listeners, but only when both noises were long. These results are consistent with MOCR-induced WF improvements, possibly via decreases in effects of compression and neural adaptation. PMID:26627798

Cooperative processing in primary somatosensory cortex and posterior parietal cortex during tactile working memory.

PubMed

Ku, Yixuan; Zhao, Di; Bodner, Mark; Zhou, Yong-Di

2015-08-01

In the present study, causal roles of both the primary somatosensory cortex (SI) and the posterior parietal cortex (PPC) were investigated in a tactile unimodal working memory (WM) task. Individual magnetic resonance imaging-based single-pulse transcranial magnetic stimulation (spTMS) was applied, respectively, to the left SI (ipsilateral to tactile stimuli), right SI (contralateral to tactile stimuli) and right PPC (contralateral to tactile stimuli), while human participants were performing a tactile-tactile unimodal delayed matching-to-sample task. The time points of spTMS were 300, 600 and 900 ms after the onset of the tactile sample stimulus (duration: 200 ms). Compared with ipsilateral SI, application of spTMS over either contralateral SI or contralateral PPC at those time points significantly impaired the accuracy of task performance. Meanwhile, the deterioration in accuracy did not vary with the stimulating time points. Together, these results indicate that the tactile information is processed cooperatively by SI and PPC in the same hemisphere, starting from the early delay of the tactile unimodal WM task. This pattern of processing of tactile information is different from the pattern in tactile-visual cross-modal WM. In a tactile-visual cross-modal WM task, SI and PPC contribute to the processing sequentially, suggesting a process of sensory information transfer during the early delay between modalities. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Bilateral responses of upper limb muscles to transcranial magnetic stimulation in human subjects.

PubMed

Bawa, P; Hamm, J D; Dhillon, P; Gross, P A

2004-10-01

Anatomical and behavioural work on primates has shown bilateral innervation of axial and proximal limb muscles, and contralateral control of distal limb muscles. The following study examined if a clear boundary exists between the distal and proximal upper limb muscles that are controlled contralaterally or bilaterally. The right motor cortical area representing the upper limb was stimulated, while surface EMG was recorded bilaterally from various upper limb muscles during rest and phasic voluntary contractions. Peak-to-peak amplitude of motor evoked potential (MEP) was measured for each muscle on both sides. The ratio R = (ipsilateral MEP: contralateral MEP) was calculated for seven pairs of muscles. For each of the seven pairs, R was less than 1.0, implying that for each muscle and subject, the contralateral control is stronger. The boundary where R changed from almost zero to a clearly measurable magnitude depended on the subject. Ipsilateral MEPs from trapezius and pectoralis could be recorded with a small background contraction from almost all subjects; on the other hand, in deltoid and biceps brachii, ipsilateral MEPs were observed only with bimanual phasic contractions. The forearm and hand muscles, in general, did not show any ipsilateral MEPs. Major differences between subjects lay in the presence or the absence of ipsilateral MEPs in biceps brachii and deltoid, without defining a sharp boundary between proximal and distal muscles.

Unique cortical physiology associated with ipsilateral hand movements and neuroprosthetic implications.

PubMed

Wisneski, Kimberly J; Anderson, Nicholas; Schalk, Gerwin; Smyth, Matt; Moran, Daniel; Leuthardt, Eric C

2008-12-01

Brain computer interfaces (BCIs) offer little direct benefit to patients with hemispheric stroke because current platforms rely on signals derived from the contralateral motor cortex (the same region injured by the stroke). For BCIs to assist hemiparetic patients, the implant must use unaffected cortex ipsilateral to the affected limb. This requires the identification of distinct electrophysiological features from the motor cortex associated with ipsilateral hand movements. In this study we studied 6 patients undergoing temporary placement of intracranial electrode arrays. Electrocorticographic (ECoG) signals were recorded while the subjects engaged in specific ipsilateral or contralateral hand motor tasks. Spectral changes were identified with regards to frequency, location, and timing. Ipsilateral hand movements were associated with electrophysiological changes that occur in lower frequency spectra, at distinct anatomic locations, and earlier than changes associated with contralateral hand movements. In a subset of 3 patients, features specific to ipsilateral and contralateral hand movements were used to control a cursor on a screen in real time. In ipsilateral derived control this was optimal with lower frequency spectra. There are distinctive cortical electrophysiological features associated with ipsilateral movements which can be used for device control. These findings have implications for patients with hemispheric stroke because they offer a potential methodology for which a single hemisphere can be used to enhance the function of a stroke induced hemiparesis.

High femoral artery bifurcation predicts contralateral high bifurcation: implications for complex percutaneous cardiovascular procedures requiring large caliber and/or dual access.

PubMed

Gupta, Vipul; Feng, Kent; Cheruvu, Pavan; Boyer, Nathan; Yeghiazarians, Yerem; Ports, Thomas A; Zimmet, Jeffrey; Shunk, Kendrick; Boyle, Andrew J

2014-09-01

Recent advances in technology have led to an increase in the use of bilateral femoral artery access and the requirement for large-bore access. Optimal access is in the common femoral artery (CFA), rather than higher (in the external iliac artery) or lower (in one of the branches of the CFA). However, there is a paucity of data in the literature about the relationship between bifurcation level of one CFA and the contralateral CFA. To define the prevalence of high bifurcation of the CFA and the relationship between bifurcation level on both sides, we performed a retrospective analysis of all patients with bilateral femoral angiography. From 4880 femoral angiograms performed at UCSF cardiac catheterization laboratory between 2005-2013, a total of 273 patients had bilateral femoral angiograms. The prevalence of low/normal, high, and very-high femoral bifurcations was 70%, 26%, and 4%, respectively, with no difference between sides. A high or very-high bifurcation significantly increased the likelihood of a high bifurcation on the contralateral side (odds ratio >3.0). Multivariable logistic regression analysis revealed age, gender, self-reported race, height, weight, and body mass index were not predictive of high or very-high bifurcations on either side. In conclusion, high femoral artery bifurcations are common and increase the likelihood of a high bifurcation of the contralateral femoral artery.

Probing the Effects and Mechanisms of Electroacupuncture at Ipsilateral or Contralateral ST36-ST37 Acupoints on CFA-induced Inflammatory Pain.

PubMed

Lu, Kung-Wen; Hsu, Chao-Kuei; Hsieh, Ching-Liang; Yang, Jun; Lin, Yi-Wen

2016-02-24

Transient receptor potential vanilloid 1 (TRPV1) and associated signaling pathways have been reported to be increased in inflammatory pain signaling. There are accumulating evidences surrounding the therapeutic effect of electroacupuncture (EA). EA can reliably attenuate the increase of TRPV1 in mouse inflammatory pain models with unclear signaling mechanisms. Moreover, the difference in the clinical therapeutic effects between using the contralateral and ipsilateral acupoints has been rarely studied. We found that inflammatory pain, which was induced by injecting the complete Freund's adjuvant (CFA), (2.14 ± 0.1, p < 0.05, n = 8) can be alleviated after EA treatment at either ipsilateral (3.91 ± 0.21, p < 0.05, n = 8) or contralateral acupoints (3.79 ± 0.25, p < 0.05, n = 8). EA may also reduce nociceptive Nav sodium currents in dorsal root ganglion (DRG) neurons. The expression of TRPV1 and associated signaling pathways notably increased after the CFA injection; this expression can be further attenuated significantly in EA treatment. TRPV1 and associated signaling pathways can be prevented in TRPV1 knockout mice, suggesting that TRPV1 knockout mice are resistant to inflammatory pain. Through this study, we have increased the understanding of the mechanism that both ipsilateral and contralateral EA might alter TRPV1 and associated signaling pathways to reduce inflammatory pain.

Can the contralateral limb be used as a control during the growing period in a rodent model?

PubMed

Mustafy, Tanvir; Londono, Irène; Villemure, Isabelle

2018-05-12

The contralateral limb is often used as a control in various clinical, forensic and anthropological studies. However, no studies have been performed to determine if the contra-lateral limb is a suitable control during the bone development period. The aim of this study was to determine the bilateral symmetry of growing rat tibiae in terms of geometric shape, mechanical strength and bone morphological parameters with developmental stages. Left and right tibias of 18 male Sprague-Dawley rats at 4, 8 and 12 weeks of age were scanned with micro-CT for bone-morphometric evaluation and for 3D deviation analysis to quantify the geometric shape variations between left and right tibiae. Overall tibial lengths and curvatures were also measured, and bone mechanical strength was investigated using three-point bending tests. Deviation distributions between bilateral tibiae remained below 0.5 mm for more than 80% of the geometry for all groups. Tibial lengths, longitudinal tibial curvatures, bone-morphometric parameters and mechanical strengths changed significantly during the growing period but kept a strong degree of symmetry between bilateral tibiae. These results suggest that bilateral tibiae can be considered symmetrical in nature and that contralateral limb can be used as a control during the growing period in different experimental scenarios. Copyright © 2018 Elsevier Ltd. All rights reserved.

The macaque midbrain reticular formation sends side-specific feedback to the superior colliculus.

PubMed

Wang, Niping; Warren, Susan; May, Paul J

2010-04-01

The central mesencephalic reticular formation (cMRF) likely plays a role in gaze control, as cMRF neurons receive tectal input and provide a bilateral projection back to the superior colliculus (SC). We examined the important question of whether this feedback is excitatory or inhibitory. Biotinylated dextran amine (BDA) was injected into the cMRF of M. fascicularis monkeys to anterogradely label reticulotectal terminals and retrogradely label tectoreticular neurons. BDA labeled profiles in the ipsi- and contralateral intermediate gray layer (SGI) were examined electron microscopically. Postembedding GABA immunochemistry was used to identify putative inhibitory profiles. Nearly all (94.7%) of the ipsilateral BDA labeled terminals were GABA positive, but profiles postsynaptic to these labeled terminals were exclusively GABA negative. In addition, BDA labeled terminals were observed to contact BDA labeled dendrites, indicating the presence of a monosynaptic feedback loop connecting the cMRF and ipsilateral SC. In contrast, within the contralateral SGI, half of the BDA labeled terminals were GABA positive, while more than a third were GABA negative. All the postsynaptic profiles were GABA negative. These results indicate the cMRF provides inhibitory feedback to the ipsilateral side of the SC, but it has more complex effects on the contralateral side. The ipsilateral projection may help tune the "winner-take-all" mechanism that produces a unified saccade signal, while the contralateral projections may contribute to the coordination of activity between the two colliculi.

Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation.

PubMed

Lindsey, Derek P; Parrish, Robin; Gundanna, Mukund; Leasure, Jeremi; Yerby, Scott A; Kondrashov, Dimitriy

2018-03-01

OBJECTIVE Bilateral symptoms have been reported in 8%-35% of patients with sacroiliac (SI) joint dysfunction. Stabilization of a single SI joint may significantly alter the stresses on the contralateral SI joint. If the contralateral SI joint stresses are significantly increased, degeneration may occur; alternatively, if the stresses are significantly reduced, bilateral stabilization may be unnecessary for patients with bilateral symptoms. The biomechanical effects of 1) unilateral stabilization on the contralateral SI joint and 2) bilateral stabilization on both SI joints are currently unknown. The objectives of this study were to characterize bilateral SI joint range of motion (ROM) and evaluate and compare the biomechanical effects of unilateral and bilateral implant placement for SI joint fusion. METHODS A lumbopelvic model (L5-pelvis) was used to test the ROM of both SI joints in 8 cadavers. A single-leg stance setup was used to load the lumbar spine and measure the ROM of each SI joint in flexion-extension, lateral bending, and axial rotation. Both joints were tested 1) while intact, 2) after unilateral stabilization, and 3) after bilateral stabilization. Stabilization consisted of lateral transiliac placement of 3 triangular titanium plasma-sprayed (TPS) implants. RESULTS Intact testing showed that during single-leg stance the contralateral SI joint had less ROM in flexion-extension (27%), lateral bending (32%), and axial rotation (69%) than the loaded joint. Unilateral stabilization resulted in significant reduction of flexion-extension ROM (46%) on the treated side; no significant ROM changes were observed for the nontreated side. Bilateral stabilization resulted in significant reduction of flexion-extension ROM of the primary (45%) and secondary (75%) SI joints. CONCLUSIONS This study demonstrated that during single-leg loading the ROMs for the stance (loaded) and swing (unloaded) SI joints are significantly different. Unilateral stabilization for SI joint dysfunction significantly reduces the ROM of the treated side, but does not significantly reduce the ROM of the nontreated contralateral SI joint. Bilateral stabilization is necessary to significantly reduce the ROM for both SI joints.

Peptide-induced prostaglandin biosynthesis in the renal-vein-constricted kidney

PubMed Central

Myers, Stuart I.; Zipser, Robert; Needleman, Philip

1981-01-01

The ipsilateral kidney was removed from a rabbit 48h after unilateral partial renal-vein-constriction and was perfused with Krebs–Henseleit media at 37°C. Hourly administration of a fixed dose of bradykinin to the renal-vein-constricted kidney demonstrated a marked time-dependent increase in the release of bioassayable prostaglandin E2 and thromboxane A2 into the venous effluent as compared with the response of the contralateral control kidney. The renal-vein-constricted kidney produced up to 60 times more prostaglandin E2 in response to bradykinin after 6h of perfusion as compared with the contralateral kidney; thromboxane A2 was not demonstratable in the contralateral kidney. Inhibition of protein synthesis de novo in the perfused renal-vein-constricted kidney with cycloheximide lessened the hormone-stimulated increase in prostaglandin E2 by 94% and in thromboxane A2 by 90% at 6h of perfusion. Covalent acetylation of the renal cyclo-oxygenase by prior oral administration of aspirin to the rabbit inhibited initial bradykinin-stimulated prostaglandin E2 biosynthesis 71% at 1h of perfusion. However, there was total recovery from aspirin in the renal-vein-constricted kidney by 2h of perfusion after bradykinin stimulation. Total cyclo-oxygenase activity as measured by [14C]arachidonate metabolism to labelled prostaglandins by renal cortical and renal medullary microsomal fractions prepared from 6h-perfused kidneys demonstrated that renal-vein-constricted kidney-cortical cyclo-oxygenase activity was significantly greater than the contralateral-kidney-cortical conversion, whereas medullary arachidonate metabolism was comparable in both the renal-vein-constricted kidney and contralateral kidney. These data suggest that perfusion of a renal-vein-constricted kidney initiates a time-dependent induction of synthesis of prostaglandin-producing enzymes, which appear to be primarily localized in the renal cortex. The presence of the synthetic capacity to generate very potent vasodilator and vasoconstrictor prostaglandins in the renal cortex suggests that these substances could mediate or modulate changes in renal vascular resistance in pathological states. PMID:6798974

Hyperpolarized (3)He magnetic resonance imaging: comparison with four-dimensional x-ray computed tomography imaging in lung cancer.

PubMed

Mathew, Lindsay; Wheatley, Andrew; Castillo, Richard; Castillo, Edward; Rodrigues, George; Guerrero, Thomas; Parraga, Grace

2012-12-01

Pulmonary functional imaging using four-dimensional x-ray computed tomographic (4DCT) imaging and hyperpolarized (3)He magnetic resonance imaging (MRI) provides regional lung function estimates in patients with lung cancer in whom pulmonary function measurements are typically dominated by tumor burden. The aim of this study was to evaluate the quantitative spatial relationship between 4DCT and hyperpolarized (3)He MRI ventilation maps. Eleven patients with lung cancer provided written informed consent to 4DCT imaging and MRI performed within 11 ± 14 days. Hyperpolarized (3)He MRI was acquired in breath-hold after inhalation from functional residual capacity of 1 L hyperpolarized (3)He, whereas 4DCT imaging was acquired over a single tidal breath of room air. For hyperpolarized (3)He MRI, the percentage ventilated volume was generated using semiautomated segmentation; for 4DCT imaging, pulmonary function maps were generated using the correspondence between identical tissue elements at inspiratory and expiratory phases to generate percentage ventilated volume. After accounting for differences in image acquisition lung volumes ((3)He MRI: 1.9 ± 0.5 L ipsilateral, 2.3 ± 0.7 L contralateral; 4DCT imaging: 1.2 ± 0.3 L ipsilateral, 1.3 ± 0.4 L contralateral), there was no significant difference in percentage ventilated volume between hyperpolarized (3)He MRI (72 ± 11% ipsilateral, 79 ± 12% contralateral) and 4DCT imaging (74 ± 3% ipsilateral, 75 ± 4% contralateral). Spatial correspondence between 4DCT and (3)He MRI ventilation was evaluated using the Dice similarity coefficient index (ipsilateral, 86 ± 12%; contralateral, 88 ± 12%). Despite rather large differences in image acquisition breathing maneuvers, good spatial and significant quantitative agreement was observed for ventilation maps on hyperpolarized (3)He MRI and 4DCT imaging, suggesting that pulmonary regions with good lung function are similar between modalities in this small group of patients with lung cancer. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

Ovum transmigration after salpingectomy for ectopic pregnancy.

PubMed

Ross, Jackie A; Davison, Amelia Z; Sana, Yasmin; Appiah, Adjoa; Johns, Jemma; Lee, Christopher T

2013-04-01

What proportion of pregnancies are a result of ovum transmigration after salpingectomy for ectopic pregnancy? Approximately one-third of spontaneously conceived pregnancies are a result of pick-up of the ovum from the ovary contralateral to the remaining tube in women with a history of salpingectomy. The corpus luteum has been found contralateral to tubal ectopic pregnancies in 32% of reported cases. The rate of contralateral ovum pick-up in intrauterine pregnancies is not known. We conducted a retrospective cohort study of clinical and ultrasound records collected over a 12-year period 1999-2010. Ten per cent of cases identified were excluded from the final analysis due to incomplete data or bilateral corpora lutea. Included were 842 pregnancies in 707 women with a history of unilateral salpingectomy for ectopic pregnancy and subsequent spontaneous pregnancy. The study was set in the Early Pregnancy Unit of a large UK inner city teaching hospital. The outcome measure was the side of the corpus luteum in relation to the side of the remaining tube. The corpus luteum was located in the ovary contralateral to the remaining tube in 266/842 pregnancies (31.6%; 95% CI 28.5-34.8%). There was no significant difference in this proportion between intrauterine and ectopic pregnancies [246/769 (32.0%) versus 21/73 (28.8%), P = 0.60]. This was a retrospective study and so did not address the conception rate according to the laterality of ovulation. Our findings were very similar to the frequency of ectopic pregnancies found contralateral to the corpus luteum described in previous studies. Ovum pick-up from the cul-de-sac probably occurs reasonably frequently and is unlikely to have a causative role in the pathogenesis of ectopic pregnancy. It is not known how often this phenomenon occurs in women with intact Fallopian tubes. No specific funding was obtained. The authors have no conflicts of interest to declare.

Hindlimb spasticity after unilateral motor cortex lesion in rats is reduced by contralateral nerve root transfer.

PubMed

Zong, Haiyang; Ma, Fenfen; Zhang, Laiyin; Lu, Huiping; Gong, Jingru; Cai, Min; Lin, Haodong; Zhu, Yizhun; Hou, Chunlin

2016-12-01

Lower extremity spasticity is a common sequela among patients with acquired brain injury. The optimum treatment remains controversial. The aim of our study was to test the feasibility and effectiveness of contralateral nerve root transfer in reducing post stroke spasticity of the affected hindlimb muscles in rats. In our study, we for the first time created a novel animal hindlimb spastic hemiplegia model in rats with photothrombotic lesion of unilateral motor cortex and we established a novel surgical procedure in reducing motor cortex lesion-induced hindlimb spastic hemiplegia in rats. Thirty six rats were randomized into three groups. In group A, rats received sham operation. In group B, rats underwent unilateral hindlimb motor cortex lesion. In group C, rats underwent unilateral hindlimb cortex lesion followed by contralateral L4 ventral root transfer to L5 ventral root of the affected side. Footprint analysis, Hoffmann reflex (H-reflex), cholera toxin subunit B (CTB) retrograde tracing of gastrocnemius muscle (GM) motoneurons and immunofluorescent staining of vesicle glutamate transporter 1 (VGLUT1) on CTB-labelled motoneurons were used to assess spasticity of the affected hindlimb. Sixteen weeks postoperatively, toe spread and stride length recovered significantly in group C compared with group B (P<0.001). H max (H-wave maximum amplitude)/M max (M-wave maximum amplitude) ratio of gastrocnemius and plantaris muscles (PMs) significantly reduced in group C (P<0.01). Average VGLUT1 positive boutons per CTB-labelled motoneurons significantly reduced in group C (P<0.001). We demonstrated for the first time that contralateral L4 ventral root transfer to L5 ventral root of the affected side was effective in relieving unilateral motor cortex lesion-induced hindlimb spasticity in rats. Our data indicated that this could be an alternative treatment for unilateral lower extremity spasticity after brain injury. Therefore, contralateral neurotization may exert a potential therapeutic candidate to improve the function of lower extremity in patients with spastic hemiplegia. © 2016 The Author(s).

The Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplant

PubMed Central

Stewart, Darren E.; Bista, Bipin R.; Salkowski, Nicholas; Snyder, Jon J.; Israni, Ajay K.; Crary, Gretchen S.; Rosendale, John D.; Matas, Arthur J.; Delmonico, Francis L.

2014-01-01

Background and objectives There is a shortage of kidneys for transplant, and many patients on the deceased donor kidney transplant waiting list would likely benefit from kidneys that are currently being discarded. In the United States, the most common reason given for discarding kidneys retrieved for transplant is procurement biopsy results. This study aimed to compare biopsy results from discarded kidneys with discard attributed to biopsy findings, with biopsy results from comparable kidneys that were successfully transplanted. Design, setting, participants, & measurements In this retrospective, observational, case-control study, biopsy reports were examined from 83 kidneys discarded in 2010 due to biopsy findings (cases), 83 contralateral transplanted kidneys from the same donor (contralateral controls), and 83 deceased donors randomly matched to cases by donor risk profile (randomly matched controls). A second procurement biopsy was obtained in 64 of 332 kidneys (19.3%). Results The quality of biopsy reports was low, with amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, and acute tubular necrosis often not indicated; 69% were wedge biopsies and 94% used frozen tissue. The correlation between first and second procurement biopsies was poor; only 25% of the variability (R2) in glomerulosclerosis was explained by biopsies being from the same kidney. The percentages of glomerulosclerosis overlapped substantially between cases, contralateral controls, and randomly matched controls: 17.1%±15.3%, 9.0%±6.6%, and 5.0%±5.9%, respectively. Of all biopsy findings, only glomerulosclerosis>20% was independently correlated with discard (cases versus contralateral controls; odds ratio, 15.09; 95% confidence interval, 2.47 to 92.41; P=0.003), suggesting that only this biopsy result was used in acceptance decisions. One-year graft survival was 79.5% and 90.7% in contralateral and randomly matched controls, respectively, versus 91.6% among all deceased donor transplants in the Scientific Registry of Transplant Recipients. Conclusions Routine use of biopsies could lead to unnecessary kidney discards. PMID:24558053

SU-E-J-87: Ventilation Weighting Effect On Mean Doses of Both Side Lungs for Patients with Advanced Stage Lung Cancer

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

Qu, H; Xia, P; Yu, N

Purpose: To study ventilation weighting effect on radiation doses to both side lungs for patients with advanced stage lung cancer. Methods: Fourteen patients with advanced stage lung cancer were included in this retrospective study. Proprietary software was developed to calculate the lung ventilation map based on 4DCT images acquired for radiation therapy. Two phases of inhale (0%) and exhale (50%) were used for the lung ventilation calculations. For each patient, the CT images were resampled to the same dose calculation resolution of 3mmx3mmx3mm. The ventilation distribution was then normalized by the mean value of the ventilation. The ventilation weighted dosemore » was calculated by applying linearly weighted ventilation to the dose of each pixel. The lung contours were automatically delineated from patient CT image with lung window, excluding the tumor and high density tissues. For contralateral and ipsilateral lungs, the mean lung doses from the original plan and ventilation weighted mean lung doses were compared using two tail t-Test. Results: The average of mean dose was 6.1 ±3.8Gy for the contralateral lungs, and 26.2 ± 14.0Gy for the ipsilateral lungs. The average of ventilation weighted dose was 6.3± 3.8Gy for the contralateral lungs and 24.6 ± 13.1Gy for the ipsilateral lungs. The statistics analysis shows the significance of the mean dose increase (p<0.015) for the contralateral lungs and decrease (p<0.005) for the ipsilateral lungs. Conclusion: Ventilation weighted doses were greater than the un-weighted doses for contralateral lungs and smaller for ipsilateral lungs. This Result may be helpful to understand the radiation dosimetric effect on the lung function and provide planning guidance for patients with advance stage lung cancer.« less

Differentiated thyroid cancer: A retrospective evaluation of the impact of changes to disease management guidelines on patients in South East Scotland.

PubMed

Williamson, A G; Wilmot, V; Ntala, C; Gibb, F W; Conn, B; Nixon, I J

2018-06-05

The British Thyroid Association (BTA) updated guidelines for the management of differentiated thyroid cancer (DTC) in 2014. A key update was that patients with unifocal disease >10-≤40 mm in diameter, aged <45 years and with no other risk factors could be considered for lobectomy alone. The aim of this study was to retrospectively evaluate the potential impact of these changes on the management of DTC in South East Scotland, and to analyse the characteristics of lobes now potentially considered for observation rather than resection. Consecutive patients were identified through prospectively held regional MDT minutes from 2009 to 13. Data included age, pT, pN, M stage, tumour size, vascular invasion and extra-thyroidal extension. From a cohort of 281 patients, 22 (8%) could now be considered for lobectomy alone. Of these, 4 had disease in the contralateral lobe (18%), all of which were low-risk tumours with no influence on recommendation for radioactive remnant ablation (RRA). Analysis of all patients, regardless of age, with pT1-2N0M0 disease (n = 50) revealed 11 (22%) had contralateral disease. The presence of index multifocal disease was predictive of disease in the contralateral lobe. One patient (2%) had a finding in the contralateral lobe which may potentially influence the recommendation for RRA. In no cases did findings in the contralateral lobe elevate a patient to a group where RRA was routinely recommended by BTA guidelines. The updated BTA guidelines are likely to affect only 8% of our cohort. Further analysis questions the role of age in excluding patients from a conservative approach. Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Features of the Retinotopic Representation in the Visual Wulst of a Laterally Eyed Bird, the Zebra Finch (Taeniopygia guttata)

PubMed Central

Michael, Neethu; Löwel, Siegrid; Bischof, Hans-Joachim

2015-01-01

The visual wulst of the zebra finch comprises at least two retinotopic maps of the contralateral eye. As yet, it is not known how much of the visual field is represented in the wulst neuronal maps, how the organization of the maps is related to the retinal architecture, and how information from the ipsilateral eye is involved in the activation of the wulst. Here, we have used autofluorescent flavoprotein imaging and classical anatomical methods to investigate such characteristics of the most posterior map of the multiple retinotopic representations. We found that the visual wulst can be activated by visual stimuli from a large part of the visual field of the contralateral eye. Horizontally, the visual field representation extended from -5° beyond the beak tip up to +125° laterally. Vertically, a small strip from -10° below to about +25° above the horizon activated the visual wulst. Although retinal ganglion cells had a much higher density around the fovea and along a strip extending from the fovea towards the beak tip, these areas were not overrepresented in the wulst map. The wulst area activated from the foveal region of the ipsilateral eye, overlapped substantially with the middle of the three contralaterally activated regions in the visual wulst, and partially with the other two. Visual wulst activity evoked by stimulation of the frontal visual field was stronger with contralateral than with binocular stimulation. This confirms earlier electrophysiological studies indicating an inhibitory influence of the activation of the ipsilateral eye on wulst activity elicited by stimulating the contralateral eye. The lack of a foveal overrepresentation suggests that identification of objects may not be the primary task of the zebra finch visual wulst. Instead, this brain area may be involved in the processing of visual information necessary for spatial orientation. PMID:25853253

A Standardized Rat Model of Volumetric Muscle Loss Injury for the Development of Tissue Engineering Therapies

PubMed Central

Wu, Xiaowu; Corona, Benjamin T.; Chen, Xiaoyu

2012-01-01

Abstract Soft tissue injuries involving volumetric muscle loss (VML) are defined as the traumatic or surgical loss of skeletal muscle with resultant functional impairment and represent a challenging clinical problem for both military and civilian medicine. In response, a variety of tissue engineering and regenerative medicine treatments are under preclinical development. A wide variety of animal models are being used, all with critical limitations. The objective of this study was to develop a model of VML that was reproducible and technically uncomplicated to provide a standardized platform for the development of tissue engineering and regenerative medicine solutions to VML repair. A rat model of VML involving excision of ∼20% of the muscle's mass from the superficial portion of the middle third of the tibialis anterior (TA) muscle was developed and was functionally characterized. The contralateral TA muscle served as the uninjured control. Additionally, uninjured age-matched control rats were also tested to determine the effect of VML on the contralateral limb. TA muscles were assessed at 2 and 4 months postinjury. VML muscles weighed 22.7% and 19.5% less than contralateral muscles at 2 and 4 months postinjury, respectively. These differences were accompanied by a reduction in peak isometric tetanic force (Po) of 28.4% and 32.5% at 2 and 4 months. Importantly, Po corrected for differences in body weight and muscle wet weights were similar between contralateral and age-matched control muscles, indicating that VML did not have a significant impact on the contralateral limb. Lastly, repair of the injury with a biological scaffold resulted in rapid vascularization and integration with the wound. The technical simplicity, reliability, and clinical relevance of the VML model developed in this study make it ideal as a standard model for the development of tissue engineering solutions for VML. PMID:23515319

Ipsilateral Breast Tumor Reappearance and Contralateral Breast Cancer after Primary Breast Cancer Treatment: A Comprehensive Retrospective Study of 15,168 Patients.

PubMed

Corso, Giovanni; Maisonneuve, Patrick; Santomauro, Giorgia Irene; De Scalzi, Alessandra Margherita; Toesca, Antonio; Bassi, Fabio Domenico; Farante, Gabriel; Caldarella, Pietro; Intra, Mattia; Galimberti, Viviana; Veronesi, Paolo

2018-05-30

The aim of this retrospective study was to assess the risk factors for developing ipsilateral breast tumor reappearance (IBTR) and de novo contralateral breast cancer (BC) after primary BC treatment. Retrospectively, 15,168 consecutive patients with primary monolateral BC were enrolled in this monocentric study (from June 1994 to December 2006). Clinicopathological features, follow-up, and survival at 15 years were considered for statistical analysis. Significant associations of increased risk for IBTR were verified with metastatic axillary lymph nodes (HR 1.37 [1.15-1.62], p = 0.0004), high tumor grade G2 (HR 1.35 [1.05-1.74], p = 0.02) and G3 (HR 1.35 [1.01-1.79], p = 0.04), luminal B (HR 1.51 [1.25-1.82], p < 0.0001), and HER2-positive (HR1.66 [1.14-2.41], p = 0.008) and triple-negative subtype (HR 1.54 [1.07-2.21], p = 0.02). Older age (HR 1.44 [1.08-1.91], p = 0.01) and positive family history (HR 1.85 [1.47-2.32], p < 0.0001) were risk factors for contralateral BC. Significant protective factors for IBTR were hormonotherapy (HR 0.71 [0.59-0.85], p = 0.0003), chemotherapy (HR 0.72 [0.60-0.87], p = 0.001), and radiotherapy (HR 0.73 [0.61-0.87], p = 0.0005). Hormonotherapy was also confirmed as a protective factor for contralateral second BC (HR 0.43 [0.30-0.60], p < 0.0001). We classified factors for IBTR and contralateral BC in high- and low-risk groups. In the high-risk group, breast surgery still remains more important than in the low-risk group, which seems to benefit more from adjuvant treatments. © 2018 S. Karger AG, Basel.

Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy.

PubMed

Na, Bub-Se; Choi, Jin-Ho; Park, In Kyu; Kim, Young Tae; Kang, Chang Hyun

2017-10-01

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

Carotid artery disease progression and related neurologic events after carotid endarterectomy.

PubMed

Avgerinos, Efthymios D; Go, Catherine; Ling, Jennifer; Naddaf, Abdallah; Steinmetz, Amy; Abou Ali, Adham N; Makaroun, Michel S; Chaer, Rabih A

2016-08-01

During the last decade, there has been a dramatic improvement in best medical treatment for patients with vascular disease. Yet, there is a paucity of contemporary long-term data for restenosis and contralateral internal carotid artery (ICA) progression. This study assessed ipsilateral and contralateral disease progression and cerebrovascular events after carotid endarterectomy (CEA). A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. End points were restenosis ≥50% and ≥70%, contralateral carotid disease progression (50%-69%, 70%-99%, or occlusion) and stroke. Survival analysis and Cox regression models were used to assess the effect of baseline predictors. During the 11-year study period, 1639 patients underwent 1782 CEAs (50.0% patch closure, 23.9% primary closure, 26.1% eversion, and 2.5% combined with coronary artery bypass grafting). The combined stroke/death rate was 2.6% overall and 1.8% in the asymptomatic cohort. The rate of restenosis ≥50% at 2, 5, and 10 years was 8.5%, 15.6%, 27.2%, and the rate for restenosis ≥70% was 3.4%, 6.5%, 10.2%, respectively. Restenosis ≥50% was predicted by hypertension (hazard ratio [HR], 2.09; P = .027), female gender (HR, 1.43; P = .042), and younger age (≤65 years; HR, 1.56; P = .016), but not by statins, surgical technique, symptoms, or other baseline risk factors. Restenoses remained asymptomatic in 125 of 148 (84.5%). Progression of contralateral ICA disease at 2, 5, and 10 years was estimated at 5.4%, 15.5%, and 46.8%, respectively. Contralateral progression was only predicted by smoking (HR, 1.74; P = .008). The stroke rate in patients with disease progression of the contralateral ICA was not different compared with those without progression (7.0% vs 3.3%; P = .063). Any-stroke rates at 2, 5, and 10 years were 4.6%, 7.3%, and 15.7%, respectively. Predictors were symptomatic lesion (HR, 1.48; P = .039), renal insufficiency, defined as a glomerular filtration rate (GFR) of 30 to 59 vs <30 mL/min/1.73 m 2 (HR, 0.34; P = .009) or GFR ≥60 vs GFR <30 mL/min/1.73 m 2 (HR, 0.55; P = .109), and statin use (HR, 0.59; P = .006). Restenosis or contralateral disease progression after CEA, to a level that might warrant consideration for treatment, is very low. The potentially associated stroke rates are also very low and not clearly related to disease progression. With the exception of the postoperative duplex, surveillance within short intervals of <1 or 2 years cannot be justified. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The medial olivocochlear reflex in children during active listening.

PubMed

Smith, Spencer B; Cone, Barbara

2015-08-01

To determine if active listening modulates the strength of the medial olivocochlear (MOC) reflex in children. Click-evoked otoacoustic emissions (CEOAEs) were recorded from the right ear in quiet and in four test conditions: one with contralateral broadband noise (BBN) only, and three with active listening tasks wherein attention was directed to speech embedded in contralateral BBN. Fifteen typically-developing children (ranging in age from 8 to14 years) with normal hearing. CEOAE levels were reduced in every condition with contralateral acoustic stimulus (CAS) when compared to preceding quiet conditions. There was an additional systematic decrease in CEOAE level with increased listening task difficulty, although this effect was very small. These CEOAE level differences were most apparent in the 8-18 ms region after click onset. Active listening may change the strength of the MOC reflex in children, although the effects reported here are very subtle. Further studies are needed to verify that task difficulty modulates the activity of the MOC reflex in children.

The medial olivocochlear reflex in children during active listening

PubMed Central

Smith, Spencer B.; Cone, Barbara

2015-01-01

Objective To determine if active listening modulates the strength of the medial olivocochlear (MOC) reflex in children. Design Click-evoked otoacoustic emissions (CEOAEs) were recorded from the right ear in quiet and in four test conditions: one with contralateral broadband noise (BBN) only, and three with active listening tasks wherein attention was directed to speech embedded in contralateral BBN. Study sample Fifteen typically-developing children (ranging in age from 8 to 14 years) with normal hearing. Results CEOAE levels were reduced in every condition with contralateral acoustic stimulus (CAS) when compared to preceding quiet conditions. There was an additional systematic decrease in CEOAE level with increased listening task difficulty, although this effect was very small. These CEOAE level differences were most apparent in the 8–18 ms region after click onset. Conclusions Active listening may change the strength of the MOC reflex in children, although the effects reported here are very subtle. Further studies are needed to verify that task difficulty modulates the activity of the MOC reflex in children. PMID:25735203

Signal enhancement, not active suppression, follows the contingent capture of visual attention.

PubMed

Livingstone, Ashley C; Christie, Gregory J; Wright, Richard D; McDonald, John J

2017-02-01

Irrelevant visual cues capture attention when they possess a task-relevant feature. Electrophysiologically, this contingent capture of attention is evidenced by the N2pc component of the visual event-related potential (ERP) and an enlarged ERP positivity over the occipital hemisphere contralateral to the cued location. The N2pc reflects an early stage of attentional selection, but presently it is unclear what the contralateral ERP positivity reflects. One hypothesis is that it reflects the perceptual enhancement of the cued search-array item; another hypothesis is that it is time-locked to the preceding cue display and reflects active suppression of the cue itself. Here, we varied the time interval between a cue display and a subsequent target display to evaluate these competing hypotheses. The results demonstrated that the contralateral ERP positivity is tightly time-locked to the appearance of the search display rather than the cue display, thereby supporting the perceptual enhancement hypothesis and disconfirming the cue-suppression hypothesis. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Site and incidence of birth canal lacerations from instrumental delivery with mediolateral episiotomy.

PubMed

Chikazawa, Kenro; Ushijima, Junko; Takagi, Kenjiro; Nakamura, Eishin; Samejima, Koki; Kadowaki, Kanako; Horiuchi, Isao

2016-12-01

Instrument-assisted vaginal delivery is a significant risk factor for birth canal lacerations. Although many obstetricians recently are recommending restrictive rather than a routine episiotomy, reports have shown restrictive episiotomy to be associated with more extensive anterior birth canal trauma compared with routine episiotomy. We retrospectively reviewed 110 cases of forceps and vacuum deliveries and investigated the site of birth canal lacerations. Birth canal lacerations were divided into four sites according to direction-anterior, ipsilateral, contralateral, and posterior. The frequency of lacerations were, from most to least, posterior (34%), lateral (21.7%), and anterior (1.9%). Moreover, among the lateral lacerations, they were more frequent in the contralateral side of episiotomy than the ipsilateral side (18.9% vs. 4.7%, p < 0.01). Our results indicate that caution is also needed concerning not only the anterior site, but also the contralateral site of an episiotomy to prevent laceration in an instrument-assisted vaginal delivery. Copyright © 2016. Published by Elsevier B.V.

Objective evaluation of cutaneous thermal sensivity

NASA Technical Reports Server (NTRS)

Vanbeaumont, W.

1972-01-01

The possibility of obtaining reliable and objective quantitative responses was investigated under conditions where only temperature changes in localized cutaneous areas evoked measurable changes in remote sudomotor activity. Both male and female subjects were studied to evaluate sex difference in thermal sensitivity. The results discussed include: sweat rate responses to contralateral cooling, comparison of sweat rate responses between men and women to contralateral cooling, influence of the menstrual cycle on the sweat rate responses to contralateral cooling, comparison of threshold of sweating responses between men and women, and correlation of latency to threshold for whole body sweating. It is concluded that the quantitative aspects of the reflex response is affected by both the density and activation of receptors as well as the rate of heat loss; men responded 8-10% more frequently than women to thermode cooling, the magnitude of responses being greater for men; and women responded 7-9% more frequently to thermode cooling on day 1 of menstruation, as compared to day 15.

Assessing Hand Muscle Structural Modifications in Chronic Stroke.

PubMed

Zong, Ya; Shin, Henry H; Wang, Ying-Chih; Li, Sheng; Zhou, Ping; Li, Xiaoyan

2018-01-01

The purpose of the study is to assess poststroke muscle structural alterations by examining muscular electrical conductivity and inherent electrophysiological properties. In particular, muscle impedance and compound muscle action potentials (CMAP) were measured from the hypothenar muscle bilaterally using the electrical impedance myography and the electrophysiological techniques, respectively. Significant changes of muscle impedance were observed in the paretic muscle compared with the contralateral side (resistance: paretic: 27.54 ± 0.97 Ω, contralateral: 25.46 ± 0.91 Ω, p  < 0.05; phase angle: paretic: 8.81 ± 0.61°, contralateral: 10.79 ± 0.69°, p  < 0.05). In addition, impedance changes correlated moderately with the CMAP amplitude in the paretic hand (phase angle: r  = 0.66, p  < 0.05; reactance: r  = 0.58, p  < 0.05). The study discloses significant muscle rearrangements as a result of fiber loss or atrophy, fat infiltration or impaired membrane integrity in chronic stroke.

Contralateral functional reorganization of the speech supplementary motor area following neurosurgical tumor resection.

PubMed

Chivukula, Srinivas; Pikul, Brian K; Black, Keith L; Pouratian, Nader; Bookheimer, Susan Y

2018-05-18

We evaluated plasticity in speech supplemental motor area (SMA) tissue in two patients using functional magnetic resonance imaging (fMRI), following resection of tumors in or associated with the dominant hemisphere speech SMA. Patient A underwent resection of a anaplastic astrocytoma NOS associated with the left speech SMA, experienced SMA syndrome related mutism postoperatively, but experienced full recovery 14 months later. FMRI performed 32 months after surgery demonstrated a migration of speech SMA to homologous contralateral hemispheric regional tissue. Patient B underwent resection of a oligodendroglioma NOS in the left speech SMA, and postoperatively experienced speech hesitancy, latency and poor fluency, which gradually resolved over 18 months. FMRI performed at 64 months after surgery showed a reorganization of speech SMA to the contralateral hemisphere. These data support the hypothesis of dynamic, time based plasticity in speech SMA tissue, and may represent a noninvasive neural marker for SMA syndrome recovery. Copyright © 2018 Elsevier Inc. All rights reserved.

Biochemical response to chronic shortening in unloaded soleus muscles

NASA Technical Reports Server (NTRS)

Jaspers, S. R.; Fagan, J. M.; Tischler, M. E.

1985-01-01

One leg of tail-casted suspended rats was immobilized in a plantar-flexed position to test whether chronic shortening of posterior leg muscles affected the metabolic response to unloading. The immobilized plantaris and gastrocnemius muscles of these animals showed approximately 20 percent loss of muscle mass in contrast to simply a slower growth rate with unloading. Loss of mass of the soleus muscle during suspension was not accentuated by chronic shortening. Although protein degradation in the isolated soleus muscle of the plantar-flexed limb was slightly faster than in the contralateral free limb, this difference was offset by faster synthesis of the myofibrillar protein fraction of the chronically shortened muscle. Total adenine nucleotides were 17 percent lower (P less than 0.005) in the chronically shortened soleus muscle following incubation. Glutamate, glutamine, and alanine metabolism showed little response to chronic shortening. These results suggest that, in the soleus muscle, chronic shortening did not alter significantly the metabolic responses to unloading and reduced activity.

Effect of fronto-orbital advancement on astigmatism in patients with anterior plagiocephaly.

PubMed

Song, Hyun Beom; Yang, Hee Kyung; Baek, Rong-Min; Hwang, Jeong-Min; Kim, Namju; Wang, Kyu-Chang; Kim, Sukwha

2016-10-01

The purpose of this study was to determine the effect of unilateral fronto-orbital advancement (FOA) or bilateral FOA on ocular aspects of plagiocephaly. A retrospective review of ocular findings in 16 patients with plagiocephaly was performed. Patients were divided into 2 groups: 12 patients who underwent bilateral FOA (bFOA) and 4 patients who underwent unilateral FOA (uFOA), and ocular findings were compared. One-half of patients showed strabismus in both groups, and all had exotropia. Hypertropia was found only on the same side of the plagiocephaly in 17% of the bFOA group and 25% of the uFOA group. One-third of the patients in the bFOA group and one-half of patients in the uFOA group had oblique muscle dysfunction. In terms of astigmatism, the degree of with-the-rule astigmatism on the contralateral side was larger in the bFOA group compared to the uFOA group (p = 0.030). The degree of with-the-rule astigmatism was larger on the contralateral side than the ipsilateral side (p = 0.005) in the bFOA group. Patients with abnormalities in ductions/versions had larger astigmatism on the contralateral side than those without abnormalities in ductions/versions. In conclusion, bilateral FOA could induce unwanted outcomes of larger astigmatism on the contralateral side. Astigmatism should be carefully evaluated after bilateral FOA. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Hemispheric asymmetry of ERPs and MMNs evoked by slow, fast and abrupt auditory motion.

PubMed

Shestopalova, L B; Petropavlovskaia, E A; Vaitulevich, S Ph; Nikitin, N I

2016-10-01

The current MMN study investigates whether brain lateralization during automatic discrimination of sound stimuli moving at different velocities is consistent with one of the three models of asymmetry: the right-hemispheric dominance model, the contralateral dominance model, or the neglect model. Auditory event-related potentials (ERPs) were recorded for three patterns of sound motion produced by linear or abrupt changes of interaural time differences. The slow motion (450deg/s) was used as standard, and the fast motion (620deg/s) and the abrupt sound shift served as deviants in the oddball blocks. All stimuli had the same onset/offset spatial positions. We compared the effects of the recording side (left, right) and of the direction of sound displacement (ipsi- or contralateral with reference to the side of recording) on the ERPs and mismatch negativity (MMN). Our results indicated different patterns of asymmetry for the ERPs and MMN responses. The ERPs showed a velocity-independent right-hemispheric dominance that emerged at the descending limb of N1 wave (at around 120-160ms) and could be related to overall context of the preattentive spatial perception. The MMNs elicited in the left hemisphere (at around 230-270ms) exhibited a contralateral dominance, whereas the right-hemispheric MMNs were insensitive to the direction of sound displacement. These differences in contralaterality between MMN responses produced by the left and the right hemisphere favour the neglect model of the preattentive motion processing indexed by MMN. Copyright © 2016 Elsevier Ltd. All rights reserved.

Probing the Effects and Mechanisms of Electroacupuncture at Ipsilateral or Contralateral ST36–ST37 Acupoints on CFA-induced Inflammatory Pain

PubMed Central

Lu, Kung-Wen; Hsu, Chao-Kuei; Hsieh, Ching-Liang; Yang, Jun; Lin, Yi-Wen

2016-01-01

Transient receptor potential vanilloid 1 (TRPV1) and associated signaling pathways have been reported to be increased in inflammatory pain signaling. There are accumulating evidences surrounding the therapeutic effect of electroacupuncture (EA). EA can reliably attenuate the increase of TRPV1 in mouse inflammatory pain models with unclear signaling mechanisms. Moreover, the difference in the clinical therapeutic effects between using the contralateral and ipsilateral acupoints has been rarely studied. We found that inflammatory pain, which was induced by injecting the complete Freund’s adjuvant (CFA), (2.14 ± 0.1, p < 0.05, n = 8) can be alleviated after EA treatment at either ipsilateral (3.91 ± 0.21, p < 0.05, n = 8) or contralateral acupoints (3.79 ± 0.25, p < 0.05, n = 8). EA may also reduce nociceptive Nav sodium currents in dorsal root ganglion (DRG) neurons. The expression of TRPV1 and associated signaling pathways notably increased after the CFA injection; this expression can be further attenuated significantly in EA treatment. TRPV1 and associated signaling pathways can be prevented in TRPV1 knockout mice, suggesting that TRPV1 knockout mice are resistant to inflammatory pain. Through this study, we have increased the understanding of the mechanism that both ipsilateral and contralateral EA might alter TRPV1 and associated signaling pathways to reduce inflammatory pain. PMID:26906464

Assessment of volume measurement of breast cancer-related lymphedema by three methods: circumference measurement, water displacement, and dual energy X-ray absorptiometry.

PubMed

Gjorup, Caroline; Zerahn, Bo; Hendel, Helle W

2010-06-01

Following treatment for breast cancer 12%-60% develop breast cancer-related lymphedema (BCRL). There are several ways of assessing BCRL. Circumference measurement (CM) and water displacement (WD) for volume measurements (VM) are frequently used methods in practice and research, respectively. The aim of this study was to evaluate CM and WD for VM of the BCRL arm and the contralateral arm, comparing the results with regional dual energy X-ray absorptiometry (DXA). Twenty-four women with unilateral BCRL were included in the study. Blinded duplicate VM were obtained from both arms using the three methods mentioned above. CM and DXA were performed by two observers. WD was performed by a group of observers. Mean differences (d) in duplicated volumes, limits of agreement (LOA), and 95% confidence intervals (CI) were calculated for each method. The repeatability expressed as d (95% CI) between the duplicated VM of the BCRL arm and the contralateral arm was for DXA 3 ml (-6-11) and 3 ml (1-7), respectively. For CM and WD, the d (95% CI) of the BCRL arm were 107 ml (86-127) and 26 ml (-26-79), respectively and in the contralateral arm 100 ml (78-122) and -6 ml (-29-17), respectively. DXA is superior in repeatability when compared to CM and WD for VM, especially for the BCRL arm but also the contralateral arm.

Salient, Irrelevant Sounds Reflexively Induce Alpha Rhythm Desynchronization in Parallel with Slow Potential Shifts in Visual Cortex.

PubMed

Störmer, Viola; Feng, Wenfeng; Martinez, Antigona; McDonald, John; Hillyard, Steven

2016-03-01

Recent findings suggest that a salient, irrelevant sound attracts attention to its location involuntarily and facilitates processing of a colocalized visual event [McDonald, J. J., Störmer, V. S., Martinez, A., Feng, W. F., & Hillyard, S. A. Salient sounds activate human visual cortex automatically. Journal of Neuroscience, 33, 9194-9201, 2013]. Associated with this cross-modal facilitation is a sound-evoked slow potential over the contralateral visual cortex termed the auditory-evoked contralateral occipital positivity (ACOP). Here, we further tested the hypothesis that a salient sound captures visual attention involuntarily by examining sound-evoked modulations of the occipital alpha rhythm, which has been strongly associated with visual attention. In two purely auditory experiments, lateralized irrelevant sounds triggered a bilateral desynchronization of occipital alpha-band activity (10-14 Hz) that was more pronounced in the hemisphere contralateral to the sound's location. The timing of the contralateral alpha-band desynchronization overlapped with that of the ACOP (∼240-400 msec), and both measures of neural activity were estimated to arise from neural generators in the ventral-occipital cortex. The magnitude of the lateralized alpha desynchronization was correlated with ACOP amplitude on a trial-by-trial basis and between participants, suggesting that they arise from or are dependent on a common neural mechanism. These results support the hypothesis that the sound-induced alpha desynchronization and ACOP both reflect the involuntary cross-modal orienting of spatial attention to the sound's location.

Contralateral Autologous Corneal Transplantation Experience in Mexico City.

PubMed

Perez-Balbuena, Ana L; Ancona-Lezama, David; Delgado-Pelayo, Sarai; Martinez, Jaime D

2017-01-01

The aim of this study is to expand the limited knowledge regarding autologous contralateral penetrating keratoplasty. We report the retrospective outcomes of patients who received autokeratoplasty and contralateral opaque corneas in the donor eye at a tertiary care ophthalmology hospital in Mexico City. Eleven patients received autokeratoplasty and contralateral opaque corneas in the donor eye at our center from 2010 to 2015. The mean patient age at the time of surgery was 58 years (range, 35-85 yrs), with 4 female and 7 male patients. There were no surgical or immediate postsurgical complications in the autokeratoplasty eye. However, 1 patient had expulsive hemorrhage in the sightless eye. Follow-up duration ranged from 11 to 65 months (mean, 26 mo). During follow-up, 3 of the autokeratoplasty procedures failed because of endothelial attenuation. Identified known risk factors for failure of the eye with visual potential included the presence of an Ahmed glaucoma drainage device in 7/11 patients (63%), history of glaucoma in 8/11 (72%), past heterologous penetrating keratoplasty in 2/11 (18%), Vogt-Koyanagi-Harada syndrome in 1/11 (9%), and 4-quadrant corneal vascularization in 1/11 (9%). Autokeratoplasty is a good choice in cases having high risk factors and when fresh corneal tissue is not available. This is the largest study describing outcomes of patients who underwent autokeratoplasty. This technique offers no risk of immune rejection and no need for immunosuppression treatment. This study reports a good prognosis in cases having high risk factors for failure.

Difference of motor overflow depending on the impaired or unimpaired hand in stroke patients.

PubMed

Kim, Yushin; Kim, Woo-Sub; Shim, Jae Kun; Suh, Dong Won; Kim, TaeYeong; Yoon, BumChul

2015-02-01

The aim of this study was to investigate the patterns of contralateral motor overflow (i.e. mirror movement) between the homologous body parts on the right and left side, in stroke patients during single-finger and multi-finger maximum force production tasks. Forty subjects, including stroke (n=20) and normal subjects (n=20), participated in this study. The stroke subjects maximally pressed force sensors with their fingers in a flexed position using a single (index, middle, ring, or little) or all fingers (all 4 fingers) using the impaired (IH) or unimpaired (UIH) hand, while the non-patient subjects used their right hands for the same tasks. The maximal voluntary forces in the ipsilateral and unintended pressing forces of each contralateral finger were recorded during the tasks. The magnitude of motor overflow to the contralateral side was calculated using the index of contralateral independence (CI). During the single finger tasks, the finger CI was significantly decreased in the UIH (91%) compared with that in the IH (99%) or normal hands (99%). Likewise, the multiple finger tasks showed that the CI was significantly lower in the UIH (84%) compared with that in the IH (96%) or normal hands (99%). However, the maximal forces were significantly lower in the IH relative to those in the UIH and normal hands. These data demonstrate that stroke patients have greater motor overflow from the UIH to the IH. Copyright © 2014 Elsevier B.V. All rights reserved.

Sensory Feedback in Interlimb Coordination: Contralateral Afferent Contribution to the Short-Latency Crossed Response during Human Walking.

PubMed

Gervasio, Sabata; Voigt, Michael; Kersting, Uwe G; Farina, Dario; Sinkjær, Thomas; Mrachacz-Kersting, Natalie

2017-01-01

A constant coordination between the left and right leg is required to maintain stability during human locomotion, especially in a variable environment. The neural mechanisms underlying this interlimb coordination are not yet known. In animals, interneurons located within the spinal cord allow direct communication between the two sides without the need for the involvement of higher centers. These may also exist in humans since sensory feedback elicited by tibial nerve stimulation on one side (ipsilateral) can affect the muscles activation in the opposite side (contralateral), provoking short-latency crossed responses (SLCRs). The current study investigated whether contralateral afferent feedback contributes to the mechanism controlling the SLCR in human gastrocnemius muscle. Surface electromyogram, kinematic and kinetic data were recorded from subjects during normal walking and hybrid walking (with the legs moving in opposite directions). An inverse dynamics model was applied to estimate the gastrocnemius muscle proprioceptors' firing rate. During normal walking, a significant correlation was observed between the magnitude of SLCRs and the estimated muscle spindle secondary afferent activity (P = 0.04). Moreover, estimated spindle secondary afferent and Golgi tendon organ activity were significantly different (P ≤ 0.01) when opposite responses have been observed, that is during normal (facilitation) and hybrid walking (inhibition) conditions. Contralateral sensory feedback, specifically spindle secondary afferents, likely plays a significant role in generating the SLCR. This observation has important implications for our understanding of what future research should be focusing on to optimize locomotor recovery in patient populations.

Increased growth rate of vestibular schwannoma after resection of contralateral tumor in neurofibromatosis type 2

PubMed Central

Peyre, Matthieu; Goutagny, Stephane; Imbeaud, Sandrine; Bozorg-Grayeli, Alexis; Felce, Michele; Sterkers, Olivier; Kalamarides, Michel

2011-01-01

Surgical management of bilateral vestibular schwannomas (VS) in neurofibromatosis type 2 (NF2) is often difficult, especially when both tumors threaten the brainstem. When the largest tumor has been removed, the management of the contralateral VS may become puzzling. To give new insights into the growth pattern of these tumors and to determine the best time point for treatment (surgery or medical treatment), we studied radiological growth in 11 VS (11 patients with NF2) over a long period (mean duration, 7.6 years), before and after removal of the contralateral tumor while both were threatening the brainstem. We used a quantitative approach of the radiological velocity of diametric expansion (VDE) on consecutive magnetic resonance images. Before first surgery, growth patterns of both tumors were similar in 9 of 11 cases. After the first surgery, VDE of the remaining VS was significantly elevated, compared with the preoperative period (2.5 ± 2.2 vs 4.4 ± 3.4 mm/year; P = .01, by Wilcoxon test). Decrease in hearing function was associated with increased postoperative growth in 3 cases. Growth pattern of coexisting intracranial meningiomas was not modified by VS surgery on the first side. In conclusion, removal of a large VS in a patient with NF2 might induce an increase in the growth rate of the contralateral medium or large VS. This possibility should be integrated in NF2 patient management to adequately treat the second VS. PMID:21798887

Three-dimensional analysis of a ballet dancer with ischial tuberosity apophysitis. A case study.

PubMed

Pohjola, Hanna; Sayers, Mark; Mellifont, Rebecca; Mellifont, Daniel; Venojärvi, Mika

2014-12-01

The purpose of this case study was to describe the three-dimensional biomechanics of common ballet exercises in a ballet dancer with ischial tuberosity apophysitis. This was achieved by comparing kinematics between the symptomatic (i.e. ischial apophyseal symptoms) and contralateral lower limbs, as well as via reported pain. Results suggest consistent differences in movement patterns in this dancer. These differences included: 1) decreased external rotation of contralateral hip, hence a decreased hip contribution to 'turn out'; 2) increased contralateral knee adduction and internal rotation; 3) an apparent synchronicity in the contralateral lower limb of the decreased hip external rotation and increased knee adduction; and 4) minimal use of ankle plantar/dorsiflexion movement for symptomatic side. Pain related to the left ischial apophysitis was associated with reduced amplitudes especially in fast ballet movements that required large range of motion in flexion and adduction in the left hip joint. These findings suggest that ischial apophysitis may limit dancer's ballet technique and performance. Key PointsThe pain related to the left ischial apophysitis was associated with reduced amplitudes especially in fast ballet movements that require large range of motion. This may affect to the lower limbs kinematics, and limit dancer's technique and performance.Compensatory strategies in the kinetic chain, differences in the joint angles between the lower limbs, traction forces, velocity and amplitude demands should be taken in consideration while training and rehabilitation of the ischial apophyseal injury within classical ballet.

Study of external root resorption during orthodontic treatment in root filled teeth compared with their contralateral teeth with vital pulps.

PubMed

Llamas-Carreras, J M; Amarilla, A; Solano, E; Velasco-Ortega, E; Rodríguez-Varo, L; Segura-Egea, J J

2010-08-01

To determine whether root filled teeth and those with vital pulps exhibit a similar degree of external root resorption (ERR) as a consequence of orthodontic treatment. The study sample consisted of 77 patients, with a mean age of 32.7 +/- 10.7 years, who had one root filled tooth before completion of multiband/bracket orthodontic therapy for at least 1 year. For each patient, digital panoramic radiographs taken before and after orthodontic treatment were used to determine the proportion of external root resorption (PRR), defined as the ratio between the root resorption in the root filled tooth and that in its contralateral tooth with a vital pulp. The student's t-test, anova and logistic regression analysis were used to determine statistical significance. The mean PRR was 1.00 +/- 0.13, indicating that, in the total sample, there were no significant differences in root resorption in the root filled teeth and their contralateral teeth with vital pulps. Multivariate logistic regression analysis suggested that PRR was significantly greater in incisors (P = 0.0014; odds ratio = 6.2885, C.I. 95% = 2.0-19.4), compared to other teeth, and in women (P = 0.0255; odds ratio = 4.2, C.I. 95% = 1.2-14.6), compared to men. There was no significant difference in the amount or severity of external root resorption during orthodontic movement between root filled teeth and their contralateral teeth with vital pulps.

The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

PubMed Central

Clarke-Pearson, Emily M; Vornovitsky, Michael; Dayan, Joseph H; Samson, William; Sultan, Mark R

2014-01-01

Background Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion. Results Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group. Conclusions Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry. PMID:25276646

Leg kinematics and kinetics in landing from a single-leg hop for distance. A comparison between dominant and non-dominant leg.

PubMed

van der Harst, J J; Gokeler, A; Hof, A L

2007-07-01

Anterior cruciate ligament (ACL) deficiency can be a major problem for athletes and subsequent reconstruction of the ACL may be indicated if a conservative regimen has failed. After ACL reconstruction signs of abnormality in the use of the leg remain for a long time. It is expected that the landing after a single-leg hop for distance (horizontal hop) might give insight in the differences in kinematics and kinetics between uninjured legs and ACL-reconstructed legs. Before the ACL-reconstructed leg can be compared with the contralateral leg, knowledge of differences between legs of uninjured subjects is needed. Kinematic and kinetic variables of both legs were measured with an optoelectronic system and a force plate and calculated by inverse dynamics. The dominant leg (the leg with biggest horizontal hop distance) and the contralateral leg of nine uninjured subjects were compared. No significant differences were found in most of the kinematic and kinetic variables between dominant leg and contralateral leg of uninjured subjects. Only hop distance and hip extension angles differed significantly. This study suggests that there are no important differences between dominant leg and contralateral leg in healthy subjects. As a consequence, the uninvolved leg of ACL-reconstructed patients can be used as a reference. The observed variables of this study can be used as a reference of normal values and normal differences between legs in healthy subjects.

Postoperative Time Dependent Tibiofemoral Articular Cartilage Contact Kinematics during Step-up after ACL Reconstruction

PubMed Central

Lin, Lin; Li, Jing-Sheng; Kernkamp, Willem A.; Hosseini, Ali; Kim, ChangWan; Yin, Peng; Wang, Lianxin; Tsai, Tsung-Yuan; Asnis, Peter; Li, Guoan

2016-01-01

This study was to investigate the in vivo tibiofemoral cartilage contact locations before and after anterior cruciate ligament (ACL) reconstruction at 6 and 36 months. Ten patients with unilateral ACL injury were included. A step-up motion was analyzed using a combined magnetic resonance modeling and dual fluoroscopic imaging techniques. The preoperative (i.e. ACL deficient and healthy contralateral) and postoperative cartilage contact locations at 6 and 36 months were analyzed. Similar patterns of the cartilage contact locations during the step-up motion were found for the preoperative and postoperative knee states as compared to the preoperative healthy contralateral side. At the end of step-up motion, the medial contact locations at postoperative 36 months were more anterior when compared to the preoperative healthy contralateral (p=0.02) and 6 months postoperative knee states (p=0.01). The changes of the cartilage contact locations at 36 months after ACL reconstruction compared to the healthy contralateral side were strongly correlated with the changes at 6 months postoperatively. This study showed that the tibiofemoral cartilage contact locations of the knee changes with time after ACL reconstruction, implying an ongoing recovery process within the 36 months after the surgery. There could be an association between the short-term (6 months) and longer-term (36 months) contact kinematics after ACL reconstruction. Future studies need to investigate the intrinsic relationship between knee kinematics at different times after ACL reconstruction. PMID:27720228

Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms.

PubMed

Burkhardt, Jan-Karl; Winkler, Ethan A; Lasker, George F; Yue, John K; Lawton, Michael T

2018-06-01

OBJECTIVE Compressive cranial nerve syndromes can be useful bedside clues to the diagnosis of an enlarging intracranial aneurysm and can also guide subsequent evaluation, as with an acute oculomotor nerve (cranial nerve [CN] III) palsy that is presumed to be a posterior communicating artery aneurysm and a surgical emergency until proven otherwise. The CN VI has a short cisternal segment from the pontomedullary sulcus to Dorello's canal, remote from most PICA aneurysms but in the hemodynamic pathway of a rupturing PICA aneurysm that projects toward Dorello's canal. The authors describe a cranial nerve syndrome for posterior inferior cerebellar artery (PICA) aneurysms that associates subarachnoid hemorrhage (SAH) and an isolated abducens nerve (CN VI) palsy. METHODS Clinical and radiological data from 106 surgical patients with PICA aneurysms (66 ruptured and 40 unruptured) were retrospectively reviewed. Data from a group of 174 patients with other aneurysmal SAH (aSAH) were analyzed in a similar manner to control for nonspecific effects of SAH. Univariate statistical analysis compared incidence and risk factors associated with CN VI palsy in subarachnoid hemorrhage. RESULTS Overall, 13 (4.6%) of 280 patients had CN VI palsy at presentation, and all of them had ruptured aneurysms (representing 13 [5.4%] of the 240 cases of ruptured aneurysms). CN VI palsies were observed in 12 patients with ruptured PICA aneurysms (12/66 [18.1%]) and 1 patient with other aSAH (1/174 [0.1%], p < 0.0001). PICA aneurysm location in ruptured aneurysms was an independent predictor for CN VI palsy on multivariate analysis (p = 0.001). PICA aneurysm size was not significantly different in patients with or without CN VI palsy (average size 4.4 mm and 5.2 mm, respectively). Within the PICA aneurysm cohort, modified Fisher grade (p = 0.011) and presence of a thick cisternal SAH (modified Fisher Grades 3 and 4) (p = 0.003) were predictors of CN VI palsy. In all patients with ruptured PICA aneurysms and CN VI palsy, dome projection and presumed direction of rupture were directed toward the ipsilateral and/or contralateral Dorello's canal, in agreement with laterality of the CN palsy. In patients with bilateral CN VI palsies, a medial projection with extensive subarachnoid blood was observed near bilateral canals. CONCLUSIONS This study establishes a localizing connection between an isolated CN VI palsy, SAH, and an underlying ruptured PICA aneurysm. CN VI palsy is an important clinical sign in aSAH and when present on initial clinical presentation may be assumed to be due to ruptured PICA aneurysms until proven otherwise. The deficit may be ipsilateral, contralateral, or bilateral and is determined by the direction of the aneurysm dome projection and extent of subarachnoid bleeding toward Dorello's canal, rather than by direct compression.

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

Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves.

PubMed

Kim, Soo Ryang; Kanda, Fumio; Kobessho, Hiroshi; Sugimoto, Koji; Matsuoka, Toshiyuki; Kudo, Masatoshi; Hayashi, Yoshitake

2006-11-07

We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI) disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

Epicrania Fugax.

PubMed

Cuadrado, María Luz; Guerrero, Angel L; Pareja, Juan A

2016-04-01

Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Some patients have ocular or nasal autonomic accompaniments, and some have triggers. Between attacks, many patients have continuous or intermittent pain and/or tenderness at the stemming area. Pain frequency is extremely variable and some patients have spontaneous remissions. Preventive therapy is required when the paroxysms are frequent and non-remitting. Neuromodulators, indomethacin, amitryptiline, nerve anesthetic blockades, and trochlear steroid injections have been used in different cases, with partial or complete response.

Comparison of the benefits of cochlear implantation versus contra-lateral routing of signal hearing aids in adult patients with single-sided deafness: study protocol for a prospective within-subject longitudinal trial

PubMed Central

2014-01-01

Background Individuals with a unilateral severe-to-profound hearing loss, or single-sided deafness, report difficulty with listening in many everyday situations despite having access to well-preserved acoustic hearing in one ear. The standard of care for single-sided deafness available on the UK National Health Service is a contra-lateral routing of signals hearing aid which transfers sounds from the impaired ear to the non-impaired ear. This hearing aid has been found to improve speech understanding in noise when the signal-to-noise ratio is more favourable at the impaired ear than the non-impaired ear. However, the indiscriminate routing of signals to a single ear can have detrimental effects when interfering sounds are located on the side of the impaired ear. Recent published evidence has suggested that cochlear implantation in individuals with a single-sided deafness can restore access to the binaural cues which underpin the ability to localise sounds and segregate speech from other interfering sounds. Methods/Design The current trial was designed to assess the efficacy of cochlear implantation compared to a contra-lateral routing of signals hearing aid in restoring binaural hearing in adults with acquired single-sided deafness. Patients are assessed at baseline and after receiving a contra-lateral routing of signals hearing aid. A cochlear implant is then provided to those patients who do not receive sufficient benefit from the hearing aid. This within-subject longitudinal design reflects the expected care pathway should cochlear implantation be provided for single-sided deafness on the UK National Health Service. The primary endpoints are measures of binaural hearing at baseline, after provision of a contra-lateral routing of signals hearing aid, and after cochlear implantation. Binaural hearing is assessed in terms of the accuracy with which sounds are localised and speech is perceived in background noise. The trial is also designed to measure the impact of the interventions on hearing- and health-related quality of life. Discussion This multi-centre trial was designed to provide evidence for the efficacy of cochlear implantation compared to the contra-lateral routing of signals. A purpose-built sound presentation system and established measurement techniques will provide reliable and precise measures of binaural hearing. Trial registration Current Controlled Trials http://www.controlled-trials.com/ISRCTN33301739 (05/JUL/2013) PMID:25152694

Glibenclamide Produces Region-Dependent Effects on Cerebral Edema in a Combined Injury Model of Traumatic Brain Injury and Hemorrhagic Shock in Mice.

PubMed

Jha, Ruchira M; Molyneaux, Bradley J; Jackson, Travis C; Wallisch, Jessica S; Park, Seo-Young; Poloyac, Samuel; Vagni, Vincent A; Janesko-Feldman, Keri L; Hoshitsuki, Keito; Minnigh, M Beth; Kochanek, Patrick M

2018-06-06

Cerebral edema is critical to morbidity/mortality in traumatic brain injury (TBI) and is worsened by hypotension. Glibenclamide may reduce cerebral edema by inhibiting sulfonylurea receptor-1 (Sur1); its effect on diffuse cerebral edema exacerbated by hypotension/resuscitation is unknown. We aimed to determine if glibenclamide improves pericontusional and/or diffuse edema in controlled cortical impact (CCI) (5m/sec, 1 mm depth) plus hemorrhagic shock (HS) (35 min), and compare its effects in CCI alone. C57BL/6 mice were divided into five groups (n = 10/group): naïve, CCI+vehicle, CCI+glibenclamide, CCI+HS+vehicle, and CCI+HS+glibenclamide. Intravenous glibenclamide (10 min post-injury) was followed by a subcutaneous infusion for 24 h. Brain edema in injured and contralateral hemispheres was subsequently quantified (wet-dry weight). This protocol brain water (BW) = 80.4% vehicle vs. 78.3% naïve, p < 0.01) but was not reduced by glibenclamide (I%BW = 80.4%). Ipsilateral edema also developed in CCI alone (I%BW = 80.2% vehicle vs. 78.3% naïve, p < 0.01); again unaffected by glibenclamide (I%BW = 80.5%). Contralateral (C) %BW in CCI+HS was increased in vehicle (78.6%) versus naive (78.3%, p = 0.02) but unchanged in CCI (78.3%). At 24 h, glibenclamide treatment in CCI+HS eliminated contralateral cerebral edema (C%BW = 78.3%) with no difference versus naïve. By 72 h, contralateral cerebral edema had resolved (C%BW = 78.5 ± 0.09% vehicle vs. 78.3 ± 0.05% naïve). Glibenclamide decreased 24 h contralateral cerebral edema in CCI+HS. This beneficial effect merits additional exploration in the important setting of TBI with polytrauma, shock, and resuscitation. Contralateral edema did not develop in CCI alone. Surprisingly, 24 h of glibenclamide treatment failed to decrease ipsilateral edema in either model. Interspecies dosing differences versus prior studies may play an important role in these findings. Mechanisms underlying brain edema may differ regionally, with pericontusional/osmolar swelling refractory to glibenclamide but diffuse edema (via Sur1) from combined injury and/or resuscitation responsive to this therapy. TBI phenotype may mandate precision medicine approaches to treat brain edema.

Engendering Allograft Ignorance in a Mouse Model of Allogeneic Skin Transplantation to the Distal Hind Limb

PubMed Central

Agarwal, Shailesh; Loder, Shawn; Wood, Sherri; Cederna, Paul S.; Bishop, D. Keith; Wang, Stewart C.; Levi, Benjamin

2015-01-01

Objective The aim of this study was to demonstrate lymphatic isolation in a model of hind limb lymph node (LN) excision, consisting of ipsilateral popliteal and inguinal LN excision and to evaluate the immunologic response to allogeneic skin transplanted onto this region of lymphatic isolation. Methods To study lymphatic flow, C57BL/6 mice underwent lymphadenectomy (n = 5), sham lymphadenectomy (n = 5), or no intervention (n = 5), followed by methylene blue injection. Mice were dissected to determine whether methylene blue traveled to the iliac LN. To study host response to skin transplantation, C57BL/6 mice underwent allogeneic skin transplantation with LN excision (n = 6), allogeneic skin transplantation alone (n = 6), or syngeneic skin transplantation (n = 4). Skin grafts were placed distal to the popliteal fossa and mice were euthanized at day 10. Grafts were stained for endothelial cell and proliferation markers (CD31 and Ki67, respectively). Secondary lymphoid tissues (spleen, ipsilateral axillary LN, and contralateral inguinal LN) were removed and rechallenged with BALB/c alloantigen in vitro with subsequent assay of interferon-γ and interleukin 4 cell expression using ELISPOT technique. Results Mice that underwent LN excision had no evidence of methylene blue in the iliac nodes; mice without surgical intervention or with sham LN excision consistently had methylene blue visible in the ipsilateral iliac nodes. Mice treated with allogeneic skin transplantation and LN excision had lower expression of interferon-γ and interleukin 4 in the secondary lymphoid tissues. Conclusions Lymph node excision completely interrupts lymphatic flow of the hind limb. This model of lymphatic isolation impairs the ability of the transplant recipient to acutely mount a Th1 or Th2 response to allogeneic skin transplants. PMID:24509194

One-step repair for cartilage defects in a rabbit model: a technique combining the perforated decalcified cortical-cancellous bone matrix scaffold with microfracture.

PubMed

Dai, Linghui; He, Zhenming; Zhang, Xin; Hu, Xiaoqing; Yuan, Lan; Qiang, Ming; Zhu, Jingxian; Shao, Zhenxing; Zhou, Chunyan; Ao, Yingfang

2014-03-01

Cartilage repair still presents a challenge to clinicians and researchers alike. A more effective, simpler procedure that can produce hyaline-like cartilage is needed for articular cartilage repair. A technique combining microfracture with a biomaterial scaffold of perforated decalcified cortical-cancellous bone matrix (DCCBM; composed of cortical and cancellous parts) would create a 1-step procedure for hyaline-like cartilage repair. Controlled laboratory study. For the in vitro portion of this study, mesenchymal stem cells (MSCs) were isolated from bone marrow aspirates of New Zealand White rabbits. Scanning electron microscopy (SEM), confocal microscopy, and 1,9-dimethylmethylene blue assay were used to assess the attachment, proliferation, and cartilage matrix production of MSCs grown on a DCCBM scaffold. For the in vivo experiment, full-thickness defects were produced in the articular cartilage of the trochlear groove of 45 New Zealand White rabbits, and the rabbits were then assigned to 1 of 3 treatment groups: perforated DCCBM combined with microfracture (DCCBM+M group), perforated DCCBM alone (DCCBM group), and microfracture alone (M group). Five rabbits in each group were sacrificed at 6, 12, or 24 weeks after the operation, and the repair tissues were analyzed by histological examination, assessment of matrix staining, SEM, and nanoindentation of biomechanical properties. The DCCBM+M group showed hyaline-like articular cartilage repair, and the repair tissues appeared to have better matrix staining and revealed biomechanical properties close to those of the normal cartilage. Compared with the DCCBM+M group, there was unsatisfactory repair tissues with less matrix staining in the DCCBM group and no matrix staining in the M group, as well as poor integration with normal cartilage and poor biomechanical properties. The DCCBM scaffold is suitable for MSC growth and hyaline-like cartilage repair induction when combined with microfracture. Microfracture combined with a DCCBM scaffold is a promising method that can be performed and adopted into clinical treatment for articular cartilage injuries.

The sulcus line of the trochlear groove is more accurate than Whiteside's Line in determining femoral component rotation.

PubMed

Talbot, Simon; Dimitriou, Pandelis; Radic, Ross; Zordan, Rachel; Bartlett, John

2015-11-01

The sulcus line (SL) is a three-dimensional curve produced from multiple points along the trochlear groove. Whiteside's Line, also known as the anteroposterior axis (APA), is derived from single anterior and posterior points. The purposes of the two studies presented in this paper are to (1) assess the results from the clinical use of the SL in a large clinical series, (2) measure the SL and the APA on three-dimensional CT reconstructions, (3) demonstrate the effect of parallax error on the use of the APA and (4) determine the accuracy of an axis derived by combining the SL and the posterior condylar axis (PCA). In the first study, we assessed the SL using a large, single surgeon series of consecutive patients undergoing primary total knee arthroplasties. The post-operative CT scans of patients (n = 200) were examined to determine the final rotational alignment of the femoral component. In the second study, measurements were taken in a series of 3DCT reconstructions of osteoarthritic knees (n = 44). The mean position of the femoral component in the clinical series was 0.6° externally rotated to the surgical epicondylar axis, with a standard deviation of 2.9° (ranges from -7.2° to 6.7°). On the 3DCT reconstructions, the APA (88.2° ± 4.2°) had significantly higher variance than the SL (90.3° ± 2.7°) (F = 5.82 and p = 0.017). An axis derived by averaging the SL and the PCA+3° produced a significant decrease in both the number of outliers (p = 0.03 vs. PCA and p = 0.007 vs. SL) and the variance (F = 6.15 and p = 0.015 vs. SL). The coronal alignment of the SL varied widely relative to the mechanical axis (0.4° ± 3.8°) and the distal condylar surface (2.6° ± 4.3°). The multiple points used to determine the SL confer anatomical and geometrical advantages, and therefore, it should be considered a separate rotational landmark to the APA. These findings may explain the high degree of variability in the measurement of the APA which is documented in the literature. Combining a geometrically correct SL and the PCA is likely to further improve accuracy.

Trochleoplasty as a Solitary Treatment for Recurrent Patellar Dislocation Results in Good Clinical Outcome in Adolescents.

PubMed

Camathias, Carlo; Studer, Katrin; Kiapour, Ata; Rutz, Erich; Vavken, Patrick

2016-11-01

The essential static patellar stabilizer is a normal-shaped trochlear groove. A dysplastic groove destabilizes the patella. Trochleoplasty approaches this underlying condition and reshapes the trochlea. However, studies have reported on trochleoplasty for revision cases or as accompanied by other interventions. The effect of trochleoplasty alone remains unexplained. To introduce trochleoplasty as a stand-alone treatment for recurrent patellar dislocation and to compare its pre- to postoperative functional and clinical variables. Case series; Level of evidence, 4. A trochleoplasty was performed in 50 knees (27 right) in 44 patients (30 females; mean ± SD age, 15.6 ± 2.0 years). The indication for surgery was recurrent patellar dislocation not responding to nonoperative treatment (>6 months), with types B through D dysplasia and closed or closing physes in adolescents aged 10 to 20 years. Assessment included J-sign and apprehension test, Kujala and Lysholm scores, patients' subjective assessment and activity level according to the International Knee Documentation Committee questionnaire, and patients' overall satisfaction. The Caton-Deschamps ratio and the lateral condyle index were measured. Pre- versus postoperative values were compared with a paired Wilcoxon signed-rank test. The minimum follow-up was 24 months (33 ± 10.6 months). The Kujala score improved from 71 preoperatively to 92 postoperatively (P < .001) and the Lysholm score from 71 to 95 (P < .001). Patients' subjective assessment improved at the final follow-up as compared with that preoperatively (P < .001). Most patients enhanced their activity (P < .001), and their overall satisfaction increased postoperatively (P < .001). Preoperatively, there was a positive J-sign in 45 knees and a positive apprehension test in 41 knees. Both markers disappeared postoperatively in 39 and 33 knees, respectively, leaving 6 knees with a positive J-sign and 8 knees with a positive apprehension test (P < .001). One patella redislocated postoperatively after 38 months. Four patients required a single arthroscopic debridement. In this study, trochleoplasty as a solitary treatment for recurrent patellofemoral dislocations in patients with trochlear dysplasia resulted in good clinical outcomes if severe torsional and axial malalignment was excluded. Kujala and Lysholm scores increased postoperatively, as well as subjective International Knee Documentation Committee assessment of outcomes, activity level, and overall satisfaction. © 2016 The Author(s).

Contralateral metachronous hernia following negative laparoscopic evaluation for contralateral patent processus vaginalis: a meta-analysis.

PubMed

Zhong, Hongji; Wang, Furan

2014-02-01

To conduct a meta-analysis of contralateral metachronous inguinal hernia (CMIH) that originated from negative laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) in children who presented with a unilateral inguinal hernia and to determine the incidence of and factors associated with such a CMIH. A PubMed search was performed for all studies concerning laparoscopic repair or evaluation of inguinal hernia in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND ("inguinal hernia" OR "metachronous hernia") AND child*. Inclusion criteria included unilateral inguinal hernia in children, negative laparoscopic evaluation of CPPV, without history of contralateral inguinal surgery previously, and clearly reporting CMIH development or not. Editorials, letters, review articles, case reports, animal studies, and duplicate patient series were excluded. Twenty-three studies comprising 6091 children with negative CPPV fulfilled the inclusion criteria and were included in the final analysis, of whom 80 (1.31%) subsequently presented with a CMIH. Subgroup analysis showed that CMIH incidence was lower through an umbilical approach than via an inguinal one (0.85% versus 1.78%, P=.009). As for the transinguinal approach, there was a CMIH incidence of 0.78% and 2.05%, respectively, for laparoscopy with a small angle (30° and 70°), whereas there was no CMIH development for that with a large angle (110°, 120°, and flexible). A high pneumoperitoneum pressure (>10 mm Hg, >12 mm Hg, and >14 mm Hg) was usually associated with a slightly higher CMIH incidence than a low one (≤10 mm Hg, ≤12 mm Hg, and ≤14 mm Hg), all without significant difference. CMIH incidence was slightly lower for using a broad CPPV definition than for using a narrow one (0.64% versus 1.35%, P=.183). CMIH following negative laparoscopic evaluation for CPPV was a rare but possible phenomenon. Choosing the transumbilical approach, transinguinal laparoscopy with a large angle, low-pressure pneumoperitoneum, and broad CPPV definition would probably reduce the occurrence of such CMIHs.

Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays?

PubMed

Aziz, Muhammad Hammad; Schneider, Frank; Clausen, Sven; Blank, Elena; Herskind, Carsten; Afzal, Muhammad; Wenz, Frederik

2011-12-16

Radiation induced secondary cancers are a rare but severe late effect after breast conserving therapy. Intraoperative radiotherapy (IORT) is increasingly used during breast conserving surgery. The purpose of this analysis was to estimate secondary cancer risks after IORT compared to other modalities of breast radiotherapy (APBI - accelerated partial breast irradiation, EBRT - external beam radiotherapy). Computer-tomography scans of an anthropomorphic phantom were acquired with an INTRABEAM IORT applicator (diameter 4 cm) in the outer quadrant of the breast and transferred via DICOM to the treatment planning system. Ipsilateral breast, contralateral breast, ipsilateral lung, contralateral lung, spine and heart were contoured. An INTRABEAM source (50 kV) was defined with the tip of the drift tube at the center of the spherical applicator. A dose of 20 Gy at 0 mm depth from the applicator surface was prescribed for IORT and 34 Gy (5 days × 2 × 3.4 Gy) at 10 mm depth for APBI. For EBRT a total dose of 50 Gy in 2 Gy fractions was planned using two tangential fields with wedges. The mean and maximal doses, DVHs and volumes receiving more than 0.1 Gy and 4 Gy of organs at risk (OAR) were calculated and compared. The life time risk for secondary cancers was estimated according to NCRP report 116. IORT delivered the lowest maximal doses to contralateral breast (< 0.3 Gy), ipsilateral (1.8 Gy) and contralateral lung (< 0.3 Gy), heart (1 Gy) and spine (< 0.3 Gy). In comparison, maximal doses for APBI were 2-5 times higher. EBRT delivered a maximal dose of 10.4 Gy to the contralateral breast and 53 Gy to the ipsilateral lung. OAR volumes receiving more than 4 Gy were 0% for IORT, < 2% for APBI and up to 10% for EBRT (ipsilateral lung). The estimated risk for secondary cancer in the respective OAR is considerably lower after IORT and/or APBI as compared to EBRT. The calculations for maximal doses and volumes of OAR suggest that the risk of secondary cancer induction after IORT is lower than compared to APBI and EBRT.

Interaction of acupuncture treatment and manipulation laterality modulated by the default mode network

PubMed Central

Niu, Xuan; Zhang, Ming; Liu, Zhenyu; Sun, Chuanzhu; Wang, Shan; Wang, Xiaocui; Chen, Zhen; Chen, Hongyan; Tian, Jie

2016-01-01

Appropriate selection of ipsilateral or contralateral electroacupuncture (corresponding to the pain site) plays an important role in reaching its better curative effect; however, the involving brain mechanism still remains unclear. Compared with the heat pain model generally established in previous study, capsaicin pain model induces reversible cutaneous allodynia and is proved to be better simulating aspects of clinical nociceptive and neuropathic pain. In the current study, 24 subjects were randomly divided into two groups with a 2 × 2 factorial design: laterality (ipsi- or contralateral side, inter-subject) × treatment with counter-balanced at an interval of one week (verum and placebo electroacupuncture, within-subject). We observed subjective pain intensity and brain activations changes induced by capsaicin allodynia pain stimuli before and after electroacupuncture treatment at acupoint LI4 for 30 min. Analysis of variance results indicated that ipsilateral electroacupuncture treatment produced significant pain relief and wide brain signal suppressions in pain-related brain areas compared with contralateral electroacupuncture. We also found that verum electroacupuncture at either ipsi- or contralateral side to the pain site exhibited comparable significant magnitudes of analgesic effect. By contrast, placebo electroacupuncture elicited significant pain reductions only on the ipsilateral rather than contralateral side. It was inferred that placebo analgesia maybe attenuated on the region of the body (opposite to pain site) where attention was less focused, suggesting that analgesic effect of placebo electroacupuncture mainly rely on the motivation of its spatial-specific placebo responses via attention mechanism. This inference can be further supported by the evidence that the significant interaction effect of manipulation laterality and treatment was exclusively located within the default mode network, including the bilateral superior parietal lobule, inferior parietal lobule, precuneus, and left posterior cingulate cortex. It is also proved that disruptions of the default mode network may account for the cognitive and behavioral impairments in chronic pain patients. Our findings further suggested that default mode network participates in the modulation of spatial-oriented attention on placebo analgesia as a mechanism underlying the degree to which treatment side corresponding to the pain. PMID:28326925

[Impacts on skin blood flow under moving cupping along meridians in different directions].

PubMed

Tian, Yu-Ying; Wang, Guang-Jun; Huang, Tao; Jia, Shu-Yong; Zhang, Yu-Qin; Zhang, Wei-Bo

2013-03-01

To compare the impacts on skin blood flow between moving cupping following the meridian running direction and that against the running direction. JLG-2 meridian cupping drainage instru ment was used for moving cupping on the back along the Bladder Meridian running course in either single direction for 20 times. The cupping device was Bian stone cup, 44 mm in inner diameter, negative pressure from -0.03 to -0.04 MPa. PeriScan PIM II laser Doppler perfusion imager was used to observe the changes in skin blood flow on the running course of the Bladder Meridian with cup moved up and down and in the same region on the contralateral Bladder Meridian. Blood flow was measured before cupping, at the immediate time after cupping and 10 min after cupping separately. Fourteen healthy volunteers received the test. The measuring region was subdivided into a moving cupping area, an upstream area, a downstream area, a contralateral moving cupping area, a contralateral upstream area and a contralateral downstream area. The mean blood flow was calculated in each area. Blood flow was increased significantly in each area and was more apparently increased in the moving cupping area. In comparison of the changing rate of blood flow between cupping following the meridian running direction and that against the running direction, it was only found that the changing rate in the upstream area of moving cupping against the running direction was significantly higher than that following the running direction (P < 0.05). The differences were not statistically significant in comparison among the other areas. Additionally, the changing rates of blood flow in the upstream and downstream area of the Bladder Meridian were increased significantly as compared with the contralateral Bladder Meridian. The local effects are similar between moving cupping following the meridian running direction and that against the running direction. The abscopal effect of moving cupping against the running direction is superior to that following the running direction. It is suggested that the dual-directional moving cupping is applicable for the treatment of local disorders and the abscopal effect is better with moving cupping against the meridian running direction.

Interaction of acupuncture treatment and manipulation laterality modulated by the default mode network.

PubMed

Niu, Xuan; Zhang, Ming; Liu, Zhenyu; Bai, Lijun; Sun, Chuanzhu; Wang, Shan; Wang, Xiaocui; Chen, Zhen; Chen, Hongyan; Tian, Jie

2017-01-01

Appropriate selection of ipsilateral or contralateral electroacupuncture (corresponding to the pain site) plays an important role in reaching its better curative effect; however, the involving brain mechanism still remains unclear. Compared with the heat pain model generally established in previous study, capsaicin pain model induces reversible cutaneous allodynia and is proved to be better simulating aspects of clinical nociceptive and neuropathic pain. In the current study, 24 subjects were randomly divided into two groups with a 2 × 2 factorial design: laterality (ipsi- or contralateral side, inter-subject) × treatment with counter-balanced at an interval of one week (verum and placebo electroacupuncture, within-subject). We observed subjective pain intensity and brain activations changes induced by capsaicin allodynia pain stimuli before and after electroacupuncture treatment at acupoint LI4 for 30 min. Analysis of variance results indicated that ipsilateral electroacupuncture treatment produced significant pain relief and wide brain signal suppressions in pain-related brain areas compared with contralateral electroacupuncture. We also found that verum electroacupuncture at either ipsi- or contralateral side to the pain site exhibited comparable significant magnitudes of analgesic effect. By contrast, placebo electroacupuncture elicited significant pain reductions only on the ipsilateral rather than contralateral side. It was inferred that placebo analgesia maybe attenuated on the region of the body (opposite to pain site) where attention was less focused, suggesting that analgesic effect of placebo electroacupuncture mainly rely on the motivation of its spatial-specific placebo responses via attention mechanism. This inference can be further supported by the evidence that the significant interaction effect of manipulation laterality and treatment was exclusively located within the default mode network, including the bilateral superior parietal lobule, inferior parietal lobule, precuneus, and left posterior cingulate cortex. It is also proved that disruptions of the default mode network may account for the cognitive and behavioral impairments in chronic pain patients. Our findings further suggested that default mode network participates in the modulation of spatial-oriented attention on placebo analgesia as a mechanism underlying the degree to which treatment side corresponding to the pain.

Knee Kinematics and Joint Moments During Stair Negotiation in Participants With Anterior Cruciate Ligament Deficiency and Reconstruction: A Systematic Review and Meta-Analysis.

PubMed

Hajizadeh, Maryam; Hashemi Oskouei, Alireza; Ghalichi, Farzan; Sole, Gisela

2016-06-01

Biomechanical changes have been reported for patients with anterior cruciate ligament deficiency (ACLD) and anterior cruciate ligament (ACL reconstruction) (ACLR), likely due to loss of stability and changes in proprioception and neuromotor control. This review evaluated kinematics and kinetics of ACLD and ACLR knees, compared with those on the contralateral uninjured sides, as well as and those in asymptomatic controls during stair navigation. This is a systematic review and meta-analysis. Electronic database searches were conducted from their original available dates to January 2015. Studies that included participants with ACLD or ACLR and reported knee joint angles or moments during stair ascent or descent were included. Nine studies met the inclusion criteria, and the methodological quality of these was assessed with a modified Downs and Black checklist. Effect sizes for differences between injured leg and uninjured contralateral leg or controls were calculated, and meta-analyses were performed if two or more studies considered the same variable. Quality assessment showed an average (± standard deviation) of 70.3% ± 7.2%. Meta-analysis showed less knee flexion at initial contact for ACLR knees compared with that in contralateral knees during stair ascent, with a moderate effect size and minimal heterogeneity. Knees with ACLD showed less peak knee flexion compared with that on contralateral sides during stair ascent, with minimal heterogeneity. External knee flexion moments were lower for ACLR compared with those in controls and contralateral sides during ascent and descent, whereas these moments were decreased for the ACLD compared with controls only during ascent. Meta-analysis results exhibited moderate/high heterogeneity or small/trivial effect sizes. Differences for kinematics and kinetics for the ACL-injured knees indicate long-term compensatory and asymmetric movement patterns while ascending and descending stairs. Due to the heterogeneity as well as the small numbers of available studies, the consequences of these differences in terms of long-term function or posttraumatic osteoarthritis need further exploration. Copyright © 2016. Published by Elsevier Inc.

Calcaneal Scoring as an Adjunct to Modified Oxford Hip Scores: Prediction of Contralateral Slipped Capital Femoral Epiphysis.

PubMed

Nicholson, Allen D; Huez, Coridon M; Sanders, James O; Liu, Raymond W; Cooperman, Daniel R

2016-03-01

In 2 recent studies, modified Oxford hip scores of 16 through 18 have been shown to predict an extremely high risk of contralateral slipping in unilateral slipped capital femoral epiphysis (SCFE). However, the modified Oxford system is not widely used. This may be due, in part, to the complexity of the scoring system, difficulty in viewing all 5 radiographic features on a single x-ray and phenotypic variation in the features. Ossification of the calcaneal apophysis provides an osteologic marker of skeletal maturation in relation to peak height velocity and has been described previously. We examine the value of the calcaneal apophyseal ossification sequence for predicting modified Oxford hip scores. We examined 279 pelvis and matching foot x-rays that were taken at the same session from 94 healthy children aged 3 to 18 years. A fellowship-trained pediatric orthopaedist determined the modified Oxford hip score for each hip radiograph. The calcaneal x-rays had been previously graded. Modified Oxford hip scores were compared with calcaneal scores for each set of matched hip and calcaneal x-rays. Stage 0 to 2 calcanei had 94% of corresponding hip radiographs rated as modified Oxford scores of 16 to 18. Stage 3 calcanei had 54% rated as 16 to 18 and 31% rated as scores 19 to 21. Stage 4 calcanei had 31% rated as scores 19 to 21, and 68% rated as scores 22 to 26. Stage 5 calcanei had 100% rated as 22 to 26. Using data from Popejoy and colleagues' study, the weighted risk of contralateral SCFE was 94% for calcaneal stage 0, 86.5% for calcaneal stage 1, 90.3% for calcaneal stage 2, 55.8% for calcaneal stage 3, 6.1% for calcaneal stage 4, and 0 for calcaneal stage 5. Calcaneal stages 0 to 3 correspond entirely to modified Oxford scores indicating elevated risk of contralateral SCFE. The calcaneal scoring system has potential for adjunctive use with the modified Oxford score for prediction of contralateral SCFE.

Masking overshoot: Effects of ipsilateral, bilateral and contralateral priming

NASA Astrophysics Data System (ADS)

Connington, Maureen Catherine

This study was concerned with masking overshoot, the elevation of the threshold of a brief signal when it is presented at the onset of a masking noise rather than at its temporal center. More specifically, it was concerned with the release from overshoot (i.e., threshold improvement) produced by priming stimuli, presented ipsilaterally, bilaterally and contralaterally at primer- masker gaps of 20, 40 and 80 msec. The more general purpose of the study was to assess the contributions of peripheral and central factors to the overshoot and overshoot-release phenomena. The primers and masking stimuli consisted of white noise bursts of 200 and 400 msec duration, respectively. The probe signal was a 20 msec 4kHz tone. The tone and masker were always presented in one ear. There were, however, 3 modes of primer presentation: ipsilateral, bilateral (identical waveforms to both ears) and contralateral. Three primer-masker gaps of 20, 40 and 80 msec were used. Five normally hearing adults were tested at primer and masker levels of 80 dB HL. Four of the five subjects exhibited significant masking overshoot, when tested without priming. Ipsilateral priming with 20 and 40 msec gaps produced significant masking release from overshoot. Threshold became poorer, however with increasing gap duration and with increasing distance of the perceived primer from the test ear (i.e. ipsilateral priming produced better thresholds than did bilateral priming and bilateral priming produced better thresholds than contralateral priming). There was significant masking enhancement (i.e. threshold was significantly poorer than in the unprimed probe at onset condition) with the contralateral 80 msec primer. The fact that ipsilateral and bilateral primers performed differently does not support the theory that masking overshoot and its release are solely the results of peripheral adaptation. In fact, the group results support the conclusion that masking overshoot is influenced by central factors. However, there were marked inter-subject differences. It seems possible that masking overshoot and its release are influenced by both peripheral adaptation effects and central processes and that the balance between the two is subject-dependent.

Cooperation Not Competition: Bihemispheric tDCS and fMRI Show Role for Ipsilateral Hemisphere in Motor Learning.

PubMed

Waters, Sheena; Wiestler, Tobias; Diedrichsen, Jörn

2017-08-02

What is the role of ipsilateral motor and premotor areas in motor learning? One view is that ipsilateral activity suppresses contralateral motor cortex and, accordingly, that inhibiting ipsilateral regions can improve motor learning. Alternatively, the ipsilateral motor cortex may play an active role in the control and/or learning of unilateral hand movements. We approached this question by applying double-blind bihemispheric transcranial direct current stimulation (tDCS) over both contralateral and ipsilateral motor cortex in a between-group design during 4 d of unimanual explicit sequence training in human participants. Independently of whether the anode was placed over contralateral or ipsilateral motor cortex, bihemispheric stimulation yielded substantial performance gains relative to unihemispheric or sham stimulation. This performance advantage appeared to be supported by plastic changes in both hemispheres. First, we found that behavioral advantages generalized strongly to the untrained hand, suggesting that tDCS strengthened effector-independent representations. Second, functional imaging during speed-matched execution of trained sequences conducted 48 h after training revealed sustained, polarity-independent increases in activity in both motor cortices relative to the sham group. These results suggest a cooperative rather than competitive interaction of the two motor cortices during skill learning and suggest that bihemispheric brain stimulation during unimanual skill learning may be beneficial because it harnesses plasticity in the ipsilateral hemisphere. SIGNIFICANCE STATEMENT Many neurorehabilitation approaches are based on the idea that is beneficial to boost excitability in the contralateral hemisphere while attenuating that of the ipsilateral cortex to reduce interhemispheric inhibition. We observed that bihemispheric transcranial direct current stimulation (tDCS) with the excitatory anode either over contralateral or ipsilateral motor cortex facilitated motor learning nearly twice as strongly as unihemispheric tDCS. These increases in motor learning were accompanied by increases in fMRI activation in both motor cortices that outlasted the stimulation period, as well as increased generalization to the untrained hand. Collectively, our findings suggest a cooperative rather than a competitive role of the hemispheres and imply that it is most beneficial to harness plasticity in both hemispheres in neurorehabilitation of motor deficits. Copyright © 2017 Waters et al.

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases.

PubMed

Sukkarieh, Hamdi G; Hitchon, Patrick W; Awe, Olatilewa; Noeller, Jennifer

2015-10-01

The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m(2). Sixty-nine percent (9 of 13) of the cysts were at L4-5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

In Vivo Shoulder Function After Surgical Repair of a Torn Rotator Cuff

PubMed Central

Bey, Michael J.; Peltz, Cathryn D.; Ciarelli, Kristin; Kline, Stephanie K.; Divine, George W.; van Holsbeeck, Marnix; Muh, Stephanie; Kolowich, Patricia A.; Lock, Terrence R.; Moutzouros, Vasilios

2015-01-01

Background Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. Hypothesis Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. Study Design Controlled laboratory study and Case series; Level of evidence, 4. Methods Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. Results Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients’ repaired shoulder was positioned more superiorly on the glenoid than both the patients’ contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients’ repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. Conclusion Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. Clinical Relevance The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function. PMID:21737834

Accuracy and predictability in use of AO three-dimensionally preformed titanium mesh plates for posttraumatic orbital reconstruction: a pilot study.

PubMed

Scolozzi, Paolo; Momjian, Armen; Heuberger, Joris; Andersen, Elene; Broome, Martin; Terzic, Andrej; Jaques, Bertrand

2009-07-01

The aim of this study was to prospectively evaluate the accuracy and predictability of new three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction.We analyzed the preoperative and postoperative clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. Fracture locations were as follows: floor (N = 7; 70%), medial wall (N = 1; 1%), and floor/medial wall (N = 2; 2%). The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures. A three-dimensional preformed AO titanium mesh plate (0.4 mm in thickness) was selected according to the size of the defect previously measured on the preoperative computed tomographic (CT) scan examination and fixed at the inferior orbital rim with 1 or 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative CT scan. Coronal CT scan slices were used to measure bony orbital volume using OsiriX Medical Image software. Reconstructed versus uninjured orbital volume were statistically correlated.Nine patients (90%) had a successful treatment outcome without complications. One patient (10%) developed a mechanical limitation of upward gaze with a resulting handicapping diplopia requiring hardware removal. Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. Volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with accuracy to within 2.5 cm(3). There was no significant difference in volume between the reconstructed and uninjured orbits.This preliminary study has demonstrated that three-dimensionally preformed AO titanium mesh plates for posttraumatic orbital wall reconstruction results in (1) a high rate of success with an acceptable rate of major clinical complications (10%) and (2) an anatomic restoration of the bony orbital contour and volume that closely approximates that of the contralateral uninjured orbit.

Effects of training programs based on ipsilateral voluntary and stimulated contractions on muscle strength and monopedal postural control of the contralateral limb.

PubMed

Kadri, Mohamed Abdelhafid; Noé, Frederic; Nouar, Merbouha Boulahbel; Paillard, Thierry

2017-09-01

To compare the effects of unilateral strength training by stimulated and voluntary contractions on muscle strength and monopedal postural control of the contralateral limb. 36 non-active healthy male subjects were recruited and split randomly into three groups. Two groups of 12 subjects took part in a strength-training program (3 sessions a week over 8 weeks) comprising 43 contractions of the quadriceps femoris of the ipsilateral limb (at 20% of the MVC). One group carried out voluntary contractions exclusively (VOL group), while the other group benefited exclusively from electro-induced contractions (NMES group). The other 12 subjects formed the control (CON) group. Assessments of MVC and monopedal postural control in static and dynamic postural tasks were performed with the ipsilateral (ISPI) and contralateral (CONTRA) limbs before (PRE) and after (POST) completion of the training program. After the training program, the MVC of the IPSI and CONTRA limbs increased similarly for both experimental groups (VOL and NMES). There were no significant improvements of monopedal postural control for the IPSI or CONTRA limbs in either the VOL or NMES experimental group. No change was observed for the CON group over the protocol period. The purposed training program with NMES vs VOL contractions induced strength gains but did not permit any improvement of contralateral monopedal postural control in healthy young subjects. This has potential for therapeutic application and allows clinicians to focus their training programs on dynamic and poly-articular exercises to improve the postural control in young subjects.

Estimating associations of mobile phone use and brain tumours taking into account laterality: a comparison and theoretical evaluation of applied methods.

PubMed

Frederiksen, Kirsten; Deltour, Isabelle; Schüz, Joachim

2012-12-10

Estimating exposure-outcome associations using laterality information on exposure and on outcome is an issue, when estimating associations of mobile phone use and brain tumour risk. The exposure is localized; therefore, a potential risk is expected to exist primarily on the side of the head, where the phone is usually held (ipsilateral exposure), and to a lesser extent at the opposite side of the head (contralateral exposure). Several measures of the associations with ipsilateral and contralateral exposure, dealing with different sampling designs, have been presented in the literature. This paper presents a general framework for the analysis of such studies using a likelihood-based approach in a competing risks model setting. The approach clarifies the implicit assumptions required for the validity of the presented estimators, particularly that in some approaches the risk with contralateral exposure is assumed to be zero. The performance of the estimators is illustrated in a simulation study showing for instance that while in some scenarios there is a loss of statistical power, others - in case of a positive ipsilateral exposure-outcome association - would result in a negatively biased estimate of the contralateral exposure parameter, irrespective of any additional recall bias. In conclusion, our theoretical evaluations and results from the simulation study emphasize the importance of setting up a formal model, which furthermore allows for estimation in more complicated and perhaps more realistic exposure settings, such as taking into account exposure to both sides of the head. Copyright © 2012 John Wiley & Sons, Ltd.

Striatal somatotopy and motor responses evoked by acute electrical stimulation of the posterior striatum in rats.

PubMed

Vilela-Filho, Osvaldo; Barros, Breno A; Arruda, Mariana M; Castro, Thaisa S; Souza, Joaquim T; Silva, Delson J; Ferraz, Fernando P; Ragazzo, Paulo C

2014-02-01

Previous experiments suggest that the striatal sensorimotor territory in rats is located in its dorsolateral region, along the rostrocaudal axis, unlike what has been observed in primates. In the present study, electrical stimulation was performed to investigate the degree of participation of the posterior striatum in its motor territory, its somatotopic organization, and the motor responses evoked by stimulation. Twenty-five rats were submitted to stereotactic stimulation of the posterior striatum under general anesthesia, receiving consecutively four different current intensities. The motor responses observed in the different body parts were registered for later comparison. We considered as threshold the smallest of these current intensities able to evoke a motor response. The observed motor responses were qualitatively different for each segment: forepaws: ipsilateral, adduction, and contralateral abduction; hindpaws: ipsilateral, flexion, and contralateral, extension/abduction; trunk, rotation/flexion; and tail, rotation/elevation. High-frequency, small-amplitude distal tremor occurred in the ipsilateral forepaw in 95% of the animals. Progressively larger current intensities were necessary for the induction of motor response in the forepaws, hindpaws, and trunk/tail, in that order. The results allowed us to infer the following posterior striatal somatotopic organization: forepaws, posterolaterally, being the contralateral medial to the ipsilateral; trunk/tail, anteromedially; and hindpaws, in an intermediate position, being the contralateral posterior to the ipsilateral. It is suggested that the tremor and the other observed motor responses derive from the excitation of striatal projection neurons and that the striatum may play an important role in the genesis of essential tremor. © 2013 International Neuromodulation Society.

Striatal infarction in the rat causes a transient reduction of tyrosine hydroxylase immunoreactivity in the ipsilateral substantia nigra.

PubMed

Soriano, M A; Justicia, C; Ferrer, I; Rodríguez-Farré, E; Planas, A M

1997-01-01

Dopaminergic neurons of the substantia nigra pars compacta were examined in the rat brain following striatal infarction subsequent to transient focal cerebral ischemia. Rats had the middle cerebral artery occluded for 2 h or were sham-operated, and tyrosine hydroxylase immunoreactivity was evaluated by Western blot and immunohistochemistry at different times ranging from 1 to 60 days after ischemia. The number of tyrosine hydroxylase-immunoreactive cells in the substantia nigra pars compacta was counted under the light microscope and compared to that in the contralateral side and controls. No changes of tyrosine hydroxylase immunoreactivity were detected in the ipsilateral versus the contralateral substantia nigra of sham-operated rats or 1 day after ischemia. However, a statistically significant reduction of tyrosine hydroxylase-immunoreactive cells became apparent in the ipsilateral compared with the contralateral substantia nigra at 7 and 14 days after ischemia. This reduction showed a clear recovery at 30 days after ischemia, and no signs of difference between the ipsilateral and the contralateral side were apparent by 60 days. Therefore, the reduction of tyrosine hydroxylase immunoreactivity in the ipsilateral substantia nigra was only transiently seen from 1 to 2 weeks following ischemia. The observed loss of tyrosine hydroxylase was not accompanied by signs of cell death or gliosis in the ipsilateral pars compacta. The present results show a transitory reduction of tyrosine hydroxylase immunoreactivity in the ipsilateral substantia nigra pars compacta after focal ischemia and suggest that striatal infarction causes a transient deficit of dopaminergic function.

IS PAIN IN ONE KNEE ASSOCIATED WITH ISOMETRIC MUSCLE STRENGTH IN THE CONTRALATERAL LIMB? - DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

PubMed Central

Steidle, E.; Wirth, W.; Glass, N.; Ruhdorfer, A.; Cotofana, S.; Eckstein, F.; Segal, N. A.

2014-01-01

Objective Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Design Of 4796 Osteoarthritis Initiative participants, 224 (mean±SD age 63.9±8.9 years) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale (NRS)≥4/10; ≥infrequent pain) and one pain-free knee (NRS 0–1; ≤infrequent pain; WOMAC≤1). Controls were defined as having bilaterally pain-free knees (NRS 0–1; ≤infrequent pain; WOMAC≤1). Maximal isometric muscle strength [N] was compared between limbs in participants with unilateral pain (cases), and between pain-free limbs of cases and controls. Results Knee extensor/flexor strength in pain-free limbs of cases was lower than in bilaterally pain-free controls (−5.5%/–8.4%; p=0.043/p=0.022). Within cases, maximum extensor/flexor strength was significantly lower in the painful than in the pain-free limb (−6.4%/4.1%; p<0.0001/p=0.015). Conclusions These results suggest that strength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength due to contralateral knee pain might be centrally mediated. PMID:25768069

Frequency tuning of medial-olivocochlear-efferent acoustic reflexes in humans as functions of probe frequency

PubMed Central

Lilaonitkul, Watjana

2012-01-01

The medial-olivocochlear (MOC) acoustic reflex is thought to provide frequency-specific feedback that adjusts the gain of cochlear amplification, but little is known about how frequency specific the reflex actually is. We measured human MOC tuning through changes in stimulus frequency otoacoustic emissions (SFOAEs) from 40-dB-SPL tones at probe frequencies (fps) near 0.5, 1.0, and 4.0 kHz. MOC activity was elicited by 60-dB-SPL ipsilateral, contralateral, or bilateral tones or half-octave noise bands, with elicitor frequency (fe) varied in half-octave steps. Tone and noise elicitors produced similar results. At all probe frequencies, SFOAE changes were produced by a wide range of elicitor frequencies with elicitor frequencies near 0.7–2.0 kHz being particularly effective. MOC-induced changes in SFOAE magnitude and SFOAE phase were surprisingly different functions of fe: magnitude inhibition largest for fe close to fp, phase change largest for fe remote from fp. The metric ΔSFOAE, which combines both magnitude and phase changes, provided the best match to reported (cat) MOC neural inhibition. Ipsilateral and contralateral MOC reflexes often showed dramatic differences in plots of MOC effect vs. elicitor frequency, indicating that the contralateral reflex does not give an accurate picture of ipsilateral-reflex properties. These differences in MOC effects appear to imply that ipsilateral and contralateral reflexes have different actions in the cochlea. The implication of these results for MOC function, cochlear mechanics, and the production of SFOAEs are discussed. PMID:22190630

Contralateral Occlusion Test: The effect of external ear canal occlusion on hearing thresholds.

PubMed

Reis, Luis Roque; Fernandes, Paulo; Escada, Pedro

Bedside testing with tuning forks may decrease turnaround time and improve decision making for a quick qualitative assessment of hearing loss. The purpose of this study was to quantify the effects of ear canal occlusion on hearing, in order to decide which tuning fork frequency is more appropriate to use for quantifying hearing loss with the Contralateral Occlusion Test. Twenty normal-hearing adults (forty ears) underwent sound field pure tone audiometry with and without ear canal occlusion. Each ear was tested with the standard frequencies. The contralateral ear was suppressed with by masking. Ear occlusion was performed by two examiners. Participants aged between 21 and 30 years (25.6±3.03 years) showed an increase in hearing thresholds with increasing frequencies from 19.94dB (250Hz) to 39.25dB (2000Hz). The threshold difference between occluded and unoccluded conditions was statistically significant and increased from 10.69dB (250Hz) to 32.12dB (2000Hz). There were no statistically significant differences according to gender or between the examiners. The occlusion effect increased the hearing thresholds and became more evident with higher frequencies. The occlusion method as performed demonstrated reproducibility. In the Contralateral Occlusion Test, 256Hz or 512Hz tuning forks should be used for diagnosis of mild hearing loss, and a 2048Hz tuning fork should be used for moderate hearing loss. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Single-unit labeling of medial olivocochlear neurons: the cochlear frequency map for efferent axons.

PubMed

Brown, M Christian

2014-06-01

Medial olivocochlear (MOC) neurons are efferent neurons that project axons from the brain to the cochlea. Their action on outer hair cells reduces the gain of the "cochlear amplifier," which shifts the dynamic range of hearing and reduces the effects of noise masking. The MOC effects in one ear can be elicited by sound in that ipsilateral ear or by sound in the contralateral ear. To study how MOC neurons project onto the cochlea to mediate these effects, single-unit labeling in guinea pigs was used to study the mapping of MOC neurons for neurons responsive to ipsilateral sound vs. those responsive to contralateral sound. MOC neurons were sharply tuned to sound frequency with a well-defined characteristic frequency (CF). However, their labeled termination spans in the organ of Corti ranged from narrow to broad, innervating between 14 and 69 outer hair cells per axon in a "patchy" pattern. For units responsive to ipsilateral sound, the midpoint of innervation was mapped according to CF in a relationship generally similar to, but with more variability than, that of auditory-nerve fibers. Thus, based on CF mappings, most of the MOC terminations miss outer hair cells involved in the cochlear amplifier for their CF, which are located more basally. Compared with ipsilaterally responsive neurons, contralaterally responsive neurons had an apical offset in termination and a larger span of innervation (an average of 10.41% cochlear distance), suggesting that when contralateral sound activates the MOC reflex, the actions are different than those for ipsilateral sound. Copyright © 2014 the American Physiological Society.

Single-unit labeling of medial olivocochlear neurons: the cochlear frequency map for efferent axons

PubMed Central

2014-01-01

Medial olivocochlear (MOC) neurons are efferent neurons that project axons from the brain to the cochlea. Their action on outer hair cells reduces the gain of the “cochlear amplifier,” which shifts the dynamic range of hearing and reduces the effects of noise masking. The MOC effects in one ear can be elicited by sound in that ipsilateral ear or by sound in the contralateral ear. To study how MOC neurons project onto the cochlea to mediate these effects, single-unit labeling in guinea pigs was used to study the mapping of MOC neurons for neurons responsive to ipsilateral sound vs. those responsive to contralateral sound. MOC neurons were sharply tuned to sound frequency with a well-defined characteristic frequency (CF). However, their labeled termination spans in the organ of Corti ranged from narrow to broad, innervating between 14 and 69 outer hair cells per axon in a “patchy” pattern. For units responsive to ipsilateral sound, the midpoint of innervation was mapped according to CF in a relationship generally similar to, but with more variability than, that of auditory-nerve fibers. Thus, based on CF mappings, most of the MOC terminations miss outer hair cells involved in the cochlear amplifier for their CF, which are located more basally. Compared with ipsilaterally responsive neurons, contralaterally responsive neurons had an apical offset in termination and a larger span of innervation (an average of 10.41% cochlear distance), suggesting that when contralateral sound activates the MOC reflex, the actions are different than those for ipsilateral sound. PMID:24598524

Interlimb Reflexes Induced by Electrical Stimulation of Cutaneous Nerves after Spinal Cord Injury

PubMed Central

Butler, Jane E.; Godfrey, Sharlene; Thomas, Christine K.

2016-01-01

Whether interlimb reflexes emerge only after a severe insult to the human spinal cord is controversial. Here the aim was to examine interlimb reflexes at rest in participants with chronic (>1 year) spinal cord injury (SCI, n = 17) and able-bodied control participants (n = 5). Cutaneous reflexes were evoked by delivering up to 30 trains of stimuli to either the superficial peroneal nerve on the dorsum of the foot or the radial nerve at the wrist (5 pulses, 300 Hz, approximately every 30 s). Participants were instructed to relax the test muscles prior to the delivery of the stimuli. Electromyographic activity was recorded bilaterally in proximal and distal arm and leg muscles. Superficial peroneal nerve stimulation evoked interlimb reflexes in ipsilateral and contralateral arm and contralateral leg muscles of SCI and control participants. Radial nerve stimulation evoked interlimb reflexes in the ipsilateral leg and contralateral arm muscles of control and SCI participants but only contralateral leg muscles of control participants. Interlimb reflexes evoked by superficial peroneal nerve stimulation were longer in latency and duration, and larger in magnitude in SCI participants. Interlimb reflex properties were similar for both SCI and control groups for radial nerve stimulation. Ascending interlimb reflexes tended to occur with a higher incidence in participants with SCI, while descending interlimb reflexes occurred with a higher incidence in able-bodied participants. However, the overall incidence of interlimb reflexes in SCI and neurologically intact participants was similar which suggests that the neural circuitry underlying these reflexes does not necessarily develop after central nervous system injury. PMID:27049521

Regenerate Healing Outcomes in Unilateral Mandibular Distraction Osteogenesis Using Quantitative Histomorphometry

PubMed Central

Schwarz, Daniel A.; Arman, Krikor G.; Kakwan, Mehreen S.; Jamali, Ameen M.; Elmeligy, Ayman A.; Buchman, Steven R.

2015-01-01

Background The authors’ goal was to ascertain regenerate bone-healing metrics using quantitative histomorphometry at a single consolidation period. Methods Rats underwent either mandibular distraction osteogenesis (n=7) or partially reduced fractures (n=7); their contralateral mandibles were used as controls (n=11). External fixators were secured and unilateral osteotomies performed, followed by either mandibular distraction osteogenesis (4 days’ latency, then 0.3 mm every 12 hours for 8 days; 5.1 mm) or partially reduced fractures (fixed immediately postoperatively; 2.1 mm); both groups underwent 4 weeks of consolidation. After tissue processing, bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, and osteocyte count per high-power field were analyzed by means of quantitative histomorphometry. Results Contralateral mandibles had statistically greater bone volume/tissue volume ratio and osteocyte count per high-power field compared with both mandibular distraction osteogenesis and partially reduced fractures by almost 50 percent, whereas osteoid volume/tissue volume ratio was statistically greater in both mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles. No statistical difference in bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, or osteocyte count per high-power field was found between mandibular distraction osteogenesis specimens and partially reduced fractures. Conclusions The authors’ findings demonstrate significantly decreased bone quantity and maturity in mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles using the clinically analogous protocols. If these results are extrapolated clinically, treatment strategies may require modification to ensure reliable, predictable, and improved outcomes. PMID:20463629

Bilateral totally extraperitoneal (TEP) repair of the ultrasound-diagnosed asymptomatic contralateral inguinal hernia.

PubMed

Malouf, Phillip A; Descallar, Joseph; Berney, Christophe R

2018-02-01

The aim of this series is to determine the clinical utility of routine ultrasound (US) of the contralateral, clinically normal groin when a unilateral inguinal hernia is referred for hernia repair-specifically assessing the morbidity and short-term change in quality-of-life (QoL) due to repair of this occult contralateral hernia when also repairing the symptomatic side. TEP inguinal hernia repair affords the opportunity to repair any groin hernia through the same small incisions. US detects 96.6% of groin hernias with 84.4% specificity. 234 consecutive male patients with clinically unilateral and clinically bilateral hernia were enrolled; those with a clinically unilateral hernia were sent for groin US and if positive, a bilateral TEP groin hernia repair was performed (USBH). If negative, a unilateral TEP groin hernia repair was performed (UNIH). Carolina's comfort scales (CCS) and visual analogue scores (VAS) were recorded at 2 and 6 weeks postoperatively, while a modified CCS (MCCS) was recorded for all patients preoperatively. Bilateral TEP repair resulted in higher VAS scores than unilateral repair at 2 weeks but not 6 weeks. CCS were worse in the USBH group than UNIH group at 2 weeks but were similar by 6 weeks. Complications' rates were similar amongst all 3 groups. Factors contributing to worse scores were: smaller hernia, complications, worse preoperative MCCS results, recurrent hernia and bilateral rather than unilateral repair. Bilateral TEP for the clinically unilateral groin hernia with an occult contralateral groin hernia can be performed without increased morbidity, accepting a minor and very temporary impairment of QoL.

Proteomic analysis of trans-hemispheric motor cortex reorganization following contralateral C7 nerve transfer

PubMed Central

Yuan, Yin; Xu, Xiu-yue; Lao, Jie; Zhao, Xin

2018-01-01

Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Previous studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth associated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function (including neuron differentiation and development, axonogenesis, and guidance), microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light (NFL) and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteomic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer. PMID:29557385

The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients.

PubMed

Ki, Hee Jong; Lee, Hyung-Jin; Lee, Hong-Jae; Yi, Jin-Seok; Yang, Ji-Ho; Lee, Il-Woo

2015-09-01

The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

The correlation of background parenchymal enhancement in the contralateral breast with patient and tumor characteristics of MRI-screen detected breast cancers.

PubMed

Vreemann, Suzan; Gubern-Mérida, Albert; Borelli, Cristina; Bult, Peter; Karssemeijer, Nico; Mann, Ritse M

2018-01-01

Higher background parenchymal enhancement (BPE) could be used for stratification of MRI screening programs since it might be related to a higher breast cancer risk. Therefore, the purpose of this study is to correlate BPE to patient and tumor characteristics in women with unilateral MRI-screen detected breast cancer who participated in an intermediate and high risk screening program. As BPE in the affected breast may be difficult to discern from enhancing cancer, we assumed that BPE in the contralateral breast is a representative measure for BPE in women with unilateral breast cancer. This retrospective study was approved by our local institutional board and a waiver for consent was granted. MR-examinations of women with unilateral breast cancers screen-detected on breast MRI were evaluated by two readers. BPE in the contralateral breast was rated according to BI-RADS. Univariate analyses were performed to study associations. Observer variability was computed. Analysis included 77 breast cancers in 76 patients (age: 48±9.8 years), including 62 invasive and 15 pure ductal carcinoma in-situ cases. A negative association between BPE and tumor grade (p≤0.016) and a positive association with progesterone status (p≤0.021) was found. The correlation was stronger when only considering invasive disease. Inter-reader agreement was substantial. Lower BPE in the contralateral breast in women with unilateral breast cancer might be associated to higher tumor grade and progesterone receptor negativity. Great care should be taken using BPE for stratification of patients to tailored screening programs.

Integrating temperature with odor processing in the olfactory bulb.

PubMed

Kludt, Eugen; Okom, Camille; Brinkmann, Alexander; Schild, Detlev

2015-05-20

Temperature perception has long been classified as a somesthetic function solely. However, in recent years several studies brought evidence that temperature perception also takes place in the olfactory system of rodents. Temperature has been described as an effective stimulus for sensory neurons of the Grueneberg ganglion located at the entrance of the nose. Here, we investigate whether a neuronal trace of temperature stimulation can be observed in the glomeruli and mitral cells of the olfactory bulb, using calcium imaging and fast line-scanning microscopy. We show in the Xenopus tadpole system that the γ-glomerulus, which receives input from olfactory neurons, is highly sensitive to temperature drops at the olfactory epithelium. We observed that thermo-induced activity in the γ-glomerulus is conveyed to the mitral cells innervating this specific neuropil. Surprisingly, a substantial number of thermosensitive mitral cells were also chemosensitive. Moreover, we report another unique feature of the γ-glomerulus: it receives ipsilateral and contralateral afferents. The latter fibers pass through the contralateral bulb, cross the anterior commissure, and then run to the ipsilateral olfactory bulb, where they target the γ-glomerulus. Temperature drops at the contralateral olfactory epithelium also induced responses in the γ-glomerulus and in mitral cells. Temperature thus appears to be a relevant physiological input to the Xenopus olfactory system. Each olfactory bulb integrates and codes temperature signals originating from receptor neurons of the ipsilateral and contralateral nasal cavities. Finally, temperature and chemical information is processed in shared cellular networks. Copyright © 2015 the authors 0270-6474/15/357892-11$15.00/0.

Retinal ganglion cell complex and peripapillary retinal nerve fiber layer thicknesses following carotid endarterectomy.

PubMed

Guclu, Orkut; Guclu, Hande; Huseyin, Serhat; Korkmaz, Selcuk; Yuksel, Volkan; Canbaz, Suat; Pelitli Gurlu, Vuslat

2018-06-23

To examine changes in retinal ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses by optical coherence tomography (OCT) in contralateral and ipsilatateral eyes of carotid artery stenosis (CAS) patients before and after carotid endarterectomy (CEA). Forty-two consecutive patients diagnosed with CAS (70-99% stenosis rate) who underwent CEA were included in this prospective cross-sectional study. The indication for CEA was based on the Asymptomatic Carotid Atherosclerosis Study. Doppler ultrasonography and computed tomography angiography were performed to calculate CAS. All the subjects underwent an ophthalmological examination, including best corrected visual acuity (BCVA), intraocular pressure (IOP) measurements, biomicroscopy, fundoscopy, and OCT before and after the surgery. The mean preoperative intraocular pressure was 15.2 ± 2.1 mmHg in the ipsilateral eye and 15.8 ± 2.7 in the contralateral eye. The mean postoperative intraocular pressure in the ipsilateral and contralateral eye was 18.6 ± 3.0 and 19.3 ± 3.8, respectively. The intraocular pressure was significantly higher in postoperative eyes (p = 0.0001). There was a statistically significant decrease in peripapillary RNFL thickness in superior quadrants postoperatively in ipsilateral eyes. The retinal GCC layer thickness was not significantly different before and after CEA in ipsilateral and contralateral eyes. Carotid endarterectomy results in thinning of the superior peripapillary RNFL thickness. To the best of our knowledge, this is the first study to examine peripapillary RNFL and GCC thicknesses before and after CEA.

Targeted mini-strokes produce changes in interhemispheric sensory signal processing that are indicative of disinhibition within minutes.

PubMed

Mohajerani, Majid H; Aminoltejari, Khatereh; Murphy, Timothy H

2011-05-31

Most processing of sensation involves the cortical hemisphere opposite (contralateral) to the stimulated limb. Stroke patients can exhibit changes in the interhemispheric balance of sensory signal processing. It is unclear whether these changes are the result of poststroke rewiring and experience, or whether they could result from the immediate effect of circuit loss. We evaluated the effect of mini-strokes over short timescales (<2 h) where cortical rewiring is unlikely by monitoring sensory-evoked activity throughout much of both cortical hemispheres using voltage-sensitive dye imaging. Blockade of a single pial arteriole within the C57BL6J mouse forelimb somatosensory cortex reduced the response evoked by stimulation of the limb contralateral to the stroke. However, after stroke, the ipsilateral (uncrossed) forelimb response within the unaffected hemisphere was spared and became independent of the contralateral forelimb cortex. Within the unaffected hemisphere, mini-strokes in the opposite hemisphere significantly enhanced sensory responses produced by stimulation of either contralateral or ipsilateral pathways within 30-50 min of stroke onset. Stroke-induced enhancement of responses within the spared hemisphere was not reproduced by inhibition of either cortex or thalamus using pharmacological agents in nonischemic animals. I/LnJ acallosal mice showed similar rapid interhemispheric redistribution of sensory processing after stroke, suggesting that subcortical connections and not transcallosal projections were mediating the novel activation patterns. Thalamic inactivation before stroke prevented the bilateral rearrangement of sensory responses. These findings suggest that acute stroke, and not merely loss of activity, activates unique pathways that can rapidly redistribute function within the spared cortical hemisphere.

The Mirror Illusion Increases Motor Cortex Excitability in Children With and Without Hemiparesis.

PubMed

Grunt, Sebastian; Newman, Christopher J; Saxer, Stefanie; Steinlin, Maja; Weisstanner, Christian; Kaelin-Lang, Alain

2017-03-01

Mirror therapy provides a visual illusion of a normal moving limb by using the mirror reflection of the unaffected arm instead of viewing the paretic limb and is used in rehabilitation to improve hand function. Little is known about the mechanism underlying its effect in children with hemiparesis. To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and adolescents. Twelve patients with hemiparesis (10-20 years) and 8 typically developing subjects (8-17 years) participated. Corticospinal reorganization was classified as contralateral (projection from contralateral hemisphere to affected hand) or ipsilateral (projection from ipsilateral hemisphere to affected hand). M1 excitability of the hemisphere projecting to the affected (nondominant in typically developing subjects) hand was obtained during 2 different conditions using single-pulse transcranial magnetic stimulation (TMS). Each condition (without/with mirror) consisted of a unimanual and a bimanual task. Motor-evoked potentials (MEPs) were recorded from the abductor pollicis brevis and flexor digitorum superficialis muscles. MEP amplitudes were significantly increased during the mirror condition ( P = .005) in typically developing subjects and in patients with contralateral reorganization. No significant effect of MI was found in subjects with ipsilateral reorganization. MI increased M1 excitability during active movements only. This increase was not correlated to hand function. MI increases the excitability of M1 in hemiparetic patients with contralateral corticospinal organization and in typically developing subjects. This finding provides neurophysiological evidence supporting the application of mirror therapy in selected children and adolescents with hemiparesis.

In vivo imaging of human burn injuries with polarization-sensitive optical coherence tomography

NASA Astrophysics Data System (ADS)

Kim, Ki Hean; Pierce, Mark C.; Maguluri, Gopi; Park, B. Hyle; Yoon, Sang June; Lydon, Martha; Sheridan, Robert; de Boer, Johannes F.

2012-06-01

The accurate determination of burn depth is critical in the clinical management of burn wounds. Polarization-sensitive optical coherence tomography (PS-OCT) has been proposed as a potentially non-invasive method for determining burn depth by measuring thermally induced changes in the structure and birefringence of skin, and has been investigated in pre-clinical burn studies with animal models and ex vivo human skin. In this study, we applied PS-OCT to the in-vivo imaging of two pediatric burn patients. Deep and superficial burned skins along with contralateral controls were imaged in 3D. The imaging size was 8 mm×6 mm×2 mm in width, length, and depth in the air respectively, and the imaging time was approximately 6 s per volume. Superficially burned skins exhibited the same layered structure as the contralateral controls, but more visible vasculature and reduced birefringence compared to the contralateral controls. In contrast, a deeply burned skin showed loss of the layered structure, almost absent vasculature, and smaller birefringence compared to superficial burns. This study suggested the vasculature and birefringence as parameters for characterizing burn wounds.

Sounds Activate Visual Cortex and Improve Visual Discrimination

PubMed Central

Störmer, Viola S.; Martinez, Antigona; McDonald, John J.; Hillyard, Steven A.

2014-01-01

A recent study in humans (McDonald et al., 2013) found that peripheral, task-irrelevant sounds activated contralateral visual cortex automatically as revealed by an auditory-evoked contralateral occipital positivity (ACOP) recorded from the scalp. The present study investigated the functional significance of this cross-modal activation of visual cortex, in particular whether the sound-evoked ACOP is predictive of improved perceptual processing of a subsequent visual target. A trial-by-trial analysis showed that the ACOP amplitude was markedly larger preceding correct than incorrect pattern discriminations of visual targets that were colocalized with the preceding sound. Dipole modeling of the scalp topography of the ACOP localized its neural generators to the ventrolateral extrastriate visual cortex. These results provide direct evidence that the cross-modal activation of contralateral visual cortex by a spatially nonpredictive but salient sound facilitates the discriminative processing of a subsequent visual target event at the location of the sound. Recordings of event-related potentials to the targets support the hypothesis that the ACOP is a neural consequence of the automatic orienting of visual attention to the location of the sound. PMID:25031419

The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

PubMed

Cole, Grayson Lee; Millis, Darryl

2017-01-16

Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.

Discharge properties of Purkinje cells in the oculomotor vermis during visually guided saccades in the macaque monkey.

PubMed

Ohtsuka, K; Noda, H

1995-11-01

1. We previously described discharge properties of cerebellar output cells in the fastigial nucleus during ipsilateral and contralateral saccades. Fastigial cells exhibited unique responses depending on the direction of saccades and were involved in execution of accurate targeting saccades. Purkinje cells in the oculomotor vermis (lobules VIc and VII) are thought to modulate these discharges of fastigial cells. In this study we reexamine discharge properties of Purkinje cells on the basis of this hypothesis. 2. Initially we physiologically identified the right and left sides of the oculomotor vermis. Saccade-related discharges of 79 Purkinje cells were recorded from both sides of the vermis during visually guided saccades toward the sides ipsilateral and contralateral to the recording side in two trained macaque monkeys. To clarify the correlation of Purkinje cell discharge with burst activities in the fastigial nucleus during saccadic eye movements, we analyzed our data by employing methods used in the study of fastigial neurons. 3. Among the 79 cells, 56 (71%) showed burst discharges during saccades (saccadic burst cells). Of the 56 cells, 29 exhibited a peak of burst discharges in both the contralateral and ipsilateral directions (bidirectional cells). The remaining 27 saccadic burst cells showed a peak of burst discharges during either contralateral or ipsilateral saccades (unidirectional cells). Among the 79 cells, 14 (18%) exhibited a pause of discharges during contralateral saccades (pause cells). Among the 79 cells, 9 (11%) showed burst discharge during contralateral saccades followed by tonic discharge that was correlated with eye position (burst tonic cells). 4. The timing of bursts in bidirectional cells with respect to saccade onset was dependent on the direction of saccade. During ipsilateral saccades, Purkinje cells exhibited a long lead burst that built up gradually, peaked near the onset of the saccade, and terminated sharply near midsaccade. The mean lead time relative to saccade onset was 29.3 +/- 24.5 (SD) ms. During contralateral saccades, Purkinje cells exhibited a short lead/late burst that built up sharply, peaked near midsaccade, and terminated gradually after the end of the saccade. The mean lead time relative to saccade onset was 10.7 +/- 20.8 ms. The burst onset time during contralateral saccades and the burst offset time during ipsilateral saccades preceded the saccade offset time by about the same interval regardless of the saccade amplitude. 5. In pause cells the pause preceded saccade onset by 17.5 +/- 10.6 ms. The duration of the pause was not correlated with the duration of saccades. There was little trial-to-trial variability in the onset time of the pause with respect to the onset of saccades, whereas there was large trial-to-trial variability in the offset time of the pause with respect to the offset of saccades. In addition, the mean onset time of the pause for each cell had a relatively narrow distribution. 6. The burst lead time of burst tonic cells relative to saccade onset was 9.5 +/- 3.9 ms. The tonic discharge rate of burst tonic cells was a nonlinear function of eye position. The regression of each cell was fit to two lines. The regression coefficient ranged from 0.95 to 0.99 (mean = 0.97). 7. Axons of Purkinje cells in the oculomotor vermis are thought to project exclusively to saccadic burst cells in the fastigial oculomotor region (FOR), which is located in the caudal portion of the fastigial nucleus. Our previous studies indicated that FOR cells provide temporal signals for controlling targeting saccades. The present results suggest that Purkinje cells in the oculomotor vermis modify the temporal signals of FOR cells for saccades in different directions and amplitudes. The modification of FOR cell activity by Purkinje cells is thought to be essential for the function of the cerebellum in the control of saccadic eye movements.

Ethanol induces rotational behavior in 6-hydroxydopamine lesioned mice

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

Silverman, P.B.

1987-03-09

Mice with unilateal striatal lesions created by 6-hydroxydopamine (6HDA) injection were screened for rotational (circling) behavior in response to injection of amphetamine and apomorphine. Those that rotated ipsilaterally in response to amphetamine and contralaterally in response to apomorphine were subsequently challenged with 1 to 3 g/kg (i.p.) ethanol. Surprisingly, ethanol induced dose related contralateral (apomorphine-like) rotation which, despite gross intoxication, was quite marked in most animals. No significant correlation was found between the number of turns made following ethanol and made after apomorphine or amphetamine. 14 references, 2 figures, 1 table.

Treatment with acetazolamide of brain-stem and spinal paroxysmal disturbances in multiple sclerosis.

PubMed Central

Voiculescu, V; Pruskauer-Apostol, B; Alecu, C

1975-01-01

Nine cases of multiple sclerosis with paroxysmal disorders were treated with acetazolamide. In most cases a brain-stem origin of the seizures was suggested by their particular pattern: crossed syndromes (facial spasm associated with contralateral weakness of the arm and leg, paroxysmal paraesthesiae in one side of the face and weakness of the contralateral leg), paroxysmal dysarthria, and ataxia. One patient with a Brown-Sequard syndrome complained of paroxysmal paraesthesiae in the lower limbs, for which a spinal origin was admitted. In all patients the paroxysmal disorders were promptly suppressed or markedly reduced by acetazolamide. PMID:1151400

Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct

PubMed Central

Xu, Yongfeng; Liu, Lan

2016-01-01

Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients. PMID:27356659

Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct.

PubMed

Xu, Yongfeng; Liu, Lan

2016-07-01

Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.

Ipsilateral Irradiation for Oral and Oropharyngeal Carcinoma Treated With Primary Surgery and Postoperative Radiotherapy

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

Vergeer, Marije R., E-mail: mr.vergeer@vumc.n; Doornaert, Patricia; Jonkman, Anja

Purpose: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials: The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck (n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27more » cases (22%). Results: Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases (p = 0.008). Borderline significance (p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. Conclusions: Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.« less

Klotho and activin A in kidney injury: plasma Klotho is maintained in unilateral obstruction despite no upregulation of Klotho biosynthesis in the contralateral kidney.

PubMed

Nordholm, Anders; Mace, Maria L; Gravesen, Eva; Hofman-Bang, Jacob; Morevati, Marya; Olgaard, Klaus; Lewin, Ewa

2018-05-01

In a new paradigm of etiology related to chronic kidney disease-mineral and bone disorder (CKD-MBD), kidney injury may cause induction of factors in the injured kidney that are released into the circulation and thereby initiate and maintain renal fibrosis and CKD-MBD. Klotho is believed to ameliorate renal fibrosis and CKD-MBD, while activin A might have detrimental effects. The unilateral ureter obstruction (UUO) model is used here to examine this concept by investigating early changes related to renal fibrosis in the obstructed kidney, untouched contralateral kidney, and vasculature which might be affected by secreted factors from the obstructed kidney, and comparing with unilateral nephrectomized controls (UNX). Obstructed kidneys showed early Klotho gene and protein depletion, whereas plasma Klotho increased in both UUO and UNX rats, indicating an altered metabolism of Klotho. Contralateral kidneys had no compensatory upregulation of Klotho and maintained normal expression of the examined fibrosis-related genes, as did remnant UNX kidneys. UUO caused upregulation of transforming growth factor-β and induction of periostin and activin A in obstructed kidneys without changes in the contralateral kidneys. Plasma activin A doubled in UUO rats after 10 days while no changes were seen in UNX rats, suggesting secretion of activin A from the obstructed kidney with potentially systemic effects on CKD-MBD. As such, increased aortic sclerostin was observed in UUO rats compared with UNX and normal controls. The present results are in line with the new paradigm and show very early vascular effects of unilateral kidney fibrosis, supporting the existence of a new kidney-vasculature axis.

Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon

PubMed Central

The, Bertram; Brutty, Mike; Wang, Allan; Campbell, Peter T.; Halliday, Michael J. C.; Ackland, Timothy R.

2014-01-01

Introduction: The objective of this study is to evaluate the biomechanical function of the upper arm after arthroscopic long head of biceps (LHB) tenotomy at long-term follow-up. Materials and Methods: Twenty-five male subjects ranging from 30 to 63 years old were evaluated at a mean follow-up of 7.0 years after tenotomy. Bilateral isokinetic testing was performed to obtain peak torque values, as well as total work done throughout the full range of elbow flexion and supination. Results: Magnetic resonance imaging scans revealed nine unrecognized LHB ruptures in the contralateral arm, leaving 16 subjects to complete the testing protocol. The mean quickDASH score was 8.1 (standard error [SE] 2.5). The mean oxford elbow score was 97.9 (SE 1.6). The tenotomy arm recorded a decrease in peak flexion torque of 7.0% (confidence interval [CI] 1.2-12.8), and a decrease in the peak supination torque of 9.1% (CI 1.8-16.4) relative to the contralateral arm. The total work carried out through the full range of joint motion was reduced in elbow flexion by 5.1% (CI −1.3-11.4) and in forearm supination by 5.7% (CI-2.4-13.9). Discussion: Maximum strength in elbow flexion and forearm supination is significantly reduced compared with the contralateral arm. However, this impairment is partially compensated for by relatively greater strength sustained through the latter stages of joint motion. This results in comparable total work measurements between the tenotomised and contralateral side, potentially accounting for ongoing high levels of patient satisfaction and clinical function in the long term after LHB tenotomy. Level of Evidence IV: Case series without comparison group. PMID:25258498

A case study of IMRT planning (Plan B) subsequent to a previously treated IMRT plan (Plan A)

NASA Astrophysics Data System (ADS)

Cao, F.; Leong, C.; Schroeder, J.; Lee, B.

2014-03-01

Background and purpose: Treatment of the contralateral neck after previous ipsilateral intensity modulated radiation therapy (IMRT) for head and neck cancer is a challenging problem. We have developed a technique that limits the cumulative dose to the spinal cord and brainstem while maximizing coverage of a planning target volume (PTV) in the contralateral neck. Our case involves a patient with right tonsil carcinoma who was given ipsilateral IMRT with 70Gy in 35 fractions (Plan A). A left neck recurrence was detected 14 months later. The patient underwent a neck dissection followed by postoperative left neck radiation to a dose of 66 Gy in 33 fractions (Plan B). Materials and Methods: The spinal cord-brainstem margin (SCBM) was defined as the spinal cord and brainstem with a 1.0 cm margin. Plan A was recalculated on the postoperative CT scan but the fluence outside of SCBM was deleted. A further modification of Plan A resulted in a base plan that was summed with Plan B to evaluate the cumulative dose received by the spinal cord and brainstem. Plan B alone was used to evaluate for coverage of the contralateral neck PTV. Results: The maximum cumulative doses to the spinal cord with 0.5cm margin and brainstem with 0.5cm margin were 51.96 Gy and 45.60 Gy respectively. For Plan B, 100% of the prescribed dose covered 95% of PTVb1. Conclusion: The use of a modified ipsilateral IMRT plan as a base plan is an effective way to limit the cumulative dose to the spinal cord and brainstem while enabling coverage of a PTV in the contralateral neck.

Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis.

PubMed

Chae, Michael P; Rozen, Warren Matthew; Patel, Nakul Gamanlal; Hunter-Smith, David J; Ramakrishnan, Venkat

2017-12-01

An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. We report a prospective case series of 3 delayed unilateral breast reconstructions where symmetrization procedure to the contralateral breast was not indicated. Using a commercial 3D scanner (VECTRA XR, Canfield Scientific), the breast region was imaged. The mirrored image was 3D-printed in-house using a desktop 3D printer. In all cases, projection of the breast mound was able to be safely achieved, with a demonstrated central volume (or 'cone') able to be highlighted on imaging and a 3D printed breast. A 3D print of the contralateral breast was able to be used intraoperatively to guide the operative approach. The St Andrew's coning technique is a useful aesthetic maneuver for achieving breast projection during DIEP flap breast reconstruction, with 3D imaging techniques able to assist in perioperative assessment of breast volume.

Body surface infrared thermometry in patients with central venous cateter-related infections

PubMed Central

Silvah, José Henrique; de Lima, Cristiane Maria Mártires; de Unamuno, Maria do Rosário Del Lama; Schetino, Marco Antônio Alves; Schetino, Luana Pereira Leite; Fassini, Priscila Giácomo; Brandão, Camila Fernanda Costa e Cunha Moraes; Basile, Anibal; da Cunha, Selma Freire Carvalho; Marchini, Julio Sergio

2015-01-01

Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections. Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject. Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus -0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus -0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus -0.22 - -0.10ºC; p<0.01). Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area. PMID:26466058

The Corticofugal Effects of Auditory Cortex Microstimulation on Auditory Nerve and Superior Olivary Complex Responses Are Mediated via Alpha-9 Nicotinic Receptor Subunit

PubMed Central

Aedo, Cristian; Terreros, Gonzalo; León, Alex; Delano, Paul H.

2016-01-01

Background and Objective The auditory efferent system is a complex network of descending pathways, which mainly originate in the primary auditory cortex and are directed to several auditory subcortical nuclei. These descending pathways are connected to olivocochlear neurons, which in turn make synapses with auditory nerve neurons and outer hair cells (OHC) of the cochlea. The olivocochlear function can be studied using contralateral acoustic stimulation, which suppresses auditory nerve and cochlear responses. In the present work, we tested the proposal that the corticofugal effects that modulate the strength of the olivocochlear reflex on auditory nerve responses are produced through cholinergic synapses between medial olivocochlear (MOC) neurons and OHCs via alpha-9/10 nicotinic receptors. Methods We used wild type (WT) and alpha-9 nicotinic receptor knock-out (KO) mice, which lack cholinergic transmission between MOC neurons and OHC, to record auditory cortex evoked potentials and to evaluate the consequences of auditory cortex electrical microstimulation in the effects produced by contralateral acoustic stimulation on auditory brainstem responses (ABR). Results Auditory cortex evoked potentials at 15 kHz were similar in WT and KO mice. We found that auditory cortex microstimulation produces an enhancement of contralateral noise suppression of ABR waves I and III in WT mice but not in KO mice. On the other hand, corticofugal modulations of wave V amplitudes were significant in both genotypes. Conclusion These findings show that the corticofugal modulation of contralateral acoustic suppressions of auditory nerve (ABR wave I) and superior olivary complex (ABR wave III) responses are mediated through MOC synapses. PMID:27195498

Assessment of DNA methylation profiling and copy number variation as indications of clonal relationship in ipsilateral and contralateral breast cancers to distinguish recurrent breast cancer from a second primary tumour.

PubMed

Huang, Katie T; Mikeska, Thomas; Li, Jason; Takano, Elena A; Millar, Ewan K A; Graham, Peter H; Boyle, Samantha E; Campbell, Ian G; Speed, Terence P; Dobrovic, Alexander; Fox, Stephen B

2015-10-09

Patients with breast cancer have an increased risk of developing subsequent breast cancers. It is important to distinguish whether these tumours are de novo or recurrences of the primary tumour in order to guide the appropriate therapy. Our aim was to investigate the use of DNA methylation profiling and array comparative genomic hybridization (aCGH) to determine whether the second tumour is clonally related to the first tumour. Methylation-sensitive high-resolution melting was used to screen promoter methylation in a panel of 13 genes reported as methylated in breast cancer (RASSF1A, TWIST1, APC, WIF1, MGMT, MAL, CDH13, RARβ, BRCA1, CDH1, CDKN2A, TP73, and GSTP1) in 29 tumour pairs (16 ipsilateral and 13 contralateral). Using the methylation profile of these genes, we employed a Bayesian and an empirical statistical approach to estimate clonal relationship. Copy number alterations were analysed using aCGH on the same set of tumour pairs. There is a higher probability of the second tumour being recurrent in ipsilateral tumours compared with contralateral tumours (38 % versus 8 %; p <0.05) based on the methylation profile. Using previously reported recurrence rates as Bayesian prior probabilities, we classified 69 % of ipsilateral and 15 % of contralateral tumours as recurrent. The inferred clonal relationship results of the tumour pairs were generally concordant between methylation profiling and aCGH. Our results show that DNA methylation profiling as well as aCGH have potential as diagnostic tools in improving the clinical decisions to differentiate recurrences from a second de novo tumour.

Real-time monitoring of ischemic and contralateral brain pO2 during stroke by variable length multisite resonators

PubMed Central

Hou, Huagang; Li, Hongbin; Dong, Ruhong; Khan, Nadeem; Swartz, Harold

2014-01-01

Purpose Electron paramagnetic resonance (EPR) oximetry using variable length multi-probe implantable resonator (IR), was used to investigate the temporal changes in the ischemic and contralateral brain pO2 during stroke in rats. Material and Methods The EPR signal to noise ratio (S/N) of the IR with four sensor loops at a depth of up to11 mm were compared with direct implantation of lithium phthalocyanine (LiPc, oximetry probe) deposits in vitro. These IRs were used to follow the temporal changes in pO2 at two sites in each hemisphere during ischemia induced by left middle cerebral artery occlusion (MCAO) in rats breathing 30% O2 or 100% O2. Results The S/N ratios of the IRs were significantly greater than the LiPc deposits. A similar pO2 at two sites in each hemisphere prior to the onset of ischemia was observed in rats breathing 30% O2. However, a significant decline in the pO2 of the left cortex and striatum occurred during ischemia but no change in the pO2 of the contralateral brain was observed. A significant increase in the pO2 of only the contralateral non-ischemic brain was observed in the rats breathing 100% O2. No significant difference in the infarct volume was evident between the animals breathing 30% O2 or 100% O2 during ischemia. Conclusions EPR oximetry with IRs can repeatedly assess temporal changes in the brain pO2 at four sites simultaneously during stroke. This oximetry approach can be used to test and develop interventions to rescue ischemic tissue by modulating cerebral pO2 during stroke. PMID:24629514

Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: A literature-based critical review.

PubMed

Al-Mamgani, Abrahim; van Werkhoven, Erik; Navran, Arash; Karakullukcu, Baris; Hamming-Vrieze, Olga; Machiels, Melanie; van der Velden, Lilly-Ann; Vogel, Wouter V; Klop, W Martin

2017-09-01

The head and neck region has rich regional lymphatic network, with a theoretical risk on contralateral metastasis from oropharyngeal cancer (OPC). There is a long-standing convention to irradiate the great majority of these tumors electively to both sides of the neck to reduce the risk of contralateral regional failure (cRF), but this can induce significant toxicity. We aimed to identify patient groups where elective contralateral irradiation may safely be omitted. PubMed and EMBASE were searched for original full-text articles in English with a combination of search terms related to the end points: cRF in OPC primarily treated by radiotherapy only to the ipsilateral neck and identifying predictive factors for increased incidence of cRF. The data from the identified studies were pooled, the incidence of cRF was calculated and the correlation with different predictive factors was investigated. Eleven full-text articles met the inclusion criteria. In these studies, 1116 patients were treated to the ipsilateral neck alone. The mean incidence of cRF was 2.42% (range 0-5.9%, 95% CI 1.6-3.5%). The incidence of cRF correlated only with T-stage (p=0.008), and involvement of midline (p=0.001). However, the significant correlation with T-stage can be explained by the very low incidence of cRF among T1 (0.77%), and disappeared when the incidence of cRF was compared between T2, T3,and T4 (p=0.344). The incidence of cRF in patients with OPC is very low, with involvement of midline providing the most significant prognosticator. These results call for trials on unilateral elective irradiation in selected groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly-diagnosed breast cancer

PubMed Central

Hamilton, Jada G.; Genoff, Margaux C.; Salerno, Melissa; Amoroso, Kimberly; Boyar, Sherry R.; Sheehan, Margaret; Fleischut, Megan Harlan; Siegel, Beth; Arnold, Angela G.; Salo-Mullen, Erin E.; Hay, Jennifer L.; Offit, Kenneth; Robson, Mark E.

2017-01-01

Purpose Women who are newly diagnosed with breast cancer may consider contralateral prophylactic mastectomy (CPM) to reduce their future risk of cancer in their unaffected breast. Pre-surgical BRCA1/2 genetic testing can provide valuable risk information to guide this choice. However, little is understood about why BRCA1/2 mutation noncarriers, who are generally not at substantially elevated risk of contralateral disease, select CPM. Methods We examined the uptake of CPM among breast cancer patients identified as BRCA1/2 mutation noncarriers (n=92) as part of a larger prospective study of the impact of pre-surgical BRCA1/2 testing. Data obtained from self-report questionnaires and patient medical records were used to examine associations between theoretically-relevant background and psychosocial factors and BRCA1/2 mutation noncarriers’ decisions to undergo CPM. Results Among BRCA1/2 mutation noncarriers, 25% (n=23) elected to undergo CPM. Psychosocial factors including a self-reported physician recommendation for CPM, greater perceived contralateral breast cancer risk, and greater perceived benefits of CPM were all significantly associated with the uptake of CPM. Conclusions A sizeable minority of BRCA1/2 mutation noncarriers choose to undergo CPM after learning their mutation status through pre-surgical genetic testing. BRCA1/2 mutation noncarriers’ cognitive perceptions and social influences appear to be important in shaping their decisions regarding CPM. This work highlights the importance of several psychosocial factors in influencing patients’ surgical decisions. Future research is needed that examines the formation of BRCA1/2 mutation noncarriers’ beliefs regarding their disease and available treatment options, and that characterizes the physician-patient communication that occurs in this complex decision-making context. PMID:28150129