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Sample records for medial longitudinal fasciculus

  1. The Superior Longitudinal Fasciculus in Typically Developing Children and Adolescents: Diffusion Tensor Imaging and Neuropsychological Correlates

    PubMed Central

    Urger, Sacide E.; De Bellis, Michael D.; Hooper, Stephen R.; Woolley, Donald P.; Chen, Steven D.; Provenzale, James

    2014-01-01

    The relationship between superior longitudinal fasciculus microstructural integrity and neuropsychological functions were examined in 49 healthy children (range: 5–17 years) using diffusion tensor imaging. Seven major cognitive domains (intellegience, fine-motor, attention, language, visual-spatial, memory, executive function) were assessed. Data analyses utilized correlational methods. After adjusting for age and gender, fractional anisotropy and axial diffusivity values in the superior longitudinal fasciculus were positively correlated with executive functions of set-shifting; while left superior longitudinal fasciculus fractional anisotropy values correlated with attention and language. Apparent diffusion coefficient values in the left superior longitudinal fasciculus negatively correlated with inhibitory control. In the left arcuate fasciculus, fractional anisotropy correlated with IQ and attention; while radial diffusivity values negatively correlated with IQ, fine-motor skills, and expressive language. Findings from this study provide an examination of the relationship between superior longitudinal fasciculus integrity and children’s neuropsychological abilities that can be useful in monitoring pediatric neurological diseases. PMID:24556549

  2. Does the Left Inferior Longitudinal Fasciculus Play a Role in Language? A Brain Stimulation Study

    ERIC Educational Resources Information Center

    Mandonnet, Emmanuel; Nouet, Aurelien; Gatignol, Peggy; Capelle, Laurent; Duffau, Hugues

    2007-01-01

    Although advances in diffusion tensor imaging have enabled us to better study the anatomy of the inferior longitudinal fasciculus (ILF), its function remains poorly understood. Recently, it was suggested that the subcortical network subserving the language semantics could be constituted, in parallel with the inferior occipitofrontal fasciculus, by…

  3. Axons from the medial habenular nucleus are topographically sorted in the fasciculus retroflexus.

    PubMed

    Ichijo, Hiroyuki; Toyama, Tomoko

    2015-09-01

    We generated transgenic mice lines with a construct consisting of the zif268/egr1 promoter and the gene for the normal long-life yellow fluorescent protein (Venus) with a membrane localization sequence. One of the lines exhibited topographic labeling in the medial habenular nucleus (MHb) during postnatal development, which confirmed the previous findings that the medial, lateral, and dorsal areas of MHb project to the ventral, dorsal, and lateral parts of the interpeduncular nucleus, respectively. In addition, the membranous localization of the labeling allowed us to observe spacial arrangement of the labeled axons in the fasciculus retroflexus (FR) in the transgenic mice. Here, we report topographic sorting of the MHb axons in the FR. At postnatal day (P) 5 and P10, the labeled axons from the medial MHb were fasciculated and ran through the narrow path in the core of the FR. At P24, the labeled axons from the medial and dorsal MHb were fasciculated and ran through the broad path in the FR core. No labeling occurred in the lateral MHb throughout development; correspondingly, parts of the FR core remained unlabeled. The results indicated that the axons from the medial and dorsal areas of the MHb are grouped together in the FR of this transgenic line and are sorted out from the axons from the lateral MHb.

  4. Tracing Superior Longitudinal Fasciculus Connectivity in the Human Brain using High Resolution Diffusion Tensor Tractography

    PubMed Central

    Kamali, Arash; Flanders, Adam E.; Brody, Joshua; Hunter, Jill V.; Hasan, Khader M.

    2013-01-01

    The major language pathways such as superior longitudinal fasciculus (SLF) pathways have been outlined by experimental and diffusion tensor imaging (DTI) studies. The SLF I and some of the superior parietal lobule connections of the SLF pathways have not been depicted by prior DTI studies due to the lack of imaging sensitivity and adequate spatial resolution. In the current study, the trajectory of the SLF fibers has been delineated on five healthy human subjects using diffusion tensor tractography on a 3.0T scanner at high spatial resolution. We also demonstrate for the first time the trajectory and connectivity of the SLF fibers in relation to other language pathways as well as the superior parietal lobule connections of the language circuit using high spatial resolution diffusion tensor imaging in the healthy adult human brain. PMID:23288254

  5. Learning Morse Code Alters Microstructural Properties in the Inferior Longitudinal Fasciculus: A DTI Study.

    PubMed

    Schlaffke, Lara; Leemans, Alexander; Schweizer, Lauren M; Ocklenburg, Sebastian; Schmidt-Wilcke, Tobias

    2017-01-01

    Learning relies on neuroplasticity, which has mainly been studied in gray matter (GM). However, there is mounting evidence indicating a critical role of white matter changes involved in learning processes. One of the most important learning processes in human development is language acquisition. However, due to the length of this learning process, it has been notoriously difficult to investigate the underlying neuroplastic changes. Here, we report a novel learning paradigm to assess the role of white matter plasticity for language acquisition. By acoustically presenting Morse Code (MC) using an in house developed audio book as a model for language-type learning, we generated a well-controlled learning environment that allows for the detection of subtle white matter changes related to language type learning in a much shorter time frame than usual language acquisition. In total 12 letters of the MC alphabet were learned within six learning session, which allowed study participants to perform a word recognition MC decoding task. In this study, we found that learning MC was associated with significant microstructural changes in the left inferior longitudinal fasciculus (ILF). The fractional anisotropy (FA) of this associative fiber bundle connecting the occipital and posterior temporal cortex with the temporal pole as well as the hippocampus and amygdala was increased. Furthermore, white matter plasticity was associated with task performance of MC decoding, indicating that the structural changes were related to learning efficiency. In conclusion, our findings demonstrate an important role of white matter neuroplasticity for acquiring a new language skill.

  6. Molecular mechanisms in the formation of the medial longitudinal fascicle

    PubMed Central

    Ahsan, Mansoor; Riley, Kerry-lyn; Schubert, Frank R

    2007-01-01

    The first neurons in the vertebrate brain form a stereotypical array of longitudinal and transversal axon tracts, the early axon scaffold. This scaffold is thought to lay down the basic structure for the later, more complex neuronal pathways in the brain. The ventral longitudinal tract is pioneered by neurons located at the ventral midbrain–forebrain boundary, which form the medial longitudinal fascicle. Recent studies have shed some light on the molecular mechanisms that control the development of the medial longitudinal fascicle. Here, we show that patterning molecules, notably the ventralizing signalling molecule Shh, are involved in the formation of medial longitudinal fascicle neurons and in medial longitudinal fascicle axon guidance. Downstream of Shh, several homeobox genes are expressed in the tegmentum. We describe the expression patterns of Sax1, Emx2, Six3, Nkx2.2 and Pax6 in the mesencephalon and pretectum in detail. Furthermore, we review the evidence of their molecular interactions, and their involvement in neuronal fate specification. In particular, Sax1 plays a major role in fate determination of medial longitudinal fascicle neurons. Finally, we discuss the available data on axon guidance mechanisms for the medial longitudinal fascicle, which suggest that different guidance molecules such as class 3 Semaphorins, Slits and Netrins act to determine the caudal and ventral course of the medial longitudinal fascicle axons. PMID:17623036

  7. Individual differences in children's global motion sensitivity correlate with TBSS-based measures of the superior longitudinal fasciculus.

    PubMed

    Braddick, Oliver; Atkinson, Janette; Akshoomoff, Natacha; Newman, Erik; Curley, Lauren B; Gonzalez, Marybel Robledo; Brown, Timothy; Dale, Anders; Jernigan, Terry

    2017-12-01

    Reduced global motion sensitivity, relative to global static form sensitivity, has been found in children with many neurodevelopmental disorders, leading to the "dorsal stream vulnerability" hypothesis (Braddick et al., 2003). Individual differences in typically developing children's global motion thresholds have been shown to be associated with variations in specific parietal cortical areas (Braddick et al., 2016). Here, in 125 children aged 5-12years, we relate individual differences in global motion and form coherence thresholds to fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF), a major fibre tract communicating between parietal lobe and anterior cortical areas. We find a positive correlation between FA of the right SLF and individual children's sensitivity to global motion coherence, while FA of the left SLF shows a negative correlation. Further analysis of parietal cortical area data shows that this is also asymmetrical, showing a stronger association with global motion sensitivity in the left hemisphere. None of these associations hold for an analogous measure of global form sensitivity. We conclude that a complex pattern of structural asymmetry, including the parietal lobe and the superior longitudinal fasciculus, is specifically linked to the development of sensitivity to global visual motion. This pattern suggests that individual differences in motion sensitivity are primarily linked to parietal brain areas interacting with frontal systems in making decisions on integrated motion signals, rather than in the extra-striate visual areas that perform the initial integration. The basis of motion processing deficits in neurodevelopmental disorders may depend on these same structures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.

    PubMed

    Bandholm, Thomas; Boysen, Lisbeth; Haugaard, Stine; Zebis, Mette Kreutzfeldt; Bencke, Jesper

    2008-01-01

    The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal-arch deformation during quiet standing and gait. Thirty subjects aged 20 to 32 years were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography. Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis. Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean +/- 1 SD, 7.7 +/- 3.1 mm) and medial longitudinal-arch deformation (5.9 +/- 3.2 degrees) during quiet standing compared with controls (5.0 +/- 2.2 mm and 3.5 +/- 2.6 degrees, P < .05). Subjects with medial tibial stress syndrome also demonstrated significantly larger medial longitudinal-arch deformation (8.8 +/- 1.8 degrees) during gait compared with controls (7.1 +/- 1.7 degrees, P = .015). There was no correlation between medial longitudinal-arch deformation during quiet standing and gait in either of the 2 groups (r < 0.127, P > .653). The subjects with medial tibial stress syndrome in this study demonstrated increased navicular drop and medial longitudinal-arch deformation during quiet standing and increased medial longitudinal-arch deformation during gait compared to healthy subjects. Medial longitudinal-arch deformation during quiet standing did not correlate with medial longitudinal-arch deformation during gait in either of the 2 groups. ACFAS Level of Clinical Evidence: 5.

  9. Language, aging, and cognition: frontal aslant tract and superior longitudinal fasciculus contribute toward working memory performance in older adults.

    PubMed

    Rizio, Avery A; Diaz, Michele T

    2016-06-15

    Previous research has documented change in white matter tract integrity with increasing age. Both interhemispheric and intrahemispheric tracts that underlie language processing are susceptible to these age-related changes. The aim of the current study was to explore age and white matter integrity in language-related tracts as predictors of cognitive task performance in younger and older adults. To this end, we carried out principal component analyses of white matter tracts and confirmatory factor analysis of neuropsychological measures. We next carried out a series of regression analyses that used white matter components to predict scores on each of the neuropsychological components. For both younger and older adults, age was a significant predictor of processing speed and working memory. However, white matter integrity did not contribute independently toward these models. In older adults only, both age and a white matter component that included the bilateral frontal aslant tract and left superior longitudinal fasciculus were significant predictors of working memory. Taken together, these results extend our understanding of the contributions of language-related white matter structure to cognitive processing and highlight the effects of age-related differences in both frontal and dorsal tracts.

  10. Short-Term Internet-Search Training Is Associated with Increased Fractional Anisotropy in the Superior Longitudinal Fasciculus in the Parietal Lobe

    PubMed Central

    Dong, Guangheng; Li, Hui; Potenza, Marc N.

    2017-01-01

    The Internet search engine has become an indispensable tool for many people, yet the ways in which Internet searching may alter brain structure and function is poorly understood. In this study, we investigated the influence of short-term Internet-search “training” on white matter microstructure using diffusion tensor imaging (DTI). Fifty-nine valid subjects (Experimental group, 43; Control group, 16) completed the whole procedure: pre- DTI scan, 6-day's training and post- DTI scan. Using track-based spatial statistics, we found increased fractional anisotropy in the right superior longitudinal fasciculus at post-test as compared to pre-test in experimental group. Within the identified region of the right superior longitudinal fasciculus, decreased radial diffusivity (RD), and unchanged axial diffusivity (AD) were observed. These results suggest that short-term Internet-search training may increase white-matter integrity in the right superior longitudinal fasciculus. A possible mechanism for the observed FA change may involve increased myelination after training, although this possibility warrants additional investigation. PMID:28706473

  11. Self-face recognition shares brain regions active during proprioceptive illusion in the right inferior fronto-parietal superior longitudinal fasciculus III network.

    PubMed

    Morita, Tomoyo; Saito, Daisuke N; Ban, Midori; Shimada, Koji; Okamoto, Yuko; Kosaka, Hirotaka; Okazawa, Hidehiko; Asada, Minoru; Naito, Eiichi

    2017-04-21

    Proprioception is somatic sensation that allows us to sense and recognize position, posture, and their changes in our body parts. It pertains directly to oneself and may contribute to bodily awareness. Likewise, one's face is a symbol of oneself, so that visual self-face recognition directly contributes to the awareness of self as distinct from others. Recently, we showed that right-hemispheric dominant activity in the inferior fronto-parietal cortices, which are connected by the inferior branch of the superior longitudinal fasciculus (SLF III), is associated with proprioceptive illusion (awareness), in concert with sensorimotor activity. Herein, we tested the hypothesis that visual self-face recognition shares brain regions active during proprioceptive illusion in the right inferior fronto-parietal SLF III network. We scanned brain activity using functional magnetic resonance imaging while twenty-two right-handed healthy adults performed two tasks. One was a proprioceptive illusion task, where blindfolded participants experienced a proprioceptive illusion of right hand movement. The other was a visual self-face recognition task, where the participants judged whether an observed face was their own. We examined whether the self-face recognition and the proprioceptive illusion commonly activated the inferior fronto-parietal cortices connected by the SLF III in a right-hemispheric dominant manner. Despite the difference in sensory modality and in the body parts involved in the two tasks, both tasks activated the right inferior fronto-parietal cortices, which are likely connected by the SLF III, in a right-side dominant manner. Here we discuss possible roles for right inferior fronto-parietal activity in bodily awareness and self-awareness. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. Importance of human right inferior frontoparietal network connected by inferior branch of superior longitudinal fasciculus tract in corporeal awareness of kinesthetic illusory movement.

    PubMed

    Amemiya, Kaoru; Naito, Eiichi

    2016-05-01

    It is generally believed that the human right cerebral hemisphere plays a dominant role in corporeal awareness, which is highly associated with conscious experience of the physical self. Prompted by our previous findings, we examined whether the right frontoparietal activations often observed when people experience kinesthetic illusory limb movement are supported by a large-scale brain network connected by a specific branch of the superior longitudinal fasciculus fiber tracts (SLF I, II, and III). We scanned brain activity with functional magnetic resonance imaging (MRI) while nineteen blindfolded healthy volunteers experienced illusory movement of the right stationary hand elicited by tendon vibration, which was replicated after the scanning. We also scanned brain activity when they executed and imagined right hand movement, and identified the active brain regions during illusion, execution, and imagery in relation to the SLF fiber tracts. We found that illusion predominantly activated the right inferior frontoparietal regions connected by SLF III, which were not substantially recruited during execution and imagery. Among these regions, activities in the right inferior parietal cortices and inferior frontal cortices showed right-side dominance and correlated well with the amount of illusion (kinesthetic illusory awareness) experienced by the participants. The results illustrated the predominant involvement of the right inferior frontoparietal network connected by SLF III when people recognize postural changes of their limb. We assume that the network bears a series of functions, specifically, monitoring the current status of the musculoskeletal system, and building-up and updating our postural model (body schema), which could be a basis for the conscious experience of the physical self. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Diffusion Tensor Fractional Anisotropy in the Superior Longitudinal Fasciculus Correlates with Functional Independence Measure Cognition Scores in Patients with Cerebral Infarction.

    PubMed

    Koyama, Tetsuo; Domen, Kazuhisa

    2017-08-01

    This study aimed to determine the relationship between fiber tract degeneration measured by diffusion-tensor imaging (DTI) and outcome of patients after cerebral infarction. Fractional anisotropy (FA) maps were generated by DTI in patients 14-21 days after the first infarction and were analyzed by tract-based spatial statistics (TBSS). Mean FA values within the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF) were extracted from individual TBSS data. Relationships between FA ratios (rFAs, lesioned to non-lesioned hemisphere) and outcomes assessed by Brunnstrom stage (BRS) and Functional Independence Measure (FIM) motor and cognition scores were examined using Spearman's rank correlation test. Forty patients (21 left and 19 right hemisphere lesions) were entered into an analytical database. BRS ranged from 1 to 6 (median, 5) for shoulder, elbow, or forearm; from 2 to 6 (median, 4.5) for hand or finger; and from 3 to 6 (median, 5) for lower extremity. FIM motor ranged from 51 to 91 (median, 79.5), and FIM cognition ranged from 16 to 35 (median, 29). rFA values in the CST ranged from .692 to 1.053 (median, .933), and those in the SLF ranged from .778 to 1.076 (median, .965). Mann-Whitney U test (P <.05) revealed no significant differences between the left and the right hemisphere lesion groups. Individual rFA values in the CST correlated with BRS scores (r = .585-0.654), whereas those in the SLF correlated with FIM cognition scores (r = .409, P <.05). DTI-FA values in the SLF and CST may be useful for outcome prediction of cognitive function and extremity function, respectively. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Medial Longitudinal Arch Development of Children Aged 7 to 9 Years: Longitudinal Investigation.

    PubMed

    Tong, Jasper W K; Kong, Pui W

    2016-08-01

    It is unclear at what age the medial longitudinal arch (MLA) of the foot becomes stable in children. The influence of footwear on MLA development also is unknown. The purpose of this study was to examine the MLA development of children using a longitudinal approach. The relationship between wearing different types of footwear and MLA development also was explored longitudinally. This was a longitudinal cohort observational study. The MLA of 111 healthy children (mean age=6.9 years, SD=0.3) was evaluated using 3 parameters (arch index [AI], midfoot peak pressure [PP], and maximum force [MF]) extracted from dynamic foot loading measurements at baseline (t0), 10-month follow-up (t1), and 22-month follow-up (t2). Information on footwear usage was surveyed. Linear mixed modeling was used to test for differences in MLA over time. The MLA of the children remained stable over time (AI: t0/t1/t2=0.25 [95% confidence interval (CI)=0.24, 0.26]/0.25 [95% CI=0.24, 0.26]/0.25 [95% CI=0.24, 0.26]; P=.95). When the children's sex was considered, the AI of boys decreased (higher arch) with age (0.26 [95% CI=0.24, 0.27]/0.25 [95% CI=0.24, 0.27]/0.25 [95% CI=0.23, 0.27]; P=.02). Boys also displayed a flatter MLA than girls at age 6.9 years (AI: mean difference=0.02 [95% CI=0.01, 0.04]; P=.02). At baseline, children who wore closed-toe shoes displayed the lowest MLA overall (AI: closed-toe shoes/sandals/slippers=0.26 [95% CI=0.24, 0.28]/0.24 [95% CI=0.23, 0.25]/0.25 [95% CI=0.24, 0.26]; P<.01). Children who used slippers at toddlers' age experienced a higher PP (flatter arch) in later childhood than those who wore sandals (mean difference=31.60 kPa [95% CI=1.44, 61.75]; post hoc P=.04). Information on the type of footwear worn was self-reported and, therefore, may be subjected to recall bias. The MLA of children remained stable from 7 to 9 years of age. The child's sex and the type of footwear worn during childhood may influence MLA development. © 2016 American Physical Therapy

  15. Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

    PubMed Central

    Ribeiro, Ana Paula; Trombini-Souza, Francis; Tessutti, Vitor; Lima, Fernanda Rodrigues; de Camargo Neves Sacco, Isabel; João, Sílvia Maria Amado

    2011-01-01

    OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms. PMID:21808870

  16. Relationship between explosive muscle strength and medial longitudinal arch of the foot.

    PubMed

    Lizis, Paweł; Posadzki, Paul; Smith, Toby

    2010-09-01

    There has been a suggested link between muscle strength and arch type of the foot. However, a distinct cause and effect dependence has yet to be established. The purpose of this study was to compare the outcomes from selected explosive strength tests with different arch heights. The medial longitudinal arch (MLA) was measured using a Clarke's angle method. Five hundred seventy-four subjects (n = 574) participated in this study and were divided into three arch height groups and three muscle strength groups, respectively. To evaluate the association between longitudinal arch of the foot with the explosive power of lower limb muscles, Chi-square (χ²) test was used. Arch heights were not significantly related to explosive muscle strength. Arch measurement was ineffective in accounting for the observed variability in the explosive strength among young adults. This data may be useful in evaluating patients with painful flat feet and any strength deficits they may have.

  17. Medial longitudinal arch biomechanics evaluation during gait in subjects with flexible flatfoot.

    PubMed

    Prachgosin, Tulaya; Chong, Desmond Y R; Leelasamran, Wipawan; Smithmaitrie, Pruittikorn; Chatpun, Surapong

    2015-01-01

    Medial longitudinal arch (MLA) strengthening has been considered an important part of successful flatfoot treatment. But, to date, the biomechanical loading behavior of the medial arch in flatfoot has not been evaluated. This study aimed to evaluate the MLA moment, MLA deformation angle, foot kinematics and ground reaction forces (GRF) in both normal foot and flatfoot groups. Each participant's foot was classified according to arch type using foot prints and radiographs. Twenty-eight non-obese adults (13 flatfeet and 15 normal feet) were involved. The biomechanics data were collected in a 3D motion analysis laboratory. The MLA biomechanics were calculated. Hindfoot and forefoot kinematics were also analyzed. The flatfoot group had a significantly greater peak eversion MLA moment (p = 0.005) and a smaller peak MLA deformation angle (p < 0.05) during specific subphases. The peak of hindfoot plantarflexion (p < 0.05) and internal rotation (p < 0.05) and the peak of forefoot abduction ( p < 0.05) in the specific subphases were greater in the flatfoot group. The flatfoot group also had significantly smaller peak vertical GRF ( p < 0.05) during late stance and larger peak medial GRF (p < 0.05) during mid stance. This study found a significantly greater eversion deforming force acting at the MLA structure, greater hindfoot and forefoot motion, less MLA flexibility and abnormal GRF in a flatfoot group during walking, which reflected the deficit of foot function in a flatfoot group.

  18. Structural deformation of longitudinal arches during running in soccer players with medial tibial stress syndrome.

    PubMed

    Noh, Byungjoo; Masunari, Akihiko; Akiyama, Kei; Fukano, Mako; Fukubayashi, Toru; Miyakawa, Shumpei

    2015-01-01

    The purpose of this study was to compare angular change and translational motion from the medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) during running between medial tibial stress syndrome (MTSS) and non-MTSS subjects. A total of 10 subjects volunteered, comprising 5 subjects with MTSS and 5 subjects without injury (non-MTSS) as the control group. All subjects performed the test movement that simulated running. Fluoroscopic imaging was used to investigate bone movement during landing in running. Sagittal motion was defined as the angular change and translational motion of the arch. A Mann-Whitney U-test was performed to determine the differences in the measured values between the MTSS and non-MTSS groups. The magnitude of angular change for the MLA and LLA was significantly greater for subjects with MTSS than for control subjects. Translational motion of the MLA and LLA of the MTSS group was also significantly greater than that of the non-MTSS group (all p < 0.05). Soccer players with MTSS have an abnormal structural deformation of foot during support (or stance) phase of running, with a large decrease in both the MLA and LLA. This abnormal motion could be a risk factor for the development of MTSS in these subjects.

  19. Subject-specific longitudinal shape analysis by coupling spatiotemporal shape modeling with medial analysis

    NASA Astrophysics Data System (ADS)

    Hong, Sungmin; Fishbaugh, James; Rezanejad, Morteza; Siddiqi, Kaleem; Johnson, Hans; Paulsen, Jane; Kim, Eun Young; Gerig, Guido

    2017-02-01

    Modeling subject-specific shape change is one of the most important challenges in longitudinal shape analysis of disease progression. Whereas anatomical change over time can be a function of normal aging, anatomy can also be impacted by disease related degeneration. Anatomical shape change may also be affected by structural changes from neighboring shapes, which may cause non-linear variations in pose. In this paper, we propose a framework to analyze disease related shape changes by coupling extrinsic modeling of the ambient anatomical space via spatiotemporal deformations with intrinsic shape properties from medial surface analysis. We compare intrinsic shape properties of a subject-specific shape trajectory to a normative 4D shape atlas representing normal aging to isolate shape changes related to disease. The spatiotemporal shape modeling establishes inter/intra subject anatomical correspondence, which in turn enables comparisons between subjects and the 4D shape atlas, and also quantitative analysis of disease related shape change. The medial surface analysis captures intrinsic shape properties related to local patterns of deformation. The proposed framework jointly models extrinsic longitudinal shape changes in the ambient anatomical space, as well as intrinsic shape properties to give localized measurements of degeneration. Six high risk subjects and six controls are randomly sampled from a Huntington's disease image database for qualitative and quantitative comparison.

  20. Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears.

    PubMed

    Uzun, Erdal; Misir, Abdulhamit; Kizkapan, Turan Bilge; Ozcamdalli, Mustafa; Akkurt, Soner; Guney, Ahmet

    2017-06-01

    Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs. To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears. Case series; Level of evidence, 4. A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated. The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both P s <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008). Peripheral

  1. Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

    PubMed Central

    Uzun, Erdal; Misir, Abdulhamit; Kizkapan, Turan Bilge; Ozcamdalli, Mustafa; Akkurt, Soner; Guney, Ahmet

    2017-01-01

    Background: Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs. Purpose: To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated. Results: The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for

  2. Beyond the arcuate fasciculus: consensus and controversy in the connectional anatomy of language.

    PubMed

    Dick, Anthony Steven; Tremblay, Pascale

    2012-12-01

    The growing consensus that language is distributed into large-scale cortical and subcortical networks has brought with it an increasing focus on the connectional anatomy of language, or how particular fibre pathways connect regions within the language network. Understanding connectivity of the language network could provide critical insights into function, but recent investigations using a variety of methodologies in both humans and non-human primates have provided conflicting accounts of pathways central to language. Some of the pathways classically considered language pathways, such as the arcuate fasciculus, are now argued to be domain-general rather than specialized, which represents a radical shift in perspective. Other pathways described in the non-human primate remain to be verified in humans. In this review, we examine the consensus and controversy in the study of fibre pathway connectivity for language. We focus on seven fibre pathways-the superior longitudinal fasciculus and arcuate fasciculus, the uncinate fasciculus, extreme capsule, middle longitudinal fasciculus, inferior longitudinal fasciculus and inferior fronto-occipital fasciculus-that have been proposed to support language in the human. We examine the methods in humans and non-human primate used to investigate the connectivity of these pathways, the historical context leading to the most current understanding of their anatomy, and the functional and clinical correlates of each pathway with reference to language. We conclude with a challenge for researchers and clinicians to establish a coherent framework within which fibre pathway connectivity can be systematically incorporated to the study of language.

  3. Medial Longitudinal Arch Angle Presents Significant Differences Between Foot Types: A Biplane Fluoroscopy Study.

    PubMed

    Balsdon, Megan E R; Bushey, Kristen M; Dombroski, Colin E; LeBel, Marie-Eve; Jenkyn, Thomas R

    2016-10-01

    The structure of the medial longitudinal arch (MLA) affects the foot's overall function and its ability to dissipate plantar pressure forces. Previous research on the MLA includes measuring the calcaneal-first metatarsal angle using a static sagittal plane radiograph, a dynamic height-to-length ratio using marker clusters with a multisegment foot model, and a contained angle using single point markers with a multisegment foot model. The objective of this study was to use biplane fluoroscopy to measure a contained MLA angle between foot types: pes planus (low arch), pes cavus (high arch), and normal arch. Fifteen participants completed the study, five from each foot type. Markerless fluoroscopic radiostereometric analysis (fRSA) was used with a three-dimensional model of the foot bones and manually matching those bones to a pair of two-dimensional radiographic images during midstance of gait. Statistically significant differences were found between barefoot arch angles of the normal and pes cavus foot types (p = 0.036), as well as between the pes cavus and pes planus foot types (p = 0.004). Dynamic walking also resulted in a statistically significant finding compared to the static standing trials (p = 0.014). These results support the classification of individuals following a physical assessment by a foot specialist for those with pes cavus and planus foot types. The differences between static and dynamic kinematic measurements were also supported using this novel method.

  4. Assessment of the Medial Longitudinal Arch in children with Flexible Pes Planus by Plantar Pressure Mapping.

    PubMed

    Elmoatasem, E M; Eid, M A

    2016-12-01

    Plantar Pressure mapping was introduced as a new modality for assessment of the height of the medial longitudinal arch of the foot. Therefore, the aim of this study is to correlate the plantar pressure mapping readings of arch index contact force ratio (AICFR) in children with flexible pes planus with radiographic measurements and static plantar footprints in order to determine the reliability of pressure mapping as a modality for the assessment and follow up of the flat foot deformity. Radiographic measurements, foot prints, and pressure mapping scans were recorded for each foot at initial presentation and at latest follow up in 28 children (56 feet) with flexible pes planus. A positive correlation of pressure mapping results was found with the talo-first metatarsal angle, the calcaneal pitch angle, as well as the footprint scans (P < 0.001). This study demonstrated that plantar pressure mapping is a reliable and effective tool in screening, diagnosis, and follow up of children with flexible pes planus.

  5. Does the weakening of intrinsic foot muscles cause the decrease of medial longitudinal arch height?

    PubMed Central

    Okamura, Kazunori; Kanai, Shusaku; Oki, Sadaaki; Tanaka, Satoshi; Hirata, Naohisa; Sakamura, Yoshiaki; Idemoto, Norikatsu; Wada, Hiroki; Otsuka, Akira

    2017-01-01

    [Purpose] There are no reliable evidences that the weakening of intrinsic foot muscles causes the decrease of the medial longitudinal arch (MLA) height. The purpose of this study was to confirm whether the fatigue of intrinsic foot muscles decrease the MLA height during standing and gait using 3D motion analysis system. [Subjects and Methods] Twenty healthy male subjects participated in this study. Foot kinematics was measured using an Oxford Foot Model before and after fatigue-inducing exercises of the abductor hallucis and flexor hallucis brevis muscles. [Results] Following fatigue-inducing exercise, in both standing and gait, the MLA height did not decrease but slightly increased. In addition, the reduction of a rear foot eversion angle was noted. [Conclusion] Fatigue of the abductor hallucis and flexor hallucis brevis muscles did not cause a change associated with collapsing of the MLA during both standing and gait. This suggested that the MLA support force from these muscles would be compensated by other MLA support structures, such as extrinsic foot muscles. PMID:28626309

  6. Does the weakening of intrinsic foot muscles cause the decrease of medial longitudinal arch height?

    PubMed

    Okamura, Kazunori; Kanai, Shusaku; Oki, Sadaaki; Tanaka, Satoshi; Hirata, Naohisa; Sakamura, Yoshiaki; Idemoto, Norikatsu; Wada, Hiroki; Otsuka, Akira

    2017-06-01

    [Purpose] There are no reliable evidences that the weakening of intrinsic foot muscles causes the decrease of the medial longitudinal arch (MLA) height. The purpose of this study was to confirm whether the fatigue of intrinsic foot muscles decrease the MLA height during standing and gait using 3D motion analysis system. [Subjects and Methods] Twenty healthy male subjects participated in this study. Foot kinematics was measured using an Oxford Foot Model before and after fatigue-inducing exercises of the abductor hallucis and flexor hallucis brevis muscles. [Results] Following fatigue-inducing exercise, in both standing and gait, the MLA height did not decrease but slightly increased. In addition, the reduction of a rear foot eversion angle was noted. [Conclusion] Fatigue of the abductor hallucis and flexor hallucis brevis muscles did not cause a change associated with collapsing of the MLA during both standing and gait. This suggested that the MLA support force from these muscles would be compensated by other MLA support structures, such as extrinsic foot muscles.

  7. Longitudinal Effects of Ketamine on Dendritic Architecture In Vivo in the Mouse Medial Frontal Cortex123

    PubMed Central

    Phoumthipphavong, Victoria; Barthas, Florent; Hassett, Samantha

    2016-01-01

    Abstract A single subanesthetic dose of ketamine, an NMDA receptor antagonist, leads to fast-acting antidepressant effects. In rodent models, systemic ketamine is associated with higher dendritic spine density in the prefrontal cortex, reflecting structural remodeling that may underlie the behavioral changes. However, turnover of dendritic spines is a dynamic process in vivo, and the longitudinal effects of ketamine on structural plasticity remain unclear. The purpose of the current study is to use subcellular resolution optical imaging to determine the time course of dendritic alterations in vivo following systemic ketamine administration in mice. We used two-photon microscopy to visualize repeatedly the same set of dendritic branches in the mouse medial frontal cortex (MFC) before and after a single injection of ketamine or saline. Compared to controls, ketamine-injected mice had higher dendritic spine density in MFC for up to 2 weeks. This prolonged increase in spine density was driven by an elevated spine formation rate, and not by changes in the spine elimination rate. A fraction of the new spines following ketamine injection was persistent, which is indicative of functional synapses. In a few cases, we also observed retraction of distal apical tuft branches on the day immediately after ketamine administration. These results indicate that following systemic ketamine administration, certain dendritic inputs in MFC are removed immediately, while others are added gradually. These dynamic structural modifications are consistent with a model of ketamine action in which the net effect is a rebalancing of synaptic inputs received by frontal cortical neurons. PMID:27066532

  8. Effects of ballet training of children in Turkey on foot anthropometric measurements and medial longitudinal arc development.

    PubMed

    Ozdinc, Sevgi Anar; Turan, Fatma Nesrin

    2016-07-01

    To investigate the effects of ballet training on foot structure and the formation of the medial longitudinal arc in childhood, and the association of body mass index with structural change secondary to ballet training. This study was conducted at Öykü Ballet and Dance School and Trakya University, Edirne, Turkey, from September 2007 to November 2008, and comprised girl students who were taking ballet classes, and a group of those who were not taking such who acted as the controls. Static footprints of both feet of all participants were taken with an ink paedogram. Parameters evaluated from footprints included foot length, metatarsal width, heel width and medial longitudinal arch. The relationship between the parameters, the ballet starting age, training duration and body mass index was investigated. Of the 67 participants, there were 36(53.7%) in the experimental group and 31(48.3%) in the control group. The difference between age, height, weight and body mass index between the two groups was insignificant (p>0.05). The average ballet starting age was 6.47±1.55 years and duration was 4.36±2.002 years. Positive correlations were found between body mass index and foot length, metatarsal width, heel width, medial longitudinal arch contact width and halluxvalgus angle; between ballet starting age and metatarsal width, heel width; between duration of training and foot length, metatarsal width and hallux valgus angle (p?0.05 each). Evidence supporting the education in children on foot anthropometric measurements and medial longitudinal arc development could not be found.

  9. Windlass Mechanism in Individuals With Diabetes Mellitus, Peripheral Neuropathy, and Low Medial Longitudinal Arch Height.

    PubMed

    Gelber, Judith R; Sinacore, David R; Strube, Michael J; Mueller, Michael J; Johnson, Jeffrey E; Prior, Fred W; Hastings, Mary K

    2014-08-01

    The windlass mechanism, acting through the plantar fascia, stabilizes the arches of the foot during stance phase of gait. The purpose of this study was to compare changes in radiographic measurements of the medial longitudinal arch (MLA) between toe-flat and -extended positions in participants with and without diabetes mellitus (DM), peripheral neuropathy (PN), and a low MLA. Twelve participants with DMPN and low MLA and 12 controls received weightbearing radiographs in a toe-flat and toe-extended position. DMPN participants were subcategorized from radiographs into DMPN severe, evidence of severe joint changes, and DMPN low, absence of joint changes. Primary measurements of MLA were determined in each position and included Meary's angle, talar declination angle, first metatarsal declination angle, and navicular height. The DMPN severe group had no difference between toe-flat and -extended positions for Meary's, talar declination, and first metatarsal declination angles (P > .35) while navicular height elevated (P < .05). The DMPN low group had no difference between toe-flat and -extended positions for talar declination angle (P = .38), while Meary's angle, first metatarsal declination angle, and navicular height elevated (P < .05). All measurements in the control group changed, consistent with arch height elevation, when toes were extended (P < .05). The DMPN severe and low groups showed impaired ability to raise the arch from the toe-flat to -extended position. Further research is needed to examine the contribution of specific windlass mechanism components (ie, plantar fascia, ligament, foot joint integrity, and mobility) as they relate to progressive foot deformity in adults with DMPN. Level III, comparative series. © The Author(s) 2014.

  10. Selected static foot assessments do not predict medial longitudinal arch motion during running.

    PubMed

    Langley, Ben; Cramp, Mary; Morrison, Stewart C

    2015-01-01

    Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected static foot assessment could predict medial longitudinal arch (MLA) motion during running. Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04 m, 80 ± 10 kg) participated in the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed standing position. MLA motion was calculated using the position of retro-reflective markers tracked by a VICON motion analysis system, while participants ran barefoot on a treadmill at a self-selected pace (2.8 ± 0.5 m.s(-1)). Bivariate linear regression was used to determine whether the static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe off. All three foot classification measures were significant predictors of MLA angle at initial contact, midsupport and toe off (p < .05) explaining 41-90 % of the variance. None of the static foot classification measures were significant predictors of MLA deformation during the stance phase of running. Selected static foot measures did not predict dynamic MLA deformation during running. Given that MLA deformation has theoretically been linked to running injuries, the clinical relevance of predicting MLA angle at discrete time points during the stance phase of running is questioned. These findings also question the validity of the selected static foot classification measures when looking to characterise the foot during running. This indicates that alternative means of assessing the foot to inform footwear selection are required.

  11. Beyond the Arcuate Fasciculus: Damage to Ventral and Dorsal Language Pathways in Aphasia.

    PubMed

    Yang, Mi; Li, Yibo; Li, Jiao; Yao, Dezhong; Liao, Wei; Chen, Huafu

    2017-03-01

    Previous regional-based diffusion tensor imaging (DTI) studies focused on impairment of the arcuate fasciculus in aphasia; little is known about the extent to which aphasia severity is affected by damage to both ventral and dorsal language white matter (WM) pathways. To understand whether disconnection of these pathways contributes to clinical symptoms, we assessed the relationship between the alterations of WM integrity and clinical characteristics in acute aphasia after stroke. Eighteen patients with acute aphasia and age-, gender-, and education-matched healthy controls underwent language assessment and DTI scanning. The whole brain unbiased tract-based spatial statistics method was employed to quantitate WM integrity (fractional anisotropy) for both groups. Linear correlation analyses were performed to evaluate the relationship between WM integrity and clinical features. The aphasic patients showed decreased WM integrity in the left inferior fronto-occipital fasciculus/inferior longitudinal fasciculus (IFOF/ILF) and the left uncinate fasciculus, which represents components of ventral language pathway, and the left superior longitudinal fasciculus (SLF), which relates to dorsal language pathway. In addition, WM integrity of the left IFOF and SLF showed a positive correlation with aphasia quotient, performance quotient, and cortical quotient, respectively. These findings suggested that impaired WM integrity in both language pathways not only contributed to language performance, but also to general cognitive status. We suggest that aphasia involves a breakdown of multiple connections of dorsal and ventral streams that directly contributes to language deficits. Damage to these dual-streams may serve as a neuromarker for aphasias after stroke.

  12. Quantitative Mapping of Human Brain Vertical-Occipital Fasciculus.

    PubMed

    Keser, Zafer; Ucisik-Keser, Fehime Eymen; Hasan, Khader M

    2016-01-01

    The vertical-occipital fasciculus (VOF), historically named as "the fasciculus occipitalis verticalis of Wernicke," has been recently brought to the attention of the neuroscience community. In this study, we delineated and quantified this tract with deterministic diffusion tensor imaging protocol. Five (all males aged 24-37 years) and 10 (7 males and 3 females aged 20-51 years) right-handed healthy subjects were studied with 1 and 2 mm DT-MRI data sets, respectively. The DTI attributes of this pathway along with its cortical representation (Brodmann areas) were presented in standard Montréal Neurological Institute space. Nearby pathways such as inferior fronto-occipital (IFOF) and inferior longitudinal fasciculi (ILF) were used as reference pathways. The total volume of VOF has been found to be approximately .8-1% of whole brain in both data sets. The fractional anisotropy and axial diffusivity of this tract have been found to be relatively 10-15% lower than adjacent pathways such as IFOF and ILF in both data sets. Although IFOF and ILF showed somewhat leftward asymmetry in diffusivity, no right-left asymmetry has been observed in VOF. We believe that our work will pave the way for future imaging studies investigating VOF in different conditions such as stroke, traumatic brain injury, and multiple sclerosis. Copyright © 2015 by the American Society of Neuroimaging.

  13. Increased medial longitudinal arch mobility, lower extremity kinematics, and ground reaction forces in high-arched runners.

    PubMed

    Williams, D S Blaise; Tierney, Robin N; Butler, Robert J

    2014-01-01

    Runners with high medial longitudinal arch structure demonstrate unique kinematics and kinetics that may lead to running injuries. The mobility of the midfoot as measured by the change in arch height is also suspected to play a role in lower extremity function during running. The effect of arch mobility in high-arched runners is an important factor in prescribing footwear, training, and rehabilitating the running athlete after injury. To examine the effect of medial longitudinal arch mobility on running kinematics, ground reaction forces, and loading rates in high-arched runners. Cross-sectional study. Human movement research laboratory. A total of 104 runners were screened for arch height. Runners were then identified as having high arches if the arch height index was greater than 0.5 SD above the mean. Of the runners with high arches, 11 rigid runners with the lowest arch mobility (R) were compared with 8 mobile runners with the highest arch mobility (M). Arch mobility was determined by calculating the left arch height index in all runners. Three-dimensional motion analysis of running over ground. Rearfoot and tibial angular excursions, eversion-to-tibial internal-rotation ratio, vertical ground reaction forces, and the associated loading rates. Runners with mobile arches exhibited decreased tibial internal-rotation excursion (mobile: 5.6° ± 2.3° versus rigid: 8.0° ± 3.0°), greater eversion-to-tibial internal-rotation ratio (mobile: 2.1 ± 0.8 versus rigid: 1.5 ± 0.5), decreased second peak vertical ground reaction force values (mobile: 2.3 ± 0.2 × body weight versus rigid: 2.4 ± 0.1 × body weight), and decreased vertical loading rate values (mobile: 55.7 ± 14.1 × body weight/s versus rigid: 65.9 ± 11.4 × body weight/s). Based on the results of this study, it appears that runners with high arch structure but differing arch mobility exhibited differences in select lower extremity movement patterns and forces. Future authors should investigate the

  14. Increased Medial Longitudinal Arch Mobility, Lower Extremity Kinematics, and Ground Reaction Forces in High-Arched Runners

    PubMed Central

    Williams, D. S. Blaise; Tierney, Robin N.; Butler, Robert J.

    2014-01-01

    Context: Runners with high medial longitudinal arch structure demonstrate unique kinematics and kinetics that may lead to running injuries. The mobility of the midfoot as measured by the change in arch height is also suspected to play a role in lower extremity function during running. The effect of arch mobility in high-arched runners is an important factor in prescribing footwear, training, and rehabilitating the running athlete after injury. Objective: To examine the effect of medial longitudinal arch mobility on running kinematics, ground reaction forces, and loading rates in high-arched runners. Design: Cross-sectional study. Setting: Human movement research laboratory. Patients or Other Participants: A total of 104 runners were screened for arch height. Runners were then identified as having high arches if the arch height index was greater than 0.5 SD above the mean. Of the runners with high arches, 11 rigid runners with the lowest arch mobility (R) were compared with 8 mobile runners with the highest arch mobility (M). Arch mobility was determined by calculating the left arch height index in all runners. Intervention(s): Three-dimensional motion analysis of running over ground. Main Outcome Measure(s): Rearfoot and tibial angular excursions, eversion-to-tibial internal-rotation ratio, vertical ground reaction forces, and the associated loading rates. Results: Runners with mobile arches exhibited decreased tibial internal-rotation excursion (mobile: 5.6° ± 2.3° versus rigid: 8.0° ± 3.0°), greater eversion-to-tibial internal-rotation ratio (mobile: 2.1 ± 0.8 versus rigid: 1.5 ± 0.5), decreased second peak vertical ground reaction force values (mobile: 2.3 ± 0.2 × body weight versus rigid: 2.4 ± 0.1 × body weight), and decreased vertical loading rate values (mobile: 55.7 ± 14.1 × body weight/s versus rigid: 65.9 ± 11.4 × body weight/s). Conclusions: Based on the results of this study, it appears that runners with high arch structure but differing

  15. Reading impairment in a patient with missing arcuate fasciculus

    PubMed Central

    Rauschecker, Andreas M.; Deutsch, Gayle K.; Ben-Shachar, Michal; Schwartzman, Armin; Perry, Lee M.; Dougherty, Robert F.

    2009-01-01

    We describe the case of a child (“S”) who was treated with radiation therapy at age 5 for a recurrent malignant brain tumor. Radiation successfully abolished the tumor but caused radiation-induced tissue necrosis, primarily affecting cerebral white matter. S was introduced to us at age 15 because of her profound dyslexia. We assessed cognitive abilities and performed diffusion tensor imaging (DTI) to measure cerebral white matter pathways. Diffuse white matter differences were evident in T1-weighted, T2-weighted, diffusion anisotropy, and mean diffusivity measures in S compared to a group of 28 normal female controls. In addition, we found specific white matter pathway deficits by comparing tensor orientation directions in S’s brain with those of the control brains. While her principal diffusion direction maps appeared consistent with those of controls over most of the brain, there were tensor orientation abnormalities in the fiber tracts that form the superior longitudinal fasciculus (SLF) in both hemispheres. Tractography analysis indicated that the left and right arcuate fasciculus (AF), as well as other tracts within the SLF, were missing in S. Other major white matter tracts, such as the corticospinal and inferior occipitofrontal pathways, were intact. Functional MRI measurements indicated left-hemisphere dominanance for language with a normal activation pattern. Despite the left AF abnormality, S had preserved oral language with average sentence repetition skills. In addition to profound dyslexia, S exhibited visuospatial, calculation, and rapid naming deficits and was impaired in both auditory and spatial working memory. We propose that the reading and visuospatial deficits were due to the abnormal left and right SLF pathways, respectively. These results advance our understanding of the functional significance of the SLF and are the first to link radiation necrosis with selective damage to a specific set of fiber tracts. PMID:18775735

  16. The longitudinal relationship between changes in body weight and changes in medial tibial cartilage, and pain among community-based adults with and without meniscal tears.

    PubMed

    Teichtahl, Andrew J; Wluka, Anita E; Wang, Yuanyuan; Strauss, Boyd J; Proietto, Joseph; Dixon, John B; Jones, Graeme; Forbes, Andrew; Kouloyan-Ilic, Susan; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Cicuttini, Flavia M

    2014-09-01

    Meniscal tears are commonly found on MRI and increase the risk for radiographic knee osteoarthritis (OA). While meniscectomy is recommended when knee pain is severe or functionally disabling, it is unclear how to best treat meniscal tears without these symptoms. The aim of this longitudinal study was to examine the effect of weight change on knee cartilage and pain in a cohort of community-based adults with and without meniscal tears detected by MRI. 250 adults with no history of knee OA or knee injury were recruited from the general community and weight-loss clinics. MRI of the knee, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), weight and height were measured at baseline and again at follow-up approximately 2 years later. Medial meniscal tears were present in 36 (18%) of the cohort. In those with medial meniscal tears, after adjustment for confounders, percentage weight change was significantly associated with percentage change in medial tibial cartilage volume (β 0.2% 95% CI 0.08% to 0.3% p=0.002) and knee pain (β 11.6% 95% CI 2.1% to 21.1% p=0.02). That is, for every 1% gain in weight, there was an associated 0.2% increased loss of medial tibial cartilage volume and 11.6% increase in pain. In those with no medial meniscal tear, neither change in medial tibial cartilage volume (β 0.02% 95% CI -0.01% to 0.10% p=0.53) or pain (β 1.9% 95% CI -2.2% to 6.1% p=0.36) were significantly associated with change in weight. This study demonstrated that among adults with medial meniscal tears, weight gain is associated with increased cartilage loss and pain, while weight loss is associated with the converse. This suggests attention to weight is particularly important in the management of people with medial meniscal tears. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch.

    PubMed

    Zuil-Escobar, Juan C; Martínez-Cepa, Carmen B; Martín-Urrialde, Jose A; Gómez-Conesa, Antonia

    2015-06-01

    To evaluate the reliability of the used diagnostic criteria of latent trigger points (LTrPs) and pressure pain thresholds and to evaluate the prevalence of LTrPs in several muscles of the lower limb in subjects with a lower medial longitudinal arch (MLA) compared with controls. Cross-sectional study. University campus. Subjects with a lower limb MLA (n=82) and controls (n=82) (N=164). Not applicable. The navicular drop test was used to classify subjects with a lower MLA (≥10mm) and controls (5-9mm). The Simons et al recommended specific diagnostic criteria and pressure pain thresholds were used to evaluate the prevalence of LTrPs in several muscles of the lower limb, which was compared between the 2 groups. The reliability was evaluated using Cohen's kappa and intraclass correlation coefficient. The unpaired Student t test and chi-square test were used to evaluate the difference in the LTrP prevalence between the 2 groups. The intrarater reliability of the navicular drop test and the diagnosis of LTrPs was excellent, with the taut band and tender spot being the most reliable diagnostic criteria. In the lower MLA group, 60 subjects (73%) presented at least 1 LTrP whereas 57 controls (70%) presented at least 1 LTrP. The lower MLA group showed more LTrPs (4.46±4.10) than did controls (3.32±3.24) (P<.05). There were significantly (P<.05) more subjects with LTrPs in the flexor digitorum longus, tibialis anterior, and vastus medialis in the lower MLA group than in the control group. LTrPs are common in the lower limb muscles in both controls and subjects with a lower MLA. A lower MLA is associated with a higher prevalence of LTrPs, which are significant in the flexor digitorum longus, tibialis anterior, and vastus medialis. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Vocabulary growth rate from preschool to school-age years is reflected in the connectivity of the arcuate fasciculus in 14-year-old children.

    PubMed

    Su, Mengmeng; Thiebaut de Schotten, Michel; Zhao, Jingjing; Song, Shuang; Zhou, Wei; Gong, Gaolang; McBride, Catherine; Ramus, Franck; Shu, Hua

    2018-02-06

    The acquisition of language involves the functional specialization of several cortical regions. Connectivity between these brain regions may also change with the development of language. Various studies have demonstrated that the arcuate fasciculus was essential for language function. Vocabulary learning is one of the most important skills in language acquisition. In the present longitudinal study, we explored the influence of vocabulary development on the anatomical properties of the arcuate fasciculus. Seventy-nine Chinese children participated in this study. Between age 4 and age 10, they were administered the same vocabulary task repeatedly. Following a previous study, children's vocabulary developmental trajectories were clustered into three subgroups (consistently good, catch-up, consistently poor). At age 14, diffusion tensor imaging data were collected. Using ROI-based tractography, the anterior, posterior and direct segments of the bilateral arcuate fasciculus were delineated in each child's native space. Group comparisons showed a significantly reduced fractional anisotropy in the left arcuate fasciculus of children in the consistently poor group, in particular in the posterior and direct segments of the arcuate fasciculus. No group differences were observed in the right hemisphere, nor in the left anterior segment. Further regression analyses showed that the rate of vocabulary development, rather than the initial vocabulary size, was a specific predictor of the left arcuate fasciculus connectivity. © 2018 John Wiley & Sons Ltd.

  19. White Matter Tracts Connected to the Medial Temporal Lobe Support the Development of Mnemonic Control.

    PubMed

    Wendelken, Carter; Lee, Joshua K; Pospisil, Jacqueline; Sastre, Marcos; Ross, Julia M; Bunge, Silvia A; Ghetti, Simona

    2015-09-01

    One of the most important factors driving the development of memory during childhood is mnemonic control, or the capacity to initiate and maintain the processes that guide encoding and retrieval operations. The ability to selectively attend to and encode relevant stimuli is a particularly useful form of mnemonic control, and is one that undergoes marked improvement over childhood. We hypothesized that structural integrity of white matter tracts, in particular those connecting medial temporal lobe memory regions to other cortical areas, and/or those connecting frontal and parietal control regions, should contribute to successful mnemonic control. To test this hypothesis, we examined the relationship between structural integrity of selected white matter tracts and an experimental measure of mnemonic control, involving enhancement of memory by attention at encoding, in 116 children aged 7-11 and 25 young adults. We observed a positive relationship between integrity of uncinate fasciculus and mnemonic enhancement across age groups. In adults, but not in children, we also observed an association between mnemonic enhancement and integrity of ventral cingulum bundle and ventral fornix/fimbria. Integrity of fronto-parietal tracts, including dorsal cingulum and superior longitudinal fasciculus, was unrelated to mnemonic enhancement. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  20. White Matter Tracts Connected to the Medial Temporal Lobe Support the Development of Mnemonic Control

    PubMed Central

    Wendelken, Carter; Lee, Joshua K.; Pospisil, Jacqueline; Sastre, Marcos; Ross, Julia M.; Bunge, Silvia A.; Ghetti, Simona

    2015-01-01

    One of the most important factors driving the development of memory during childhood is mnemonic control, or the capacity to initiate and maintain the processes that guide encoding and retrieval operations. The ability to selectively attend to and encode relevant stimuli is a particularly useful form of mnemonic control, and is one that undergoes marked improvement over childhood. We hypothesized that structural integrity of white matter tracts, in particular those connecting medial temporal lobe memory regions to other cortical areas, and/or those connecting frontal and parietal control regions, should contribute to successful mnemonic control. To test this hypothesis, we examined the relationship between structural integrity of selected white matter tracts and an experimental measure of mnemonic control, involving enhancement of memory by attention at encoding, in 116 children aged 7–11 and 25 young adults. We observed a positive relationship between integrity of uncinate fasciculus and mnemonic enhancement across age groups. In adults, but not in children, we also observed an association between mnemonic enhancement and integrity of ventral cingulum bundle and ventral fornix/fimbria. Integrity of fronto-parietal tracts, including dorsal cingulum and superior longitudinal fasciculus, was unrelated to mnemonic enhancement. PMID:24675870

  1. Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment

    PubMed Central

    Goedert, Kelly M.; Shah, Priyanka; Foundas, Anne L.; Barrett, A. M.

    2013-01-01

    Prism adaptation treatment (PAT) is a promising rehabilitative method for functional recovery in persons with spatial neglect. Previous research suggests that PAT improves motor-intentional “aiming” deficits that frequently occur with frontal lesions. To test whether presence of frontal lesions predicted better improvement of spatial neglect after PAT, the current study evaluated neglect-specific improvement in functional activities (assessment with the Catherine Bergego Scale) over time in 21 right-brain-damaged stroke survivors with left-sided spatial neglect. The results demonstrated that neglect patients' functional activities improved after two weeks of PAT and continued improving for four weeks. Such functional improvement did not occur equally in all of the participants: Neglect patients with lesions involving the frontal cortex (n=13) experienced significantly better functional improvement than did those without frontal lesions (n=8). More importantly, voxel-based lesion-behavior mapping (VLBM) revealed that in comparison to the group of patients without frontal lesions, the frontal-lesioned neglect patients had intact regions in the medial temporal areas, the superior temporal areas, and the inferior longitudinal fasciculus. The medial cortical and subcortical areas in the temporal lobe were especially distinguished in the “frontal lesion” group. The findings suggest that the integrity of medial temporal structures may play an important role in supporting functional improvement after PAT. PMID:22941243

  2. The allocentric neglect due to injury of the inferior fronto-occipital fasciculus in a stroke patient: A case report.

    PubMed

    Jang, Sung Ho; Jang, Woo Hyuk

    2018-01-01

    We report on a patient who developed allocentric neglect due to injury of the inferior fronto-occipital fasciculus (IFOF) following intracranial hemorrhage, diagnosed using diffusion tensor tractography (DTT). Her cognition seemed normal (A 17-year-old, right-handed female patient). However, in spite of a normal visual field, her perception was missing on the left side, and she had no awareness of her deficit. She was unable to perceive the left side in each of 2 objects, regardless of position of the 2 objects, and failed at detail exploration of the left side of 1 object. In addition, the line bisection test, the most representative neglect test, did not reveal any abnormality. She was diagnosed with an intracerebral hemorrhage (right thalamus), intraventricular hemorrhage, and subarachnoid hemorrhage due to arteriovenous malformation in the right thalamus. Seven weeks after onset, she began rehabilitation. Consequently, the apple cancellation test to discriminate between allocentric and egocentric neglect was performed, with the result of severe allocentric neglect. The right superior longitudinal fasciculus and inferior longitudinal fasciculus were well-reconstructed without definite injury compared with those of the left side. However, the right IFOF was discontinued in the anterior portion around the frontal lobe. Allocentric neglect due to injury of IFOF was demonstrated in a stroke patient using DTT. It appears that DTT would be helpful in demonstrating the neglect type and pathway in patients with neglect. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  3. The medial longitudinal arch as a possible risk factor for ankle sprains: a prospective study in 83 female infantry recruits.

    PubMed

    Mei-Dan, Omer; Kahn, Gadi; Zeev, Aviva; Rubin, Amir; Constantini, Naama; Even, Adi; Nyska, Meir; Mann, Gideon

    2005-02-01

    Ankle sprains are frequent, especially in athletes, soldiers, or others who perform high levels of physical activity. Although prevention is a primary goal, little is known about the risk factors. We evaluated the association of the structure of the medial arch of the foot to the occurrence of acute and recurrent ankle sprains in 83 female infantry recruits. We found no previous studies on ankle sprains in women in the English literature. Arch height was quantified using the Chippaux-Smirak index, and each arch was classified as high, normal, or low. Retrospective data were obtained from questionnaires in which the soldiers noted whether or not they had had ankle sprains in the past, the grade of the sprain, and recurrence. Prospective data were accumulated in the 4 months of basic training, during which time every ankle sprain was documented and classified according to its grade and cause. The retrospective data showed more frequent ankle sprains in the low arch group than in the normal arch group, mainly in the right foot (RR of 2.9, p <0.05). Recurrent sprains studied retrospectively also showed that more sprains occurred in the low arch group than in the normal arch and high arch groups (RR of 10.3, p <0.05). The prospective data suggested a pattern toward the same outcome (50% in the low arch as opposed to 36% in the normal arch group, RR, 1.3), but with no statistical significance. We concluded that a low arch of the foot might be a risk factor for ankle sprains. However, our study consisted of a relatively small population, and further studies are needed.

  4. The Role of the Arcuate Fasciculus in Conduction Aphasia

    ERIC Educational Resources Information Center

    Bernal, Byron; Ardila, Alfredo

    2009-01-01

    In aphasia literature, it has been considered that a speech repetition defect represents the main constituent of conduction aphasia. Conduction aphasia has frequently been interpreted as a language impairment due to lesions of the arcuate fasciculus (AF) that disconnect receptive language areas from expressive ones. Modern neuroradiological…

  5. [Tractography of the uncinate fasciculus and the posterior cingulate fasciculus in patients with mild cognitive impairment and Alzheimer disease].

    PubMed

    Larroza, A; Moratal, D; D'ocón Alcañiz, V; Arana, E

    2014-01-01

    Brain tractography is a non-invasive medical imaging technique which enables in vivo visualisation and various types of quantitative studies of white matter fibre tracts connecting different parts of the brain. We completed a quantitative study using brain tractography with diffusion tensor imaging in patients with mild cognitive impairment, patients with Alzheimer disease, and normal controls, in order to analyse the reproducibility and validity of the results. Fractional anisotropy (FA) and mean diffusivity (MD) were measured across the uncinate fasciculus and the posterior cingulate fasciculus in images, obtained from a database and a research centre, representing 52 subjects distributed among the 3 study groups. Two observers took the measurements twice in order to evaluate intra- and inter-observer reproducibility. Measurements of FA and MD of the uncinate fasciculus delivered an intraclass correlation coefficient above 0.9; ICC was above 0.68 for the posterior cingulate fasciculus. Patients with Alzheimer disease showed lower values of FA and higher MD values in the right uncinate fasciculus in images from the research centre. A comparison of the measurements from the 2 centres revealed significant differences. We established a reproducible methodology for performing tractography of the tracts in question. FA and MD indexes may serve as early indicators of Alzheimer disease. The type of equipment and the method used to acquire images must be considered because they may alter results as shown by comparing the 2 data sets in this study. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  6. THE RELIABILITY OF THE MODIFIED REVERSE-6 TAPING PROCEDURE WITH ELASTIC TAPE TO ALTER THE HEIGHT AND WIDTH OF THE MEDIAL LONGITUDINAL ARCH

    PubMed Central

    Lebec, Michael; DeGeyter, Julie; McPoil, Thomas G.

    2013-01-01

    Purpose/Background: Anti-pronation-taping utilizing both inelastic and elastic tape has been advocated to reduce pain and symptoms associated with excessive foot pronation. An important question regarding the use of taping is whether it can be applied consistently from one therapist to the next, from one session to the next or from one day to the next. Thus, the purpose of this study was to determine whether the “modified” Reverse-6 taping procedure using elastic tape could be applied to produce a consistent within-day and between-day change in the height and width of the medial longitudinal arch for a single clinician as well as between clinicians. A second purpose was to determine if the amount of general clinical experience influenced this consistency. Methods: Fifteen asymptomatic individuals (10 female and 5 male) with a mean age of 28.7 years were recruited to participate in this study. The height and width of the midfoot at 50% of each subject's foot length was measured in standing using a digital gauge and caliper. These measurements were done twice on the same day, on two different days and again by two clinicians with different levels of experience before and after having their feet taped using the “modified” Reverse-6 taping technique using elastic tape. Both clinicians received a one-hour training session on how to apply the taping technique and were also given a DVD showing the technique that they could review. In addition to descriptive statistics, intra-class correlation coefficients (ICC) were used to assess each clinician's within-day and between-day reliability. Between-clinician reliability was also determined. Results: The mean dorsal arch height and midfoot width before the application of tape was 62.7 and 78.9 mm. The mean dorsal arch height and width after the application of tape was 66.6 and 78.8 mm. The within-day reliability ICC(2,1) values for the two clinicians ranged from .865 to .991. The between-day reliability ICC(2,1) values

  7. Differences in the angle of the medial longitudinal arch and muscle activity of the abductor hallucis and tibialis anterior during sitting short-foot exercises between subjects with pes planus and subjects with neutral foot.

    PubMed

    Lee, Ji-Hyun; Cynn, Heon-Seock; Yoon, Tae-Lim; Choi, Sil-Ah; Kang, Tae-Woo

    2016-11-21

    Excessive activity of the tibialis anterior muscle may be a causal mechanism in overuse injuries such as stress fracture in pes planus patients. However, information about this relationship is limited. In this study, we compared the angle of the medial longitudinal arch, the activities of the abductor hallucis and tibialis anterior muscles, and the activity ratio of tibialis anterior/abductor hallucis in individuals with pes planus and those with a neutral foot position during short-foot exercises conducted while sitting. Differences between the groups were analyzed using an independent t-test. In all, 28 university students participated in this study (14 subjects in each group). The activity of the abductor hallucis muscle was significantly lower (p < 0.001), and the activity ratio of tibialis anterior/abductor hallucis was significantly greater (p = 0.012) in the pes planus group than in the neutral foot group during the exercise. Clinicians should recognize that pes planus patients may compensate for reduced activation of the abductor hallucis to maintain the angle of the medial longitudinal arch during the sitting short-foot exercise.

  8. Longitudinal analysis of MR spin-spin relaxation times (T2) in medial femorotibial cartilage of adolescent vs mature athletes: dependence of deep and superficial zone properties on sex and age.

    PubMed

    Wirth, W; Eckstein, F; Boeth, H; Diederichs, G; Hudelmaier, M; Duda, G N

    2014-10-01

    Cartilage spin-spin magnetic resonance imaging (MRI) relaxation time (T2) represents a promising imaging biomarker of "early" osteoarthritis (OA) known to be associated with cartilage composition (collagen integrity, orientation, and hydration). However, no longitudinal imaging studies have been conducted to examine cartilage maturation in healthy subjects thus far. Therefore, we explore T2 change in the deep and superficial cartilage layers at the end of adolescence. Twenty adolescent and 20 mature volleyball athletes were studied (each 10 men and 10 women). Multi-echo spin-echo (MESE) images were acquired at baseline and 2-year follow-up. After segmentation, cartilage T2 was calculated in the deep and superficial cartilage layers of the medial tibial (MT) and the central, weight-bearing part of the medial femoral condyle (cMF), using five echoes (TE 19.4-58.2 ms). 16 adolescent (6 men, 10 women, baseline age 15.8 ± 0.5 years) and 17 mature (nine men, eight women, age 46.5 ± 5.2 years) athletes had complete baseline and follow-up images of sufficient quality to compute T2. In adolescents, a longitudinal decrease in T2 was observed in the deep layers of MT (-2.0 ms; 95% confidence interval (CI): [-3.4, -0.6] ms; P < 0.01) and cMF (-1.3 ms; [-2.4, -0.3] ms; P < 0.05), without obvious differences between males and females. No significant change was observed in the superficial layers, or in the deep or superficial layers of the mature athletes. In this first pilot study on quantitative imaging of cartilage maturation in healthy, athletic subjects, we find evidence of cartilage compositional change in deep cartilage layers of the medial femorotibial compartment in adolescents, most likely related to organizational changes in the collagen matrix. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Correlation between language function and the left arcuate fasciculus detected by diffusion tensor imaging tractography after brain tumor surgery.

    PubMed

    Hayashi, Yutaka; Kinoshita, Masashi; Nakada, Mitsutoshi; Hamada, Jun-ichiro

    2012-11-01

    Disturbance of the arcuate fasciculus in the dominant hemisphere is thought to be associated with language-processing disorders, including conduction aphasia. Although the arcuate fasciculus can be visualized in vivo with diffusion tensor imaging (DTI) tractography, its involvement in functional processes associated with language has not been shown dynamically using DTI tractography. In the present study, to clarify the participation of the arcuate fasciculus in language functions, postoperative changes in the arcuate fasciculus detected by DTI tractography were evaluated chronologically in relation to postoperative changes in language function after brain tumor surgery. Preoperative and postoperative arcuate fasciculus area and language function were examined in 7 right-handed patients with a brain tumor in the left hemisphere located in proximity to part of the arcuate fasciculus. The arcuate fasciculus was depicted, and its area was calculated using DTI tractography. Language functions were measured using the Western Aphasia Battery (WAB). After tumor resection, visualization of the arcuate fasciculus was increased in 5 of the 7 patients, and the total WAB score improved in 6 of the 7 patients. The relative ratio of postoperative visualized area of the arcuate fasciculus to preoperative visualized area of the arcuate fasciculus was increased in association with an improvement in postoperative language function (p = 0.0039). The role of the left arcuate fasciculus in language functions can be evaluated chronologically in vivo by DTI tractography after brain tumor surgery. Because increased postoperative visualization of the fasciculus was significantly associated with postoperative improvement in language functions, the arcuate fasciculus may play an important role in language function, as previously thought. In addition, postoperative changes in the arcuate fasciculus detected by DTI tractography could represent a predicting factor for postoperative language

  10. Anatomical Properties of the Arcuate Fasciculus Predict Phonological and Reading Skills in Children

    ERIC Educational Resources Information Center

    Yeatman, Jason D.; Dougherty, Robert F.; Rykhlevskaia, Elena; Sherbondy, Anthony J.; Deutsch, Gayle K.; Wandell, Brian A.; Ben-Shachar, Michal

    2011-01-01

    For more than a century, neurologists have hypothesized that the arcuate fasciculus carries signals that are essential for language function; however, the relevance of the pathway for particular behaviors is highly controversial. The primary objective of this study was to use diffusion tensor imaging to examine the relationship between individual…

  11. Aging-Resilient Associations between the Arcuate Fasciculus and Vocabulary Knowledge: Microstructure or Morphology?

    PubMed

    Teubner-Rhodes, Susan; Vaden, Kenneth I; Cute, Stephanie L; Yeatman, Jason D; Dougherty, Robert F; Eckert, Mark A

    2016-07-06

    Vocabulary knowledge is one of the few cognitive functions that is relatively preserved in older adults, but the reasons for this relative preservation have not been well delineated. We tested the hypothesis that individual differences in vocabulary knowledge are influenced by arcuate fasciculus macrostructure (i.e., shape and volume) properties that remain stable during the aging process, rather than white matter microstructure that demonstrates age-related declines. Vocabulary was not associated with age compared to pronounced age-related declines in cognitive processing speed across 106 healthy adults (19.92-88.29 years) who participated in this neuroimaging experiment. Fractional anisotropy in the left arcuate fasciculus was significantly related to individual variability in vocabulary. This effect was present despite marked age-related differences in a T1-weighted/T2-weighted ratio (T1w/T2w) estimate of myelin that were observed throughout the left arcuate fasciculus and associated with age-related differences in cognitive processing speed. However, atypical patterns of arcuate fasciculus morphology or macrostructure were associated with decreased vocabulary knowledge. These results suggest that deterioration of tissue in the arcuate fasciculus occurs with normal aging, while having limited impact on tract organization that underlies individual differences in the acquisition and retrieval of lexical and semantic information. Vocabulary knowledge is resilient to widespread age-related declines in brain structure that limit other cognitive functions. We tested the hypothesis that arcuate fasciculus morphology, which supports the development of reading skills that bolster vocabulary, could explain this relative preservation. We disentangled (1) the effects of age-related declines in arcuate microstructure (mean diffusivity; myelin content estimate) that predicted cognitive processing speed but not vocabulary, from (2) relatively stable arcuate macrostructure

  12. Aging-Resilient Associations between the Arcuate Fasciculus and Vocabulary Knowledge: Microstructure or Morphology?

    PubMed Central

    Vaden, Kenneth I.; Cute, Stephanie L.; Yeatman, Jason D.; Dougherty, Robert F.

    2016-01-01

    Vocabulary knowledge is one of the few cognitive functions that is relatively preserved in older adults, but the reasons for this relative preservation have not been well delineated. We tested the hypothesis that individual differences in vocabulary knowledge are influenced by arcuate fasciculus macrostructure (i.e., shape and volume) properties that remain stable during the aging process, rather than white matter microstructure that demonstrates age-related declines. Vocabulary was not associated with age compared to pronounced age-related declines in cognitive processing speed across 106 healthy adults (19.92–88.29 years) who participated in this neuroimaging experiment. Fractional anisotropy in the left arcuate fasciculus was significantly related to individual variability in vocabulary. This effect was present despite marked age-related differences in a T1-weighted/T2-weighted ratio (T1w/T2w) estimate of myelin that were observed throughout the left arcuate fasciculus and associated with age-related differences in cognitive processing speed. However, atypical patterns of arcuate fasciculus morphology or macrostructure were associated with decreased vocabulary knowledge. These results suggest that deterioration of tissue in the arcuate fasciculus occurs with normal aging, while having limited impact on tract organization that underlies individual differences in the acquisition and retrieval of lexical and semantic information. SIGNIFICANCE STATEMENT Vocabulary knowledge is resilient to widespread age-related declines in brain structure that limit other cognitive functions. We tested the hypothesis that arcuate fasciculus morphology, which supports the development of reading skills that bolster vocabulary, could explain this relative preservation. We disentangled (1) the effects of age-related declines in arcuate microstructure (mean diffusivity; myelin content estimate) that predicted cognitive processing speed but not vocabulary, from (2) relatively stable

  13. White Matter Microstructure in Superior Longitudinal Fasciculus Associated with Spatial Working Memory Performance in Children

    ERIC Educational Resources Information Center

    Vestergaard, Martin; Madsen, Kathrine Skak; Baare, William F. C.; Skimminge, Arnold; Ejersbo, Lisser Rye; Ramsoy, Thomas Z.; Gerlach, Christian; Akeson, Per; Paulson, Olaf B.; Jernigan, Terry L.

    2011-01-01

    During childhood and adolescence, ongoing white matter maturation in the fronto-parietal cortices and connecting fiber tracts is measurable with diffusion-weighted imaging. Important questions remain, however, about the links between these changes and developing cognitive functions. Spatial working memory (SWM) performance improves significantly…

  14. A combinatorial optogenetic approach to medial habenula function

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

  15. The relationship between uncinate fasciculus white matter integrity and verbal memory proficiency in children.

    PubMed

    Schaeffer, David J; Krafft, Cynthia E; Schwarz, Nicolette F; Chi, Lingxi; Rodrigue, Amanda L; Pierce, Jordan E; Allison, Jerry D; Yanasak, Nathan E; Liu, Tianming; Davis, Catherine L; McDowell, Jennifer E

    2014-08-20

    During childhood, verbal learning and memory are important for academic performance. Recent functional MRI studies have reported on the functional correlates of verbal memory proficiency, but few have reported the underlying structural correlates. The present study sought to test the relationship between fronto-temporal white matter integrity and verbal memory proficiency in children. Diffusion weighted images were collected from 17 Black children (age 8-11 years) who also completed the California Verbal Learning Test. To index white matter integrity, fractional anisotropy values were calculated for bilateral uncinate fasciculus. The results revealed that low anisotropy values corresponded to poor verbal memory, whereas high anisotropy values corresponded to significantly better verbal memory scores. These findings suggest that a greater degree of myelination and cohesiveness of axonal fibers in uncinate fasciculus underlie better verbal memory proficiency in children.

  16. Microstructural connectivity of the arcuate fasciculus in adolescents with high-functioning autism

    PubMed Central

    Fletcher, P. Thomas; Whitaker, Ross T.; Tao, Ran; DuBray, Molly B.; Froehlich, Alyson; Ravichandran, Caitlin; Alexander, Andrew L.; Bigler, Erin D.; Lange, Nicholas; Lainhart, Janet E.

    2010-01-01

    The arcuate fasciculus is a white matter fiber bundle of great importance in language. In this study, diffusion tensor imaging (DTI) was used to infer white matter integrity in the arcuate fasciculi of a group of subjects with high-functioning autism and a control group matched for age, handedness, IQ, and head size. The arcuate fasciculus for each subject was automatically extracted from the imaging data using a new volumetric DTI segmentation algorithm. The results showed a significant increase in mean diffusivity (MD) in the autism group, due mostly to an increase in the radial diffusivity (RD). A test of the lateralization of DTI measurements showed that both MD and fractional anisotropy (FA) were less lateralized in the autism group. These results suggest that white matter microstructure in the arcuate fasciculus is affected in autism and that the language specialization apparent in the left arcuate of healthy subjects is not as evident in autism, which may be related to poorer language functioning. PMID:20132894

  17. 'For the benefit of the people': the Dutch translation of the Fasciculus medicinae, Antwerp 1512.

    PubMed

    Coppens, Christian

    2009-01-01

    The article deals with the Dutch translation of the Fasciculus medicinae based on the Latin edition, Venice 1495, with the famous woodcuts created in 1494 for the Italian translation of the original Latin edition of 1491. The woodcuts are compared with the Venetian model. New features in the Antwerp edition include the Skeleton and the Zodiac Man, bot originally based on German models. The text also deals with other woodcuts in the Low Countries based on these Venetian illustrations. The Appendices provide a short title catalog of all the editions and translations based on the Venetian edition and a stemma.

  18. Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia

    PubMed Central

    Guo, Dazhou; Fillmore, Paul; Holland, Audrey; Rorden, Chris

    2013-01-01

    Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca’s area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca’s and global aphasia

  19. Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.

    PubMed

    Fridriksson, Julius; Guo, Dazhou; Fillmore, Paul; Holland, Audrey; Rorden, Chris

    2013-11-01

    Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia

  20. Pediatric traumatic brain injury: Language outcomes and their relationship to the arcuate fasciculus

    PubMed Central

    Liégeois, Frédérique J.; Mahony, Kate; Connelly, Alan; Pigdon, Lauren; Tournier, Jacques-Donald; Morgan, Angela T.

    2013-01-01

    Pediatric traumatic brain injury (TBI) may result in long-lasting language impairments alongside dysarthria, a motor-speech disorder. Whether this co-morbidity is due to the functional links between speech and language networks, or to widespread damage affecting both motor and language tracts, remains unknown. Here we investigated language function and diffusion metrics (using diffusion-weighted tractography) within the arcuate fasciculus, the uncinate fasciculus, and the corpus callosum in 32 young people after TBI (approximately half with dysarthria) and age-matched healthy controls (n = 17). Only participants with dysarthria showed impairments in language, affecting sentence formulation and semantic association. In the whole TBI group, sentence formulation was best predicted by combined corpus callosum and left arcuate volumes, suggesting this “dual blow” seriously reduces the potential for functional reorganisation. Word comprehension was predicted by fractional anisotropy in the right arcuate. The co-morbidity between dysarthria and language deficits therefore seems to be the consequence of multiple tract damage. PMID:23756046

  1. A Combined fMRI and DTI Examination of Functional Language Lateralization and Arcuate Fasciculus Structure: Effects of Degree versus Direction of Hand Preference

    ERIC Educational Resources Information Center

    Propper, Ruthe E.; O'Donnell, Lauren J.; Whalen, Stephen; Tie, Yanmei; Norton, Isaiah H.; Suarez, Ralph O.; Zollei, Lilla; Radmanesh, Alireza; Golby, Alexandra J.

    2010-01-01

    The present study examined the relationship between hand preference degree and direction, functional language lateralization in Broca's and Wernicke's areas, and structural measures of the arcuate fasciculus. Results revealed an effect of degree of hand preference on arcuate fasciculus structure, such that consistently-handed individuals,…

  2. Longitudinal changes in microstructural white matter metrics in Alzheimer's disease.

    PubMed

    Mayo, Chantel D; Mazerolle, Erin L; Ritchie, Lesley; Fisk, John D; Gawryluk, Jodie R

    2017-01-01

    Alzheimer's disease (AD) is a progressive neurodegenerative disorder. Current avenues of AD research focus on pre-symptomatic biomarkers that will assist with early diagnosis of AD. The majority of magnetic resonance imaging (MRI) based biomarker research to date has focused on neuronal loss in grey matter and there is a paucity of research on white matter. Longitudinal DTI data from the Alzheimer's Disease Neuroimaging Initiative 2 database were used to examine 1) the within-group microstructural white matter changes in individuals with AD and healthy controls at baseline and year one; and 2) the between-group microstructural differences in individuals with AD and healthy controls at both time points. 1) Within-group: longitudinal Tract-Based Spatial Statistics revealed that individuals with AD and healthy controls both had widespread reduced fractional anisotropy (FA) and increased mean diffusivity (MD) with changes in the hippocampal cingulum exclusive to the AD group. 2) Between-group: relative to healthy controls, individuals with AD had lower FA and higher MD in the hippocampal cingulum, as well as the corpus callosum, internal and external capsule; corona radiata; posterior thalamic radiation; superior and inferior longitudinal fasciculus; fronto-occipital fasciculus; cingulate gyri; fornix; uncinate fasciculus; and tapetum. The current results indicate that sensitivity to white matter microstructure is a promising avenue for AD biomarker research. Additional longitudinal studies on both white and grey matter are warranted to further evaluate potential clinical utility.

  3. Psychopathic traits modulate microstructural integrity of right uncinate fasciculus in a community population.

    PubMed

    Sobhani, Mona; Baker, Laura; Martins, Bradford; Tuvblad, Catherine; Aziz-Zadeh, Lisa

    2015-01-01

    Individuals with psychopathy possess emotional and behavioral abnormalities. Two neural regions, involved in behavioral control and emotion regulation, are often implicated: amygdala and ventromedial prefrontal cortex (VMPFC). Recently, in studies using adult criminal populations, reductions in microstructural integrity of the white matter connections (i.e., uncinate fasciculus (UF)) between these two neural regions have been discovered in criminals with psychopathy, supporting the notion of neural dysfunction in the amygdala-VMPFC circuit. Here, a young adult, community sample is used to assess whether psychopathic traits modulate microstructural integrity of UF, and whether this relationship is dependent upon levels of trait anxiety, which is sometimes used to distinguish subtypes of psychopathy. Results reveal a negative association between psychopathic traits and microstructural integrity of UF, supporting previous findings. However, no moderation of the relationship by trait anxiety was discovered. Findings provide further support for the notion of altered amygdala-VMPFC connectivity in association with higher psychopathic traits.

  4. Relatively normal repetition performance despite severe disruption of the left arcuate fasciculus.

    PubMed

    Epstein-Peterson, Zachary; Vasconcellos Faria, Andreia; Mori, Susumu; Hillis, Argye E; Tsapkini, Kyrana

    2012-01-01

    The arcuate fasciculus (AF) is believed to be fundamental to the neural circuitry behind many important cognitive processes. Connecting Wernicke's and Broca's area, these fibers are thought to be especially important for repetition. In this case study we present evidence from a patient that set doubt on these assumptions. We present structural imaging, diffusion tensor imaging, and language data on a patient with a large left-sided stroke and severely damaged left AF who showed intact word repetition and relatively intact sentence repetition performance. Specifically, his sentence repetition is more fluent and grammatical, with less hesitation than spontaneous speech, and with rare omissions only during the longest sentences. These results challenge classical theories that maintain the left AF is the dominant language processing pathway or mechanism for repetition.

  5. Diffusion tensor MRI tractography reveals increased fractional anisotropy (FA) in arcuate fasciculus following music-cued motor training.

    PubMed

    Moore, Emma; Schaefer, Rebecca S; Bastin, Mark E; Roberts, Neil; Overy, Katie

    2017-08-01

    Auditory cues are frequently used to support movement learning and rehabilitation, but the neural basis of this behavioural effect is not yet clear. We investigated the microstructural neuroplasticity effects of adding musical cues to a motor learning task. We hypothesised that music-cued, left-handed motor training would increase fractional anisotropy (FA) in the contralateral arcuate fasciculus, a fibre tract connecting auditory, pre-motor and motor regions. Thirty right-handed participants were assigned to a motor learning condition either with (Music Group) or without (Control Group) musical cues. Participants completed 20minutes of training three times per week over four weeks. Diffusion tensor MRI and probabilistic neighbourhood tractography identified FA, axial (AD) and radial (RD) diffusivity before and after training. Results revealed that FA increased significantly in the right arcuate fasciculus of the Music group only, as hypothesised, with trends for AD to increase and RD to decrease, a pattern of results consistent with activity-dependent increases in myelination. No significant changes were found in the left ipsilateral arcuate fasciculus of either group. This is the first evidence that adding musical cues to movement learning can induce rapid microstructural change in white matter pathways in adults, with potential implications for therapeutic clinical practice. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Longitudinal changes in white matter microstructure after heavy cannabis use.

    PubMed

    Becker, Mary P; Collins, Paul F; Lim, Kelvin O; Muetzel, R L; Luciana, M

    2015-12-01

    Diffusion tensor imaging (DTI) studies of cannabis users report alterations in brain white matter microstructure, primarily based on cross-sectional research, and etiology of the alterations remains unclear. We report findings from longitudinal voxelwise analyses of DTI data collected at baseline and at a 2-year follow-up on 23 young adult (18-20 years old at baseline) regular cannabis users and 23 age-, sex-, and IQ-matched non-using controls with limited substance use histories. Onset of cannabis use was prior to age 17. Cannabis users displayed reduced longitudinal growth in fractional anisotropy in the central and parietal regions of the right and left superior longitudinal fasciculus, in white matter adjacent to the left superior frontal gyrus, in the left corticospinal tract, and in the right anterior thalamic radiation lateral to the genu of the corpus callosum, along with less longitudinal reduction of radial diffusion in the right central/posterior superior longitudinal fasciculus, corticospinal tract, and posterior cingulum. Greater amounts of cannabis use were correlated with reduced longitudinal growth in FA as was relatively impaired performance on a measure of verbal learning. These findings suggest that continued heavy cannabis use during adolescence and young adulthood alters ongoing development of white matter microstructure, contributing to functional impairment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Longitudinal changes in white matter microstructure after heavy cannabis use

    PubMed Central

    Becker, Mary P.; Collins, Paul F.; Lim, Kelvin O.; Muetzel, R.L.; Luciana, M.

    2015-01-01

    Diffusion tensor imaging (DTI) studies of cannabis users report alterations in brain white matter microstructure, primarily based on cross-sectional research, and etiology of the alterations remains unclear. We report findings from longitudinal voxelwise analyses of DTI data collected at baseline and at a 2-year follow-up on 23 young adult (18-20 years old at baseline) regular cannabis users and 23 age-, sex-, and IQ-matched non-using controls with limited substance use histories. Onset of cannabis use was prior to age 17. Cannabis users displayed reduced longitudinal growth in fractional anisotropy in the central and parietal regions of the right and left superior longitudinal fasciculus, in white matter adjacent to the left superior frontal gyrus, in the left corticospinal tract, and in the right anterior thalamic radiation lateral to the genu of the corpus callosum, along with less longitudinal reduction of radial diffusion in the right central/posterior superior longitudinal fasciculus, corticospinal tract, and posterior cingulum. Greater amounts of cannabis use were correlated with reduced longitudinal growth in FA as was relatively impaired performance on a measure of verbal learning. These findings suggest that continued heavy cannabis use during adolescence and young adulthood alters ongoing development of white matter microstructure, contributing to functional impairment. PMID:26602958

  8. The Uncinate Fasciculus as a Predictor of Conversion from Amnestic Mild Cognitive Impairment to Alzheimer Disease.

    PubMed

    Hiyoshi-Taniguchi, Kazuko; Oishi, Naoya; Namiki, Chihiro; Miyata, Jun; Murai, Toshiya; Cichocki, Andrzej; Fukuyama, Hidenao

    2015-01-01

    Amnestic mild cognitive impairment (aMCI) is associated with the risk of Alzheimer's disease (AD). Although diffusion tensor imaging (DTI)-based fractional anisotropy (FA) analyses have been used to evaluate white matter changes in patients with AD, it remains unknown how FA values change during the conversion of aMCI to AD. This study aimed to elucidate the prediction of conversion to AD and cognitive decline by FA values in uncinate fasciculus (UF) in aMCI patients. Twenty-two aMCI patients were evaluated for their UF FA values by a tractography-based method with DTI and cognitive performance by neuropsychological testing at baseline and after a 3-year follow-up. Patients were divided into 2 groups after 3 years: 14 aMCI-stable (aMCI-aMCI) and 8 AD-conversion (aMCI-AD). At baseline, FA values in the right UF were significantly lower in the aMCI-AD group than in the aMCI-aMCI group. These values also showed significant correlations with the neuropsychological scores after a 3-year follow-up. The area under the curve of the receiver operation characteristic curves for predicting conversion to AD was .813. These results suggested that FA values in the right UF might be an effective predictor of conversion of aMCI to AD. Copyright © 2014 by the American Society of Neuroimaging.

  9. Interpersonal traits of psychopathy linked to reduced integrity of the uncinate fasciculus.

    PubMed

    Wolf, Richard C; Pujara, Maia S; Motzkin, Julian C; Newman, Joseph P; Kiehl, Kent A; Decety, Jean; Kosson, David S; Koenigs, Michael

    2015-10-01

    Psychopathy is a personality disorder characterized by callous lack of empathy, impulsive antisocial behavior, and criminal recidivism. Here, we performed the largest diffusion tensor imaging (DTI) study of incarcerated criminal offenders to date (N = 147) to determine whether psychopathy severity is linked to the microstructural integrity of major white matter tracts in the brain. Consistent with the results of previous studies in smaller samples, we found that psychopathy was associated with reduced fractional anisotropy in the right uncinate fasciculus (UF; the major white matter tract connecting ventral frontal and anterior temporal cortices). We found no such association in the left UF or in adjacent frontal or temporal white matter tracts. Moreover, the right UF finding was specifically related to the interpersonal features of psychopathy (glib superficial charm, grandiose sense of self-worth, pathological lying, manipulativeness), rather than the affective, antisocial, or lifestyle features. These results indicate a neural marker for this key dimension of psychopathic symptomatology. © 2015 Wiley Periodicals, Inc.

  10. The vertical occipital fasciculus: A century of controversy resolved by in vivo measurements

    PubMed Central

    Yeatman, Jason D.; Weiner, Kevin S.; Pestilli, Franco; Rokem, Ariel; Mezer, Aviv; Wandell, Brian A.

    2014-01-01

    The vertical occipital fasciculus (VOF) is the only major fiber bundle connecting dorsolateral and ventrolateral visual cortex. Only a handful of studies have examined the anatomy of the VOF or its role in cognition in the living human brain. Here, we trace the contentious history of the VOF, beginning with its original discovery in monkey by Wernicke (1881) and in human by Obersteiner (1888), to its disappearance from the literature, and recent reemergence a century later. We introduce an algorithm to identify the VOF in vivo using diffusion-weighted imaging and tractography, and show that the VOF can be found in every hemisphere (n = 74). Quantitative T1 measurements demonstrate that tissue properties, such as myelination, in the VOF differ from neighboring white-matter tracts. The terminations of the VOF are in consistent positions relative to cortical folding patterns in the dorsal and ventral visual streams. Recent findings demonstrate that these same anatomical locations also mark cytoarchitectonic and functional transitions in dorsal and ventral visual cortex. We conclude that the VOF is likely to serve a unique role in the communication of signals between regions on the ventral surface that are important for the perception of visual categories (e.g., words, faces, bodies, etc.) and regions on the dorsal surface involved in the control of eye movements, attention, and motion perception. PMID:25404310

  11. Integration of diffusion tensor-based arcuate fasciculus fibre navigation and intraoperative MRI into glioma surgery.

    PubMed

    Zhao, Yan; Chen, Xiaolei; Wang, Fei; Sun, Guochen; Wang, Yubo; Song, Zhijun; Xu, Bainan

    2012-02-01

    This study was designed to evaluate the feasibility and efficacy of diffusion tensor-based arcuate fasciculus (AF) fibre navigation in combination with 1.5-Tesla (1.5-T) intraoperative MRI (iMRI) for the resection of gliomas involving eloquent language fibre tracts (AF tracts). Twenty patients with AF tract-involved gliomas in the dominant hemisphere were prospectively enrolled. The patients were divided into two groups. The normal group included nine patients with preoperative intact language function, while the aphasia group consisted of 11 patients who presented with different levels of conduction aphasia. The AF tractography results were integrated into three-dimensional (3D) datasets used for neuronavigation, and their course was superimposed onto the surgical field during glioma resection. The iMRI was used to compensate for the effects of brain shift and to evaluate the extent of resection. Fibre tract visualisation provided a quick and intuitive overview of the displaced course of the AF in 3D space and the surgical field under a microscope. At a 3-month to 6-month follow-up, only two patients from the normal group suffered exacerbated language deficits due to tumour recurrence. Meanwhile, language function in all patients in the aphasia group had improved. Therefore, AF neuronavigation, combined with 1.5 T iMRI, is a feasible method of maximising resection and minimising language deficits when removing gliomas that involve the AF. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Diffusivity of the uncinate fasciculus in heroin users relates to their levels of anxiety

    PubMed Central

    Wong, N M L; Cheung, S-H; Chan, C C H; Zeng, H; Liu, Y-P; So, K-F; Lee, T M C

    2015-01-01

    Heroin use is closely associated with emotional dysregulation, which may explain its high comorbidity with disorders such as anxiety and depression. However, the understanding of the neurobiological etiology of the association between heroin use and emotional dysregulation is limited. Previous studies have suggested an impact of heroin on diffusivity in white matter involving the emotional regulatory system, but the specificity of this finding remains to be determined. Therefore, this study investigated the association between heroin use and diffusivity of white matter tracts in heroin users and examined whether the tracts were associated with their elevated anxiety and depression levels. A sample of 26 right-handed male abstinent heroin users (25 to 42 years of age) and 32 matched healthy controls (19 to 55 years of age) was recruited for this study. Diffusion tensor imaging data were collected, and their levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Our findings indicated that heroin users exhibited higher levels of anxiety and depression, but the heroin use-associated left uncinate fasciculus was only related to their anxiety level, suggesting that association between heroin and anxiety has an incremental organic basis but that for depression could be a threshold issue. This finding improves our understanding of heroin addiction and its comorbid affective disorder and facilitates future therapeutic development. PMID:25918991

  13. Individual differences in crossmodal brain activity predict arcuate fasciculus connectivity in developing readers.

    PubMed

    Gullick, Margaret M; Booth, James R

    2014-07-01

    Crossmodal integration of auditory and visual information, such as phonemes and graphemes, is a critical skill for fluent reading. Previous work has demonstrated that white matter connectivity along the arcuate fasciculus (AF) is predicted by reading skill and that crossmodal processing particularly activates the posterior STS (pSTS). However, the relationship between this crossmodal activation and white matter integrity has not been previously reported. We investigated the interrelationship of crossmodal integration, both in terms of behavioral performance and pSTS activity, with AF tract coherence using a rhyme judgment task in a group of 47 children with a range of reading abilities. We demonstrate that both response accuracy and pSTS activity for crossmodal (auditory-visual) rhyme judgments was predictive of fractional anisotropy along the left AF. Unimodal (auditory-only or visual-only) pSTS activity was not significantly related to AF connectivity. Furthermore, activity in other reading-related ROIs did not show the same AV-only AF coherence relationship, and AV pSTS activity was not related to connectivity along other language-related tracts. This study is the first to directly show that crossmodal brain activity is specifically related to connectivity in the AF, supporting its role in phoneme-grapheme integration ability. More generally, this study helps to define an interdependent neural network for reading-related integration.

  14. Correlation between uncinate fasciculus and memory tasks in healthy individual using diffusion tensor tractography.

    PubMed

    Sato, T; Maruyama, N; Hoshida, T; Minato, K

    2012-01-01

    Tractography is a procedure that can track and demonstrate the 3D neural tracts of the white matter of the brain. The images of the brain are obtained by analyzing the diffusion tensor, identification of which can provide the anatomical connections of the brain. Studying these connections is integral to the understanding of the brain function. Specifically, the uncinate fasciculus (UF), which is the white matter in the human brain, is said to be related to cognitive function. The UF tractography is calculated using diffusion tensor imaging (DTI) parameter. Studies have shown that the DTI parameter of dementia patients is lower than that of healthy individuals. It is also suggested that the DTI parameter of healthy individuals decreases with age. In addition, the WMS-R score, which is indicative of general memory, verbal memory and other cognitive functions, of the elderly are lower than of the young. However, there is no report yet that has holistically investigated DTI parameter and the memory functions. Thus, in this research, we have calculated the correlation coefficient between the DTI parameter of UF and WMS-R score. Our result shows that the correlation coefficient of diffusivity of the fiber direction and visual memory of a left UF is -0.226 at the maximum. Correlation between DTI measurement and memory performance suggests the relationships between the UF and function in memory tasks lateralization. Our finding matches previous reports on the correlation between FA in the left, or L1 in the right UF, and performance on visual memory.

  15. Atypical hemispheric asymmetry in the arcuate fasciculus of completely nonverbal children with autism.

    PubMed

    Wan, Catherine Y; Marchina, Sarah; Norton, Andrea; Schlaug, Gottfried

    2012-04-01

    Despite the fact that as many as 25% of the children diagnosed with autism spectrum disorders are nonverbal, surprisingly little research has been conducted on this population. In particular, the mechanisms that underlie their absence of speech remain unknown. Using diffusion tensor imaging, we compared the structure of a language-related white matter tract (the arcuate fasciculus, AF) in five completely nonverbal children with autism to that of typically developing children. We found that, as a group, the nonverbal children did not show the expected left-right AF asymmetry--rather, four of the five nonverbal children actually showed the reversed pattern. It is possible that this unusual pattern of asymmetry may underlie some of the severe language deficits commonly found in autism, particularly in children whose speech fails to develop. Furthermore, novel interventions (such as auditory-motor mapping training) designed to engage brain regions that are connected via the AF may have important clinical potential for facilitating expressive language in nonverbal children with autism. © 2012 New York Academy of Sciences.

  16. Sex Differences of Uncinate Fasciculus Structural Connectivity in Individuals with Conduct Disorder

    PubMed Central

    Zhang, Jibiao; Gao, Junling; Shi, Huqing; Huang, Bingsheng; Wang, Xiang; Situ, Weijun; Cai, Weixiong; Yi, Jinyao; Zhu, Xiongzhao; Yao, Shuqiao

    2014-01-01

    Conduct disorder (CD) is one of the most common behavior disorders in adolescents, such as impulsivity, aggression, and running from school. Males are more likely to develop CD than females, and two previous diffusion tensor imaging (DTI) studies have demonstrated abnormal microstructural integrity in the uncinate fasciculus (UF) in boys with CD compared to a healthy control group. However, little is known about changes in the UF in females with CD. In this study, the UF was illustrated by tractography; then, the fractional anisotropy (FA), axial diffusivity, mean diffusion, radial diffusivity (RD), and the length and number of the UF fiber bundles were compared between male and female patients with CD and between female patients with CD and female healthy controls, as well as between males with CD and healthy males. We found that males with CD showed significantly higher FA of the bilateral UF and significantly lower RD of the left UF when comparing with females with CD. Meanwhile, significantly higher FA and lower RD of the bilateral UF were also found in boys with CD relative to the male healthy controls. Our results replicated previous reports that the microstructural integrity of the UF was abnormal in boys with CD. Additionally, our results demonstrated significant gender effects on the UF of patients with CD, which may indicate why boys have higher rates of conduct problems than girls. PMID:24829912

  17. Diffusivity of the uncinate fasciculus in heroin users relates to their levels of anxiety.

    PubMed

    Wong, N M L; Cheung, S-H; Chan, C C H; Zeng, H; Liu, Y-P; So, K-F; Lee, T M C

    2015-04-28

    Heroin use is closely associated with emotional dysregulation, which may explain its high comorbidity with disorders such as anxiety and depression. However, the understanding of the neurobiological etiology of the association between heroin use and emotional dysregulation is limited. Previous studies have suggested an impact of heroin on diffusivity in white matter involving the emotional regulatory system, but the specificity of this finding remains to be determined. Therefore, this study investigated the association between heroin use and diffusivity of white matter tracts in heroin users and examined whether the tracts were associated with their elevated anxiety and depression levels. A sample of 26 right-handed male abstinent heroin users (25 to 42 years of age) and 32 matched healthy controls (19 to 55 years of age) was recruited for this study. Diffusion tensor imaging data were collected, and their levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Our findings indicated that heroin users exhibited higher levels of anxiety and depression, but the heroin use-associated left uncinate fasciculus was only related to their anxiety level, suggesting that association between heroin and anxiety has an incremental organic basis but that for depression could be a threshold issue. This finding improves our understanding of heroin addiction and its comorbid affective disorder and facilitates future therapeutic development.

  18. Medialization laryngoplasty for odynophonia.

    PubMed

    Kupfer, Robbi A; Merati, Albert L; Sulica, Lucian

    2015-06-01

    Medialization laryngoplasty (ML) remains the gold standard for the long-term treatment of hoarseness related to glottal insufficiency. Odynophonia is a less common manifestation of glottal insufficiency related to vocal fold motion impairment (VFMI), and ML is hypothesized to relieve pain associated with this condition. To evaluate whether patients with VFMI and a chief complaint of odynophonia may achieve pain relief with ML, regardless of the degree of vocal impairment. We conducted a retrospective review of medical records for 8 patients with VFMI and a chief complaint of odynophonia who were treated at 2 tertiary care laryngology centers over a 2-year period. All patients underwent ML. Patient-reported relief of pain, preoperative and postoperative Voice Handicap Index 10 (VHI-10) scores, and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores were obtained. All eight patients (5 women and 3 men; mean age, 42 years) had durable relief of their discomfort postoperatively (average follow-up, 14 months). Mean VHI-10 scores improved significantly from 17.9 preoperatively to 6.3 postoperatively (P = .001), while perceptual voice parameters as measured by CAPE-V were unchanged. There were no complications. In select cases of VFMI, ML can relieve pain related to voice use, even in the absence of significant hoarseness.

  19. Congenital dystrophic medial rectus muscles.

    PubMed

    Murthy, Ramesh

    2017-01-01

    We report two patients, one with congenital dystrophic medial rectus muscles and one with absence of the medial rectus muscles; in addition, one of them had absence of the lateral rectus muscles. While absence of the superior oblique and superior rectus has been more commonly reported in literature, especially with craniofacial syndromes, our patients were nonsyndromic. Considering the risk of anterior segment ischemia, correction of the large-angle exotropia was performed by horizontal rectus muscle surgery where possible, along with transfer of the superior oblique tendon to the superior part of the normal medial rectus muscle insertion area to create a tethering effect with a good outcome.

  20. Medial surfaces of hyperbolic structures

    NASA Astrophysics Data System (ADS)

    Schröder, G. E.; Ramsden, S. J.; Christy, A. G.; Hyde, S. T.

    2003-10-01

    We describe an algorithm for numerical computation of a medial surface and an associated medial graph for three-dimensional shapes bounded by oriented triangulated surface manifolds in three-dimensional Euclidean space (domains). We apply the construction to bicontinuous domain shapes found in molecular self-assemblies, the cubic infinite periodic minimal surfaces of genus three: Gyroid (G), Diamond (D) and Primitive (P) surfaces. The medial surface is the locus of centers of maximal spheres, i.e. spheres wholly contained within the domains which graze the surface tangentially and are not contained in any other such sphere. The construction of a medial surface is a natural generalization of Voronoi diagrams to continuous surfaces. The medial surface provides an explicit construction of the volume element associated with a patch of the bounding surface, leading to a robust measure of the surface to volume ratio for complex forms. It also allows for sensible definition of a line graph (the medial graph), particularly useful for domains consisting of connected channels, and not reliant on symmetries of the domains. In addition, the medial surface construction produces a length associated with any point on the surface. Variations of this length give a useful measure of global homogeneity of topologically complex morphologies. Comparison of medial surfaces for the P, D and G surfaces reveal the Gyroid to be the most globally homogeneous of these cubic bicontinuous forms (of genus three). This result is compared with the ubiquity of the G surface morphology in soft mesophases, including lyotropic liquid crystals and block copolymers.

  1. Effects of practice and experience on the arcuate fasciculus: comparing singers, instrumentalists, and non-musicians.

    PubMed

    Halwani, Gus F; Loui, Psyche; Rüber, Theodor; Schlaug, Gottfried

    2011-01-01

    Structure and function of the human brain are affected by training in both linguistic and musical domains. Individuals with intensive vocal musical training provide a useful model for investigating neural adaptations of learning in the vocal-motor domain and can be compared with learning in a more general musical domain. Here we confirm general differences in macrostructure (tract volume) and microstructure (fractional anisotropy, FA) of the arcuate fasciculus (AF), a prominent white-matter tract connecting temporal and frontal brain regions, between singers, instrumentalists, and non-musicians. Both groups of musicians differed from non-musicians in having larger tract volume and higher FA values of the right and left AF. The AF was then subdivided in a dorsal (superior) branch connecting the superior temporal gyrus and the inferior frontal gyrus (STG ↔ IFG), and ventral (inferior) branch connecting the middle temporal gyrus and the inferior frontal gyrus (MTG ↔ IFG). Relative to instrumental musicians, singers had a larger tract volume but lower FA values in the left dorsal AF (STG ↔ IFG), and a similar trend in the left ventral AF (MTG ↔ IFG). This between-group comparison controls for the general effects of musical training, although FA was still higher in singers compared to non-musicians. Both musician groups had higher tract volumes in the right dorsal and ventral tracts compared to non-musicians, but did not show a significant difference between each other. Furthermore, in the singers' group, FA in the left dorsal branch of the AF was inversely correlated with the number of years of participants' vocal training. Our findings suggest that long-term vocal-motor training might lead to an increase in volume and microstructural complexity of specific white-matter tracts connecting regions that are fundamental to sound perception, production, and its feedforward and feedback control which can be differentiated from a more general musician

  2. Reduced Volume of the Arcuate Fasciculus in Adults with High-Functioning Autism Spectrum Conditions

    PubMed Central

    Moseley, Rachel L.; Correia, Marta M.; Baron-Cohen, Simon; Shtyrov, Yury; Pulvermüller, Friedemann; Mohr, Bettina

    2016-01-01

    Atypical language is a fundamental feature of autism spectrum conditions (ASC), but few studies have examined the structural integrity of the arcuate fasciculus, the major white matter tract connecting frontal and temporal language regions, which is usually implicated as the main transfer route used in processing linguistic information by the brain. Abnormalities in the arcuate have been reported in young children with ASC, mostly in low-functioning or non-verbal individuals, but little is known regarding the structural properties of the arcuate in adults with ASC or, in particular, in individuals with ASC who have intact language, such as those with high-functioning autism or Asperger syndrome. We used probabilistic tractography of diffusion-weighted imaging to isolate and scrutinize the arcuate in a mixed-gender sample of 18 high-functioning adults with ASC (17 Asperger syndrome) and 14 age- and IQ-matched typically developing controls. Arcuate volume was significantly reduced bilaterally with clearest differences in the right hemisphere. This finding remained significant in an analysis of all male participants alone. Volumetric reduction in the arcuate was significantly correlated with the severity of autistic symptoms as measured by the Autism-Spectrum Quotient. These data reveal that structural differences are present even in high-functioning adults with ASC, who presented with no clinically manifest language deficits and had no reported developmental language delay. Arcuate structural integrity may be useful as an index of ASC severity and thus as a predictor and biomarker for ASC. Implications for future research are discussed. PMID:27242478

  3. Altered Anterior-Posterior Connectivity Through the Arcuate Fasciculus in Temporal Lobe Epilepsy

    PubMed Central

    Takaya, Shigetoshi; Liu, Hesheng; Greve, Douglas N.; Tanaka, Naoaki; Leveroni, Catherine; Cole, Andrew J.; Stufflebeam, Steven M.

    2017-01-01

    How the interactions between cortices through a specific white matter pathway change during cognitive processing in patients with epilepsy remains unclear. Here, we used surface-based structural connectivity analysis to examine the change in structural connectivity with Broca’s area/the right Broca’s homologue in the lateral temporal and inferior parietal cortices through the arcuate fasciculus (AF) in 17 patients with left temporal lobe epilepsy (TLE) compared with 17 healthy controls. Then, we investigated its functional relevance to the changes in task-related responses and task-modulated functional connectivity with Broca’s area/the right Broca’s homologue during a semantic classification task of a single word. The structural connectivity through the AF pathway and task-modulated functional connectivity with Broca’s area decreased in the left midtemporal cortex. Furthermore, task-related response decreased in the left mid temporal cortex that overlapped with the region showing a decrease in the structural connectivity. In contrast, the region showing an increase in the structural connectivity through the AF overlapped with the regions showing an increase in task-modulated functional connectivity in the left inferior parietal cortex. These structural and functional changes in the overlapping regions were correlated. The results suggest that the change in the structural connectivity through the left frontal–temporal AF pathway underlies the altered functional networks between the frontal and temporal cortices during the language-related processing in patients with left TLE. The left frontal–parietal AF pathway might be employed to connect anterior and posterior brain regions during language processing and compensate for the compromised left frontal–temporal AF pathway. PMID:27452151

  4. The Arcuate Fasciculus and Language Development in a Cohort of Pediatric Patients with Malformations of Cortical Development.

    PubMed

    Paldino, M J; Hedges, K; Golriz, F

    2016-01-01

    Patients with epilepsy and malformations of cortical development have a high prevalence of language deficits. The purpose of this study was to investigate whether the status of the arcuate fasciculus at diffusion tractography could provide a clinically meaningful marker of language function in patients with cortical malformations. Thirty-seven patients 3-18 years of age who had DTI performed at 3T and language evaluation by a pediatric neurologist were retrospectively identified. Twenty-two age-matched children without any neurologic, language, or MR imaging abnormalities who had identical DTI performed for an indication of headache were selected as a control cohort. The arcuate fasciculi were constructed and segmented by deterministic tractography for all subjects. Twenty-one patients had intact language; 11 had mild-to-moderate and 5, profound language impairment. All patients with normal language and all control subjects had an identifiable left arcuate. The left arcuate was absent in 11 patients; all 11 were language-impaired. Failure to identify the left arcuate was strongly associated with some degree of language impairment (P < .001). Sensitivity, specificity, and positive predictive value for language dysfunction were 65%, 100%, and 100%, respectively. The absence of the arcuate bilaterally was associated with complete failure to develop oral language (P < .015). Failure to identify the left arcuate fasciculus at diffusion tractography was a highly specific marker of language dysfunction in a cohort of pediatric patients with malformations of cortical development. Failure to identify the arcuate fasciculus on either side was associated with failure to develop oral language. © 2016 by American Journal of Neuroradiology.

  5. Detection and Growth Pattern of Arcuate Fasciculus from Newborn to Adult

    PubMed Central

    Wilkinson, Molly; Lim, Ashley R.; Cohen, Andrew H.; Galaburda, Albert M.; Takahashi, Emi

    2017-01-01

    Fractional anisotropy (FA) threshold is commonly used to perform diffusion MRI tractography. However, FA threshold may be one aspect of tractography that needs additional scrutiny in accurately assessing pathways in immature, developing brains, as well as in adult brains. Using high-angular resolution diffusion MRI (HARDI) tractography without an FA threshold, we identified the arcuate fasciculus (AF) of 83 healthy subjects ranging in age from 40 gestational weeks (GW) (newborns) to 28-year-old adults. The AF was identified in both hemispheres in all subjects with high inter-rater reliability. The detected AF included regions with very low FA values. The entire AF was segmented into anterior, posterior, and long tracts. Growth and laterality patterns were investigated using tract count (number of detected streamlines), total volume of imaging voxels (touched by the detected streamlines), mean length, mean FA, and mean apparent diffusion coefficient (ADC). Comparison of subjects under 3 years old, to those that were older, revealed the three AF tracts that took different developmental courses. As expected, the anterior and long tracts showed lower ADC values in subjects over 3 years old, while the posterior tract showed higher ADC in that same age range. The posterior tract did not show age-related effect in terms of FA, tract count, length, and volume. These results suggest that the posterior AF tract shows a matured state, indexed by most of the used measurements in early postnatal developmental ages, and ADC is a measurement that can detect further maturation of the posterior tract. Interestingly, in all tracts, hemispheric asymmetries were found in raw (leftright) tract count, as well as in raw volume (left

  6. Forefoot flexibility and medial tibial stress syndrome.

    PubMed

    Kudo, Shintarou; Hatanaka, Yasuhiko

    2015-12-01

    To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively. Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.

  7. Transfrontoethmoidal approach to medial intraconal lesions.

    PubMed

    Jittapiromsak, Pakrit; Deshmukh, Pushpa; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

    2009-12-01

    Object The standard superior craniotomy approach through the orbital roof is obstructed by numerous muscles, nerves, and vessels. Accessing the medial intraconal space also involves considerable brain retraction. The authors present a modified approach through the frontal sinus that overcomes these limitations. Methods Seven fixed silicone-injected cadaveric specimens were dissected bilaterally. In addition to the superior orbital wall, the ethmoidal sinuses and medial orbital wall were removed. The anatomical relationships between the major neurovascular complexes in the medial intraconal space and the optic nerve were observed. Results Intraconally, working space was created both in a "superior window" between the superior oblique and levator palpebrae muscle and in a "medial window" between the superior oblique and medial rectus muscle. The superior window mainly created an ipsilateral trajectory to the deep target. The medial window, which created a contralateral trajectory, provided a more inferior view of the medial intraconal space. Removal of the medial orbital wall further widened the exposure obtained from the superior window. The combination of these working windows makes the medial surface of the optic nerve available for exploration from multiple angles. Most of the major neurovascular complexes of the posterior orbit can be retracted safely without impinging on the optic nerve. Conclusions This novel extradural transfrontoethmoidal approach affords a direct view to the medial posterior orbit without major conflicts with intraconal neurovascular structures and requires minimal brain manipulation. The approach appears to offer advantages for medially located intraconal lesions.

  8. Symmetry of the arcuate fasciculus and its impact on language performance of patients with brain tumors in the language-dominant hemisphere.

    PubMed

    Jehna, Margit; Becker, Juliane; Zaar, Karla; von Campe, Gord; Mahdy Ali, Kariem; Reishofer, Gernot; Payer, Franz; Synowitz, Michael; Fazekas, Franz; Enzinger, Christian; Deutschmann, Hannes

    2017-12-01

    OBJECTIVE Cerebral damage in frontal, parietal, and temporal brain areas and, probably more importantly, their interconnections can lead to deficits in language. However, neural plasticity and repair allow the brain to partly compensate for neural injury, mediated by both functional and structural changes. In this study, the authors sought to systematically investigate the relationship between language performance in brain tumor patients and structural perisylvian pathways (i.e., the arcuate fasciculus [AF]) using probabilistic fiber tracking on diffusion tensor imaging. The authors used a previously proposed model in which the AF is divided into anterior, long, and posterior segments. The authors hypothesized that right-handed patients with gliomas in the language-dominant (left) hemisphere would benefit from a more symmetrical or right-lateralized language pathway in terms of better preservation of language abilities. Furthermore, they investigated to what extent specific tumor characteristics, including proximity to the AF, affect language outcome in such patients. METHODS Twenty-seven right-handed patients (12 males and 15 females; mean age 52 ± 16 years) with 11 low-grade and 16 high-grade gliomas of the left hemisphere underwent 3-T diffusion-weighted MRI (30 directions) and language assessment as part of presurgical planning. For a systematic quantitative evaluation of the AF, probabilistic fiber tracking with a 2 regions of interest approach was carried out. Volumes of the 3 segments of both hemispheric AFs were evaluated by quantifying normalized and thresholded pathways. Resulting values served to generate the laterality index of the AFs. RESULTS Patients without language deficits tended to have an AF that was symmetric or lateralized to the right, whereas patients with deficits in language significantly more often demonstrated a left-lateralized posterior segment of the AF. Patients with high-grade gliomas had more severe language deficits than those

  9. Neuropsychological evidence for the crucial role of the right arcuate fasciculus in the face-based mentalizing network: A disconnection analysis.

    PubMed

    Nakajima, Riho; Yordanova, Yordanka N; Duffau, Hugues; Herbet, Guillaume

    2018-01-26

    Recent evidence from axonal stimulation mapping studies suggests that at least two white matter connectivities in the right hemisphere may be involved in face-based mentalizing, i.e. the ability to infer complex cognitive and affective states from human faces: the inferior fronto-occipital (IFOF) and the superior longitudinal/arcuate (SLF/AF) fasciculi. However, to date, only a handful of neuropsychological studies have focused on the white matter tracts subserving mentalizing in general, and face-based mentalizing in particular. Therefore, the main goal of this study was to confirm the abovementioned results by applying voxelwise and tractwise lesion-symptom analyses to a set of behavioral data obtained from a large and homogeneous group of neurological participants. More precisely, 122 patients operated on for diffuse low-grade glioma were assessed postoperatively with the well-validated "Reading the Mind in the Eyes" (RME) test. For each patient, the resection cavity and the residual tumor infiltration were mapped separately on the respective postoperative structural MRI. Behavioral data, previously controlled for sociodemographic factors, were then submitted to a standard voxel-based and to a less conservative, region-of-interest (ROI)-based, lesion-deficit analyses. Results were invariably the same: no anatomo-functional relationships were pinpointed by these investigations, making thus impossible the cortical topological localization of mentalizing deficits. In a second time, two kinds of tractwise lesion-symptom analyses based on the damaged volume and the disconnection probabilities of the white matter tracts, were performed. All results were corrected with the Bonferroni correction. Converging and strong evidence was found that resection-related disconnection of the right AF is especially deleterious for face-based mentalizing. More anecdotally, we identified the involvement of certain ventral tracts, especially the IFOF and the uncinate fasciculus (UF

  10. Acute Medial Plantar Fascia Tear.

    PubMed

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

  11. Bilateral discoid medial meniscus associated with meniscal tears and hypoplasia of the medial femoral condyle

    PubMed Central

    Wang, Hong-De; Gao, Shi-Jun

    2017-01-01

    Abstract Rationale: Bilateral discoid medial menisci is an extremely rare abnormality of the knee joint. The presence of a discoid medial meniscus has been associated with magnetic resonance imaging (MRI) and radiographic changes in the tibial region, such as cupping of the medial tibial plateau and tibial physis collapse. While discoid medial meniscal tears with hypoplasia of the femoral medial condyles have not been previously reported. Herein, we report a case of bilateral discoid medial menisci associated with meniscal tears and femoral bone changes. Patient concerns: A 28-year-old man presented with left knee pain and restricted range of motion; the right knee was asymptomatic. Diagnoses: Based on radiographic and MRI findings, he was diagnosed with bilateral discoid medial meniscal tears. Interventions: Partial meniscectomy and reshaping were performed for the torn discoid medial meniscus of the left knee only. Outcomes: MRI revealed short, flattened femoral medial condyles in the coronal and sagittal planes, and hypoplasia of the femoral medial condyles in the axial plane; these findings were confirmed arthroscopically in the left knee. The patient had a satisfactory results at the 12-month follow-up. Lessons: This case indicates a potential link between discoid medial menisci and hypoplasia of the femoral medial condyle. We recommend preservation of the discoid medial meniscus in asymptomatic patients, while arthroscopic partial meniscectomy and reshaping is recommended in symptomatic patients. PMID:29145286

  12. Gender moderates the association between dorsal medial prefrontal cortex volume and depressive symptoms in a subclinical sample.

    PubMed

    Carlson, Joshua M; Depetro, Emily; Maxwell, Joshua; Harmon-Jones, Eddie; Hajcak, Greg

    2015-08-30

    Major depressive disorder is associated with lower medial prefrontal cortex volumes. The role that gender might play in moderating this relationship and what particular medial prefrontal cortex subregion(s) might be implicated is unclear. Magnetic resonance imaging was used to assess dorsal, ventral, and anterior cingulate regions of the medial prefrontal cortex in a normative sample of male and female adults. The Depression, Anxiety, and Stress Scale (DASS) was used to measure these three variables. Voxel-based morphometry was used to test for correlations between medial prefrontal gray matter volume and depressive traits. The dorsal medial frontal cortex was correlated with greater levels of depression, but not anxiety and stress. Gender moderates this effect: in males greater levels of depression were associated with lower dorsal medial prefrontal volumes, but in females no relationship was observed. The results indicate that even within a non-clinical sample, male participants with higher levels of depressive traits tend to have lower levels of gray matter volume in the dorsal medial prefrontal cortex. Our finding is consistent with low dorsal medial prefrontal volume contributing to the development of depression in males. Future longitudinal work is needed to substantiate this possibility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Injection medialization laryngoplasty in children.

    PubMed

    Cohen, Michael S; Mehta, Deepak K; Maguire, Raymond C; Simons, Jeffrey P

    2011-03-01

    To review our experience with vocal fold injection medialization in children. Retrospective case series. Tertiary care academic children's hospital. All pediatric patients at our institution who underwent injection laryngoplasty for vocal fold medialization from 2003 to 2009. Age, sex, indication for injection, injection material, surgical and anesthetic technique, outcomes including effect on voice and swallowing, and complications. Thirteen patients underwent 27 injections. Mean patient age was 8.0 years (range, 1.3-18.0 years). The causes of glottic insufficiency included prolonged intubation (6 patients, 46%), patent ductus arteriosus ligation (2 patients, 15%), other cardiac surgery (2 patients, 15%), neck surgery or trauma (2 patients, 15%), and postviral status (1 patient, 8%). Eight patients had vocal fold paralysis or paresis; 3 had vocal fold atrophy; and 2 had vocal fold scarring. Indications for surgery included hoarseness (11 patients), aspiration (5 patients), and dysphagia without aspiration (1 patient). Materials injected included Gelfoam (n = 13), Radiesse Voice (n = 10), and Radiesse Voice Gel (n = 4). The average number of injections per patient was 2.1 (range, 1-9). Patients experienced improvement in symptoms (subjective or objective) after injection in 24 of 27 cases (89%); 15 of 16 injections in patients with hoarseness led to improvement (94%); and 11 of 13 injections in patients with dysphagia or aspiration led to improvement (85%). One patient experienced 2 days of inspiratory stridor postoperatively, which resolved spontaneously. There were no other complications. This study supports injection laryngoplasty as a safe and effective intervention for children with glottic insufficiency. Further prospective studies are necessary to confirm these findings.

  14. Mild Traumatic Brain Injury and Conduction Aphasia from a Close Proximity Blast Resulting in Arcuate Fasciculus Damage Diagnosed on DTI Tractography

    DTIC Science & Technology

    2009-11-01

    Conduction Aphasia from a Close Proximity Blast Resulting in Arcuate Fasciculus Damage Diagnosed on DTI Tractography Guarantor: J. Wesson Ashford...November 2009 issue. 1 The authors present a case demonstrating that a blast injury was associated with both conduction aphasia and an abnormality in...study demonstrating that damage to the AF is associated with conduction aphasia .2 Based on the patient’s length of posttraumatic amnesia this

  15. The lateralized arcuate fasciculus in developmental pitch disorders among mandarin amusics: left for speech and right for music.

    PubMed

    Chen, Xizhuo; Zhao, Yanxin; Zhong, Suyu; Cui, Zaixu; Li, Jiaqi; Gong, Gaolang; Dong, Qi; Nan, Yun

    2018-01-10

    The arcuate fasciculus (AF) is a neural fiber tract that is critical to speech and music development. Although the predominant role of the left AF in speech development is relatively clear, how the AF engages in music development is not understood. Congenital amusia is a special neurodevelopmental condition, which not only affects musical pitch but also speech tone processing. Using diffusion tensor tractography, we aimed at understanding the role of AF in music and speech processing by examining the neural connectivity characteristics of the bilateral AF among thirty Mandarin amusics. Compared to age- and intelligence quotient (IQ)-matched controls, amusics demonstrated increased connectivity as reflected by the increased fractional anisotropy in the right posterior AF but decreased connectivity as reflected by the decreased volume in the right anterior AF. Moreover, greater fractional anisotropy in the left direct AF was correlated with worse performance in speech tone perception among amusics. This study is the first to examine the neural connectivity of AF in the neurodevelopmental condition of amusia as a result of disrupted music pitch and speech tone processing. We found abnormal white matter structural connectivity in the right AF for the amusic individuals. Moreover, we demonstrated that the white matter microstructural properties of the left direct AF is modulated by lexical tone deficits among the amusic individuals. These data support the notion of distinctive pitch processing systems between music and speech.

  16. Words are not enough: nonword repetition as an indicator of arcuate fasciculus integrity during brain tumor resection.

    PubMed

    Sierpowska, Joanna; Gabarrós, Andreu; Fernandez-Coello, Alejandro; Camins, Àngels; Castañer, Sara; Juncadella, Montserrat; Morís, Joaquín; Rodríguez-Fornells, Antoni

    2017-02-01

    OBJECTIVE Subcortical electrical stimulation during brain surgery may allow localization of functionally crucial white matter fibers and thus tailoring of the tumor resection according to its functional limits. The arcuate fasciculus (AF) is a white matter bundle connecting frontal, temporal, and parietal cortical areas that is often disrupted by left brain lesions. It plays a critical role in several cognitive functions related to phonological processing, but current intraoperative monitoring methods do not yet allow mapping of this tract with sufficient precision. In the present study the authors aimed to test a new paradigm for the intraoperative monitoring of the AF. METHODS In this report, the authors studied 12 patients undergoing awake brain surgery for tumor resection with a related risk of AF damage. To preserve AF integrity and the cognitive processes sustained by this tract in the intraoperative context, the authors used real word repetition (WR) and nonword repetition (NWR) tasks as complements to standard picture naming. RESULTS Compared with the errors identified by WR or picture naming, the NWR task allowed the detection of subtle errors possibly related to AF alterations. Moreover, only 3 patients demonstrated phonological paraphasias in standard picture naming, and in 2 of these patients the paraphasias co-occurred with the total loss of WR and NWR ability. Before surgery, lesion volume predicted a patient's NWR performance. CONCLUSIONS The authors suggest that monitoring NWR intraoperatively may complement the standard naming tasks and could permit better preservation of the important language production functions subserved by the AF.

  17. The clinical application of the arcuate fasciculus for stroke patients with aphasia: a diffusion tensor tractography study.

    PubMed

    Kim, Soo Hyun; Lee, Dong Gyu; You, Hee; Son, Su Min; Cho, Yun Woo; Chang, Min Cheol; Lee, Jun; Jang, Sung Ho

    2011-01-01

    Little is known about the clinical usefulness of diffusion tensor tractography (DTT) for the arcuate fasciculus (AF) in stroke patients with aphasia. Using DTT, we attempted to investigate the clinical usefulness of the AF in patients with aphasia. Five stroke patients and 7 age- and sex-matched normal subjects were recruited for this study. We recruited stroke patients with language dysfunction who had lesions in the left corona radiata and basal ganglia level. DTT for the AF was reconstructed using DTI-studio software. Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. Patient 1, who showed mild dysarthria, revealed a normal left AF in terms of integrity and DTT parameters. In patient 2, with conduction aphasia, the left AF showed partial injury; however, the integrity of the left AF was spared. Patients 3 and 4, who had no brain lesions at Broca's area on conventional brain MRI, showed disruptions of the left AF over the stroke lesions after originating from Wernicke's area and they presented with Broca's aphasia. Patient 5 revealed global aphasia on K-WAB and the left AF was not reconstructed due to severe injury and Wallerian degeneration. We found that DTT for the AF could provide useful information on the presence or severity of injury of the AF, which could not be detected on conventional brain MRI in stoke patients. In addition, it could be helpful in classification of the aphasia type of stroke patients.

  18. Excellent recovery of aphasia in a patient with complete injury of the arcuate fasciculus in the dominant hemisphere.

    PubMed

    Kwon, Hyeok Gyu; Jang, Sung Ho

    2011-01-01

    The arcuate fasciculus (AF) is the neural tract that connects Wernicke's area and Broca's area. The main role of the AF is speech repetition; therefore, injury to the AF typically causes conduction aphasia. We report on a patient who showed excellent recovery of aphasia despite complete injury of the AF due to a cerebral infarct. A 54-year-old, right-handed male presented with aphasia and right hemiparesis. Brain MRI showed an infarct in the left centrum semiovale and corona radiata. Diffusion tensor tractography for the AF was reconstructed using DTI-studio software. The Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. On K-WAB at 1 week after onset, his aphasia type was compatible with global aphasia (aphasia quotient: 12‰, fluency: 5‰, comprehension: 24‰, repetition: 15‰, and naming: 31‰). The patient underwent rehabilitative therapy, including language therapy and medication, which is known to facilitate recovery from aphasia, for a period of 24 months. His aphasia had improved to a nearly normal state at 30 months after onset; aphasia quotient: 93‰ (fluency: 91‰, comprehension: 92‰, repetition: 85‰, and naming: 96‰). The left AF showed a complete disruption on 27-month diffusion tensor tractography. Findings from this study suggest the possibility that aphasia might show good recovery, even in cases of severe injury of the AF.

  19. Changes in maps of language function and the integrity of the arcuate fasciculus after therapy for chronic aphasia.

    PubMed

    Breier, Joshua I; Juranek, Jenifer; Papanicolaou, Andrew C

    2011-12-01

    A patient with chronic aphasia secondary to unilateral stroke in the left hemisphere underwent language testing, diffusion tensor imaging (DTI), and functional imaging using magnetoencephalography (MEG) at four time points: 3 weeks prior to, immediately prior to, immediately after, and 3 months after Constraint Induced Language Therapy (CILT). Performance on language tests involving visual naming and repetition of spoken sentences improved between the immediately prior to and immediately after CILT testing sessions, but not between the pre-CILT sessions. MEG activation in putative pre-morbid language areas of the left hemisphere and homotopic areas of the right hemisphere increased immediately after therapy, as did integrity within the arcuate fasciculus bilaterally. These changes were not evident between the two pre-CILT sessions. While some of these functional, neurophysiological and structural changes had regressed 3 months after therapy, all remained at or above baseline levels. Results provide evidence for an association between improvement in functional status and the increased integrity within a white matter tract known to be involved in language function and its contralateral homologue, as well as increased neurophysiological activity in areas that have the potential to subserve language function bilaterally.

  20. Internal knee lesions and medial discoid meniscus.

    PubMed

    Mazzarri, N F; Lotti, A

    1977-04-01

    The authors stress the great importance of stability in the normal functioning of the knee and its resistance to injury. They describe a case of multiple internal lesions involving the anterior cruciate ligament, the medial collateral ligament and the lateral meniscus sustained in a knee already affected by a discoid medial meniscus. These lesions were caused by a relatively slight injury and the knee for some time over reacted to the slightest stress. Operation revealed the existance of a discoid medial meniscus and in the view of the authors this was the cause both of the knee's instability and previous episodes as well as the final severe traumatic syndrome revealed at operation. Discoid medial meniscus is extremely rare. Smillie's classification into three groups and the various pathogenetic hypotheses are discussed. The authors analyse the relation between knee instability and meniscal malformation and conclude that discoid medial meniscus plays a primary role in rendering the joint highly vulnerable.

  1. 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

  2. Impact of reading habit on white matter structure: Cross-sectional and longitudinal analyses.

    PubMed

    Takeuchi, Hikaru; Taki, Yasuyuki; Hashizume, Hiroshi; Asano, Kohei; Asano, Michiko; Sassa, Yuko; Yokota, Susumu; Kotozaki, Yuka; Nouchi, Rui; Kawashima, Ryuta

    2016-06-01

    Psychological studies showed the quantity of reading habit affects the development of their reading skills, various language skills, and knowledge. However, despite a vast amount of literature, the effects of reading habit on the development of white matter (WM) structures critical to language and reading processes have never been investigated. In this study, we used the fractional anisotropy (FA) measure of diffusion tensor imaging to measure WM microstructural properties and examined cross-sectional and longitudinal correlations between reading habit and FA of the WM bundles in a large sample of normal children. In both cross-sectional and longitudinal analyses, we found that greater strength of reading habit positively affected FA in the left arcuate fasciculus (AF), in the left inferior fronto-occipital fasciculus (IFOF), and in the left posterior corona radiata (PCR). Consistent with previous studies, we also confirmed the significance or a tendency for positive correlation between the strength of reading habit and the Verbal Comprehension score in cross-sectional and longitudinal analyses. These cross-sectional and longitudinal findings indicate that a healthy reading habit may be directly or indirectly associated with the advanced development of WM critical to reading and language processes. Future intervention studies are needed to determine the causal effects of reading habits on WM in normal children. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Relationship between small-size medial orbital wall fracture and late enophthalmos.

    PubMed

    Lee, Won Taeg; Kim, Han Kyeol; Chung, Seung Moon

    2009-01-01

    According to the result of retrospective studies for patients who have not taken medical treatment, most patients experience late enophthalmos and perceive their facial asymmetry. Thus, correct diagnosis method and concrete operative indication were required for medial orbital wall fracture. Retrospective investigation on all patients with facial trauma, who had visited the emergency room between January 1, 2000 and December 31, 2006, was made. Height and longitudinal length of the defect were obtained, and computed tomographic scan of the defect area was obtained. The degree of enophthalmos was measured, and investigation on enophthalmos and presence of facial asymmetry perceived by the patients was made. When the defect area of medial orbital wall fracture was 0.55 cm, late enophthalmos of 1 mm occurred, and patients with late enophthalmos of 1 mm or more perceived their enophthalmos and facial asymmetry. In conclusion, medial orbital wall fracture whose defect area is 0.55 cm or more requires operation.

  4. Aneurysmal bone cyst of medial cuneiform and a novel surgical technique for mid-foot reconstruction.

    PubMed

    Kumar, Venkatesan Sampath; Jalan, Divesh; Khan, Shah Alam; Mridha, Asit Ranjan

    2014-02-21

    Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.

  5. Postoperative change in medial meniscal length in concurrent all-inside meniscus repair with anterior cruciate ligament reconstruction.

    PubMed

    Furumatsu, Takayuki; Miyazawa, Shinichi; Tanaka, Takaaki; Okada, Yukimasa; Fujii, Masataka; Ozaki, Toshifumi

    2014-07-01

    Meniscus repair can restore meniscal function that transfers the axial compressive force to circumferential tensile strain. However, few reports have investigated the relationship between concurrent meniscus repair with acute anterior cruciate ligament (ACL) reconstruction and postoperative meniscal position. This study aimed to evaluate medial meniscal size and clinical results in patients who underwent ACL reconstruction and concomitant all-inside medial meniscus repair. Twenty patients underwent ACL reconstruction and concurrent medial meniscus repair of a peripheral longitudinal tear using the FasT-Fix meniscal repair device. Medial tibial plateau length (MTPL) and width (MTPW) were determined by radiographic images. We evaluated the Lysholm score, anteroposterior instability, meniscal healing and magnetic resonance imaging (MRI)-based medial meniscal length (MML) and width (MMW). Correlations between MRI-based meniscal size, radiographic measurement and height were investigated. All patients showed complete healing of the repaired meniscus in arthroscopic evaluation. However, one patient needed a subsequent meniscus repair during the follow-up period. Lysholm score and anteroposterior instability improved significantly. A better correlation was observed between MMW and MTPW than between MML and MTPL. Concurrent all-inside medial meniscus repair with ACL reconstruction significantly increased MML percentage (%MML) (100 MML/MTPL) but did not affect MMW percentage (%MMW) (100 MMW/MTPW). Concurrent all-inside medial meniscus repair with ACL reconstruction had satisfactory clinical results. %MML was increased by concurrent medial meniscus repair without affecting %MMW. Our results suggest that medial meniscus repair associated with ACL reconstruction may restore meniscal function by adjusting the anteroposterior length of the torn medial meniscus.

  6. Subcomponents and Connectivity of the Inferior Fronto-Occipital Fasciculus Revealed by Diffusion Spectrum Imaging Fiber Tracking

    PubMed Central

    Wu, Yupeng; Sun, Dandan; Wang, Yong; Wang, Yibao

    2016-01-01

    The definitive structure and functional role of the inferior fronto-occipital fasciculus (IFOF) are still controversial. In this study, we aimed to investigate the connectivity, asymmetry, and segmentation patterns of this bundle. High angular diffusion spectrum imaging (DSI) analysis was performed on 10 healthy adults and a 90-subject DSI template (NTU-90 Atlas). In addition, a new tractography approach based on the anatomic subregions and two regions of interest (ROI) was evaluated for the fiber reconstructions. More widespread anterior-posterior connections than previous “standard” definition of the IFOF were found. This distinct pathway demonstrated a greater inter-subjects connective variability with a maximum of 40% overlap in its central part. The statistical results revealed no asymmetry between the left and right hemispheres and no significant differences existed in distributions of the IFOF according to sex. In addition, five subcomponents within the IFOF were identified according to the frontal areas of originations. As the subcomponents passed through the anterior floor of the external capsule, the fibers radiated to the posterior terminations. The most common connection patterns of the subcomponents were as follows: IFOF-I, from frontal polar cortex to occipital pole, inferior occipital lobe, middle occipital lobe, superior occipital lobe, and pericalcarine; IFOF-II, from orbito-frontal cortex to occipital pole, inferior occipital lobe, middle occipital lobe, superior occipital lobe, and pericalcarine; IFOF-III, from inferior frontal gyrus to inferior occipital lobe, middle occipital lobe, superior occipital lobe, occipital pole, and pericalcarine; IFOF-IV, from middle frontal gyrus to occipital pole, and inferior occipital lobe; IFOF-V, from superior frontal gyrus to occipital pole, inferior occipital lobe, and middle occipital lobe. Our work demonstrates the feasibility of high resolution diffusion tensor tractography with sufficient sensitivity

  7. Damage to the left uncinate fasciculus is associated with heightened schizotypal traits: A multimodal lesion-mapping study.

    PubMed

    Lemaitre, Anne-Laure; Lafargue, Gilles; Duffau, Hugues; Herbet, Guillaume

    2018-02-27

    A growing body of evidence suggests that individuals with pronounced schizotypal traits also display particular neurophysiological and morphological features - notably with regard to left frontotemporal connectivity. However, the studies published to date have focused on subclinical subjects and psychiatric patients, rather than brain-damaged patients. Here, we used the French version of the Schizotypal Personality Questionnaire to assess schizotypal traits in a sample of 97 patients having undergone surgical resection of a diffuse low-grade glioma. Patients having received other neurooncological treatments (including chemotherapy and radiotherapy) were not included. A combination of ROI-based based voxel-wise and tract-wise lesion-symptom mapping and a disconnectome analysis were performed, in order to identify the putative neural network associated with schizotypy. The ROI-based lesion-symptom mapping revealed a significant relationship between the cognitive-perceptual (positive) dimension of schizotypy and the left inferior gyrus (including the pars opercularis and the pars orbitalis). Importantly, we found that disconnection of the left uncinate fasciculus (UF) was a powerful predictor of the positive dimension of schizotypy. Lastly, the disconnection analysis indicated that the positive dimension of schizotypy was significantly associated with the white matter fibres deep in the left orbital and inferior frontal gyri and the left superior temporal pole, which mainly correspond to the spatial topography of the left UF. Taken as a whole, our results suggest that dysconnectivity of the neural network supplied by the left UF is associated with heightened positive schizotypal traits. Our new findings may be of value in interpreting current research in the field of biological psychiatry. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Asymmetric projections of the arcuate fasciculus to the temporal cortex underlie lateralized language function in the human brain

    DOE PAGES

    Takaya, Shigetoshi; Kuperberg, Gina R.; Liu, Hesheng; ...

    2015-09-15

    The arcuate fasciculus (AF) in the human brain has asymmetric structural properties. However, the topographic organization of the asymmetric AF projections to the cortex and its relevance to cortical function remain unclear. Here we mapped the posterior projections of the human AF in the inferior parietal and lateral temporal cortices using surface-based structural connectivity analysis based on diffusion MRI and investigated their hemispheric differences. We then performed the cross-modal comparison with functional connectivity based on resting-state functional MRI (fMRI) and task-related cortical activation based on fMRI using a semantic classification task of single words. Structural connectivity analysis showed that themore » left AF connecting to Broca's area predominantly projected in the lateral temporal cortex extending from the posterior superior temporal gyrus to the mid part of the superior temporal sulcus and the middle temporal gyrus, whereas the right AF connecting to the right homolog of Broca's area predominantly projected to the inferior parietal cortex extending from the mid part of the supramarginal gyrus to the anterior part of the angular gyrus. The left-lateralized projection regions of the AF in the left temporal cortex had asymmetric functional connectivity with Broca's area, indicating structure-function concordance through the AF. During the language task, left-lateralized cortical activation was observed. Among them, the brain responses in the temporal cortex and Broca's area that were connected through the left-lateralized AF pathway were specifically correlated across subjects. These results suggest that the human left AF, which structurally and functionally connects the mid temporal cortex and Broca's area in asymmetrical fashion, coordinates the cortical activity in these remote cortices during a semantic decision task. As a result, the unique feature of the left AF is discussed in the context of the human capacity for language.« less

  9. Asymmetric projections of the arcuate fasciculus to the temporal cortex underlie lateralized language function in the human brain

    SciTech Connect

    Takaya, Shigetoshi; Kuperberg, Gina R.; Liu, Hesheng; Greve, Douglas N.; Makris, Nikos; Stufflebeam, Steven M.

    2015-09-15

    The arcuate fasciculus (AF) in the human brain has asymmetric structural properties. However, the topographic organization of the asymmetric AF projections to the cortex and its relevance to cortical function remain unclear. Here we mapped the posterior projections of the human AF in the inferior parietal and lateral temporal cortices using surface-based structural connectivity analysis based on diffusion MRI and investigated their hemispheric differences. We then performed the cross-modal comparison with functional connectivity based on resting-state functional MRI (fMRI) and task-related cortical activation based on fMRI using a semantic classification task of single words. Structural connectivity analysis showed that the left AF connecting to Broca's area predominantly projected in the lateral temporal cortex extending from the posterior superior temporal gyrus to the mid part of the superior temporal sulcus and the middle temporal gyrus, whereas the right AF connecting to the right homolog of Broca's area predominantly projected to the inferior parietal cortex extending from the mid part of the supramarginal gyrus to the anterior part of the angular gyrus. The left-lateralized projection regions of the AF in the left temporal cortex had asymmetric functional connectivity with Broca's area, indicating structure-function concordance through the AF. During the language task, left-lateralized cortical activation was observed. Among them, the brain responses in the temporal cortex and Broca's area that were connected through the left-lateralized AF pathway were specifically correlated across subjects. These results suggest that the human left AF, which structurally and functionally connects the mid temporal cortex and Broca's area in asymmetrical fashion, coordinates the cortical activity in these remote cortices during a semantic decision task. As a result, the unique feature of the left AF is discussed in the context of the human capacity for language.

  10. [Tibial periostitis ("medial tibial stress syndrome")].

    PubMed

    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  11. Medial Double Arthrodesis: Technique Guide and Tips.

    PubMed

    So, Eric; Reb, Christopher W; Larson, David R; Hyer, Christopher F

    2017-12-15

    The triple arthrodesis procedure remains the historical standard to treat complex hindfoot pathology. However, in recent data, the medial double arthrodesis has been documented to provide similar benefit with decreased complication rates compared with the triple arthrodesis. Therefore, increased interest in this procedure for the treatment of complex hindfoot pathologies has ensued. We describe the technical components of the medial double arthrodesis. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?

    PubMed

    Victor, Jan; Wong, Pius; Witvrouw, Eric; Sloten, Jos Vander; Bellemans, Johan

    2009-10-01

    Ligament isometry is a cornerstone in the description of normal knee function and thorough knowledge is mandatory for successful repair of torn ligaments. This study was undertaken to validate a novel experimental model for the study of ligament strains and to determine the length changes in the superficial medial collateral, lateral collateral, and medial patellofemoral ligaments. Descriptive laboratory study. Passive motions and loaded squats of 12 cadaveric specimens were performed while controlling ankle load and optically tracking the motion of the bones. Preexperiment and postexperiment computed axial tomography scans allow the transformation of rigid body motion to relative motion of relevant anatomic landmarks on the femur, tibia, and patella. The superficial medial collateral ligament is a near-isometric ligament with a strain of less than 2%. The ligament is a little more slack in midflexion (30 degrees to 50 degrees ) and in deep flexion, but length changes are not significant (P > .05). The lateral collateral ligament behaves near isometric (<2% strain) from 0 degrees to 70 degrees of knee flexion. Cartilage compression in a loaded environment relieves tension from the collateral ligaments (P < .05). The medial patellofemoral ligament is nonisometric. The cranial part of the medial patellofemoral ligament is most taut at full extension, while the caudal part is most taut at 30 degrees of knee flexion. Ligament insertion sites on the femur, patella, and fibula can be derived from computed axial tomography scans. The described model allows the study of dynamic ligament behavior. The superficial medial collateral ligament is a near-isometric ligament with no significant length changes. The medial patellofemoral ligament behaves differently in its cranial and caudal parts. In knees with chronic medial collateral ligament insufficiency, isometric repair of the superficial medial collateral ligament can be attempted. A medial patellofemoral ligament

  13. Injuries to the medial collateral ligament and associated medial structures of the knee.

    PubMed

    Wijdicks, Coen A; Griffith, Chad J; Johansen, Steinar; Engebretsen, Lars; LaPrade, Robert F

    2010-05-01

    *The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most commonly injured ligamentous structures of the knee. *The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament. *Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20 degrees and 30 degrees of knee flexion. *Because nonoperative treatment has a favorable outcome, there is a consensus that it should be the first step in the management of acute isolated grade-III injuries of the medial collateral ligament or such injuries combined with an anterior cruciate ligament tear. *If operative treatment is required, an anatomic repair or reconstruction is recommended.

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

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

    2017-12-01

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

  16. Medial Impingement of the Ankle in Athletes

    PubMed Central

    Manoli, Arthur

    2010-01-01

    Context: Medial impingement syndrome of the ankle is common in the athletic population. A marginal osteophyte on the leading edge of the medial talar facet and a corresponding “kissing” osteophyte on the tibia, in front of the medial malleolus, may abut and cause pain and limited dorsiflexion. Background: Palpation of the talar osteophyte and standard imaging—especially, the oblique view of the foot—are useful in making the diagnosis. Surgical removal of the osteophyte may be necessary. Conclusions: Ankle impingement is commonly seen in running and jumping sports, especially if the athlete has a subtle cavus foot. It may be associated with ankle instability, osteochondritis dissecans of the talus, and stress fractures of the foot. PMID:23015980

  17. Arthroscopic detection of medial meniscal injury with the use of a joint distractor in small-breed dogs.

    PubMed

    Kim, Joo-Ho; Heo, Su-Young; Lee, Hae-Beom

    2017-12-31

    The goal of the present study was to evaluate the diagnostic value of a joint distractor in arthroscopy in small-breed dogs. Sixty stifle joints, which were collected from thirty cadavers, were used in this study. To simulate different injuries, no medial meniscal tear, a full-thickness vertical longitudinal tear, a partial-thickness vertical longitudinal tear, full- and partial-thickness vertical longitudinal tears, or a peripheral detachment were created on the caudal horn of the medial meniscus of each stifle joint along with rupture of the cranial cruciate ligament. Each stifle joint then underwent arthroscopy with and without a joint distractor. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and correct classification rate (CCR) for the diagnosis of each type of medial meniscus pathology were calculated. For arthroscopy with and without a joint distractor, the Sn was 85% and 60%, the Sp was 96% and 92%, the PPV was 85% and 65%, the NPV was 96% and 90%, and the CCR was 94% and 86%, respectively. Arthroscopy is an effective diagnostic method for the assessment of medial meniscal pathologies in small-breed dogs, especially when performed with the aid of a joint distractor.

  18. Adult medial orbital wall trapdoor fracture with missing medial rectus muscle.

    PubMed

    Kakizaki, Hirohiko; Zako, Masahiro; Katori, Nobutada; Iwaki, Masayoshi

    2006-03-01

    We report the case of a 28-year-old man presenting with a medial orbital wall trapdoor fracture with a missing medial rectus muscle. We believe this to be the first case report of an adult medial orbital wall trapdoor fracture. Trapdoor fractures most commonly occur in the pediatric population, and those involving the medial orbital wall generally occur in areas with less developed ethmoid air cells. Since the present case followed neither pattern, a different injury mechanism was considered. The ethmoid air cells in this case were well developed, which may have played an important role in the pathogenesis of this adult medial orbital wall trapdoor fracture. Based on our findings, we propose a possible mechanism for a medial orbital wall trapdoor fracture in an adult. The cellular frames enable the medial bone to shift just minimally, regardless of the high orbital pressure during a blow. The excess volume of the orbital content escapes into the cells through narrow cracks; therefore, after a blow, it cannot move back completely into the orbit. Consequently, it pushes the shifted bone towards the orbit, becoming trapped in a manner similar to that of a check-valve mechanism.

  19. Inversion/Eversion Strength Dysbalance in Patients With Medial Tibial Stress Syndrome

    PubMed Central

    Yüksel, Oguz; Özgürbüz, Cengizhan; Ergün, Metin; Işlegen, Çetin; Taskiran, Emin; Denerel, Nevzad; Ertat, Ahmet

    2011-01-01

    The main purpose of the study is to investigate the inversion/eversion muscle strength balance of the ankle in patients with medial tibial stress syndrome (MTSS). A dysbalance of these muscles may play a role in the pathophysiology of MTSS. Another aim is to measure the medial longitudinal arch and navicular drop in patients with MTSS. A total of 11 patients diagnosed with MTSS in the outpatient clinic of Ege University School of Medicine Sports Medicine Department were enrolled in this study. The control group consisted of 11 regularly exercising individuals. The mean age of the patient group and the control group was 21. 0 ± 1.9 years (18-23 years) and 23.2 ± 2.9 years (18-27 years), respectively. A detailed exercise questionnaire was administered to all subjects. Isokinetic muscle strength testing was performed at 30°/sec and 120°/sec to assess invertor and evertor muscle strength of the ankle. Photographs of the weight bearing and non-weight bearing foot were taken to measure the medial longitudinal arch deformation and the navicular drop. At 30°/sec, the average eversion concentric strength was significantly higher in the patient group, and the inversion/eversion strength ratio was significantly higher in the control group (p < 0.05). At 120°/sec velocity, average concentric eversion strength was significantly higher in the patient group (p < 0.05). The measurements of pronation indicators did not reveal any statistically significant differences between the two groups (p > 0.05). MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles. This observation may be of additional value in the prevention and therapy of MTSS. Key points At 30°/sec, the average eversion concentric strength was significantly higher in the MTSS group, and the inversion

  20. Inversion/Eversion strength dysbalance in patients with medial tibial stress syndrome.

    PubMed

    Yüksel, Oguz; Ozgürbüz, Cengizhan; Ergün, Metin; Işlegen, Cetin; Taskiran, Emin; Denerel, Nevzad; Ertat, Ahmet

    2011-01-01

    The main purpose of the study is to investigate the inversion/eversion muscle strength balance of the ankle in patients with medial tibial stress syndrome (MTSS). A dysbalance of these muscles may play a role in the pathophysiology of MTSS. Another aim is to measure the medial longitudinal arch and navicular drop in patients with MTSS. A total of 11 patients diagnosed with MTSS in the outpatient clinic of Ege University School of Medicine Sports Medicine Department were enrolled in this study. The control group consisted of 11 regularly exercising individuals. The mean age of the patient group and the control group was 21. 0 ± 1.9 years (18-23 years) and 23.2 ± 2.9 years (18-27 years), respectively. A detailed exercise questionnaire was administered to all subjects. Isokinetic muscle strength testing was performed at 30°/sec and 120°/sec to assess invertor and evertor muscle strength of the ankle. Photographs of the weight bearing and non-weight bearing foot were taken to measure the medial longitudinal arch deformation and the navicular drop. At 30°/sec, the average eversion concentric strength was significantly higher in the patient group, and the inversion/eversion strength ratio was significantly higher in the control group (p < 0.05). At 120°/sec velocity, average concentric eversion strength was significantly higher in the patient group (p < 0.05). The measurements of pronation indicators did not reveal any statistically significant differences between the two groups (p > 0.05). MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles. This observation may be of additional value in the prevention and therapy of MTSS. Key pointsAt 30°/sec, the average eversion concentric strength was significantly higher in the MTSS group, and the inversion

  1. Medial tibial stress syndrome: case report.

    PubMed

    Jovicić, Milica; Jovicić, Vladimir; Hrković, Marija; Lazović, Milica

    2014-01-01

    Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome.

  2. Medial branch neurotomy in low back pain.

    PubMed

    Masala, Salvatore; Nano, Giovanni; Mammucari, Matteo; Marcia, Stefano; Simonetti, Giovanni

    2012-07-01

    This study aimed to assess the effectiveness of pulsed radiofrequency medial branch dorsal ramus neurotomy in patients with facet joint syndrome. From January 2008 to April 2010, 92 patients with facet joint syndrome diagnosed by strict inclusion criteria and controlled diagnostic blocks undergone medial branch neurotomy. We did not exclude patients with failed back surgery syndrome (FBSS). Electrodes (20G) with 5-mm active tip were placed under fluoroscopy guide parallel to medial branch. Patients were followed up by physical examination and by Visual Analog Scale and Oswestry Disability Index at 1, 6, and 12 months. In all cases, pain improvement was statistically significant and so quality of life. Three non-FBSS patients had to undergo a second neurotomy because of non-satisfactory pain decrease. Complications were reported in no case. Medial branch radiofrequency neurotomy has confirmed its well-established effectiveness in pain and quality of life improvement as long as strict inclusion criteria be fulfilled and nerve ablation be accomplished by parallel electrode positioning. This statement can be extended also to FBSS patients.

  3. [Arthritis of the Medial Knee Joint Compartment].

    PubMed

    Matziolis, G; Röhner, E

    2015-10-01

    23 % of all persons older than 65 years suffer from osteoarthritis of the medial compartment of the knee joint, a very common situation in orthopaedic practice 1. As a result of the demographic trend the number of patients is expected to increase in the future. Based on specific joint biomechanics and kinematics the medial knee joint compartment is more frequently affected than the lateral. Only an understanding of the functional anatomy and underlying pathology allows a critical evaluation of different available conservative and operative treatment options. This article gives an overview of diagnostic and therapeutic strategies of osteoarthritis of the medial knee joint. Frequently performed surgeries, e.g. high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) will be presented in a comparative manner. The actual scientific evidence will be given with the goal of an evidence based therapy that is adopted to stage and pathology of osteoarthritis of the medial compartment of the knee joint. Georg Thieme Verlag KG Stuttgart · New York.

  4. Isolated Medial Rectus Palsy: Rare Presentation of Mesencephalon Infarction.

    PubMed

    Yao, Yindan; Hong, Wenke; Fan, Zhenyi; Li, Da; Chang, Xianchao; Fan, Weinv

    2017-04-01

    Isolated medial rectus palsy due to mesencephalon lesion is extremely rare. We here describe a patient of midbrain infarction involving the medial rectus subnuclei presenting as isolated medial rectus palsy. Axial diffusion-weighted and coronal T2-weighted magnetic resonance imaging showed acute ischemic lesion in mesencephalon. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Natural history of medial clavicle fractures.

    PubMed

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

    2016-10-01

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

  6. [SECOT consensus on medial femorotibial osteoarthritis].

    PubMed

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

    A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  7. Axonal synapse sorting in medial entorhinal cortex

    NASA Astrophysics Data System (ADS)

    Schmidt, Helene; Gour, Anjali; Straehle, Jakob; Boergens, Kevin M.; Brecht, Michael; Helmstaedter, Moritz

    2017-09-01

    Research on neuronal connectivity in the cerebral cortex has focused on the existence and strength of synapses between neurons, and their location on the cell bodies and dendrites of postsynaptic neurons. The synaptic architecture of individual presynaptic axonal trees, however, remains largely unknown. Here we used dense reconstructions from three-dimensional electron microscopy in rats to study the synaptic organization of local presynaptic axons in layer 2 of the medial entorhinal cortex, the site of grid-like spatial representations. We observe path-length-dependent axonal synapse sorting, such that axons of excitatory neurons sequentially target inhibitory neurons followed by excitatory neurons. Connectivity analysis revealed a cellular feedforward inhibition circuit involving wide, myelinated inhibitory axons and dendritic synapse clustering. Simulations show that this high-precision circuit can control the propagation of synchronized activity in the medial entorhinal cortex, which is known for temporally precise discharges.

  8. Use of a 3D laser scan technique to compare the surface geometry of the medial coronoid process in dogs affected with medial compartment disease with unaffected controls.

    PubMed

    Breit, Sabine; Pfeiffer, Kristina; Pichler, Reinhard

    2010-09-01

    Subchondral bone surface geometry of the medial coronoid process was examined in 20 grossly normal elbow joints of adult German Shepherd dogs (GSDs) and compared with results obtained from 10 joints of adult GSDs and 12 joints of adult Rottweilers affected with bilateral fragmentation of the medial coronoid process (FMCP). Additionally, seven dogs (4 GSDs and 3 Rottweilers) with unilateral FMCP were investigated. The subchondral contour of the ulnar trochlear notch was digitised to obtain the 3D coordinates of its surface points. Geometry was investigated in two defined section planes along the longitudinal and transverse axes of the medial coronoid process. The coordinates of the surface points in the section planes were normalised along one axis and geometry was estimated by the position of the surface points along its third coordinate and by calculation of the angle of inclination of the medial coronoid process. Subchondral bone surface geometry was not related to the type of fragmentation (i.e. single sagittal versus multiple sagittal or transverse fragmentation). No differences were noted when comparing joints of dogs affected unilaterally with FMCP and their contralateral normal joints. In addition, no differences in geometry were seen between GSDs affected with fragmentation and normal GSDs. The most evident differences were found between Rottweilers affected with FMCP and normal GSDs as well as FMCP affected GSDs. The results suggest that subchondral bone geometry (geometric incongruity) plays no role in the development of FMCP. Geometric differences between breeds were more prevalent than differences between normal joints and those affected with FMCP within one breed. Copyright 2009 Elsevier Ltd. All rights reserved.

  9. Osteoligamentous injuries of the medial ankle joint.

    PubMed

    Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

    2015-12-01

    Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

  10. Medial septal lesion enhances general anesthesia response.

    PubMed

    Leung, L Stan; Ma, Jingyi; Shen, Bixia; Nachim, Ilan; Luo, Tao

    2013-09-01

    Electrolytic lesion of the medial septum, a basal forebrain nucleus that projects to the hippocampus, prolonged the emergence from general anesthesia in rats. Septal lesioned rats required a longer time to recover from a loss of righting reflex (LORR) and a loss of tail-pinch response after injectable (20 mg/kg i.p. pentobarbital, 5mg/kg i.v. propofol) or volatile (1.5% halothane, 2% isoflurane) anesthetic. When incremental doses of propofol were given i.p., septal lesioned rats as compared to control rats showed LORR at a lower dose of propofol. Similarly, when the rats were exposed to increasing concentrations of isoflurane, the percent of rats showing LORR was leftward shifted for lesioned rats as compared to control rats. Septal lesioned rats as compared to control rats showed decreased locomotor activity when exposed to 1.5% halothane. Lesion of the medial septum was confirmed by thionin-stained histological sections as well as loss of acetylcholinesterase (AchE) staining in the hippocampus, indicating a depletion of septohippocampal cholinergic afferents. Medial septal lesion resulted in a near complete loss of hippocampal theta rhythm during walking and a general decrease in power of the hippocampal EEG at all frequencies (0-100 Hz), during walking or immobility. It is concluded that lesion of medial septum, in part through a loss of septohippocampal cholinergic afferents, increased the anesthesia response to volatile and injectable general anesthetics, during both induction and emergence. It is suggested that the septohippocampal system participates in many components of general anesthesia including hypnosis, immobility, and analgesia. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Loss of mechanical directional dependency of the ascending aorta with severe medial degeneration.

    PubMed

    Chung, Jennifer; Lachapelle, Kevin; Cartier, Raymond; Mongrain, Rosaire; Leask, Richard L

    Biomechanical characterization of the aortic wall may help risk stratify patients with aneurysms. We investigated the degree of anisotropy, the directional dependency of mechanical properties, in control and aneurysmal ascending aortic tissue. We hypothesized that medial degeneration and aortic wall remodeling as found in aneurysmal tissue alter energy loss in both the circumferential and longitudinal directions, thereby reducing anisotropy. Aneurysmal and control ascending aortic tissue excised during surgery was subjected to biaxial tensile testing. Stress-strain relationships were collected in the circumferential and longitudinal directions; from these data, the mechanical properties of energy loss and the apparent modulus of elasticity were derived, and the associated anisotropy indices were calculated. Movat pentachrome histological staining was performed, and aortic wall medial degeneration was quantified. Energy loss was greater in the circumferential than the longitudinal direction, demonstrating significant anisotropy in both normal and aneurysmal aortas (P<.0001). This directional dependency diminished in (a) larger aortas (r 2 =0.15, P=.01), especially when indexed to body surface area (r 2 =0.29, P=.002); (b) aortas with greater overall energy loss (r 2 =0.44, P<.0001); (3) aortas associated with tricuspid valves (P=.004); and (4) higher collagen-to-elastin ratio (r 2 =0.29, P=.001). Aortas with collagen-to-elastin ratios greater than 2 were uniformly isotropic. Furthermore, the greatest energy loss anisotropy was found on the inner curvature of the aorta (P=.01). Energy loss demonstrates the directional dependency of aortic tissue. Energy loss isotropy is associated with medial degeneration, indicating that microstructural changes can be captured by global biomechanics, thereby identifying it as a marker of disease severity. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column

    PubMed Central

    He, Yu; He, Jiliang; Wang, Fu; Zhou, Dongsheng; Wang, Yan; Wang, Bomin; Xu, Shihong

    2015-01-01

    Abstract The purpose of this study was to use finite element analysis to compare the biomechanical characteristics after lateral locking plate (LLP) or LLP with a medial anatomical locking plate (LLP-MLP) fixation of proximal humeral fractures with an unstable medial column. First, a 3-dimensional, finite element analysis model was developed. Next, LLP and LLP-MLP implants were instrumented into the proximal humeral fracture models. Compressive and rotational loads were then applied to the humerus model to determine the biomechanical characteristics. Both normal and osteoporotic proximal humerus fractures were simulated using 2 internal fixation methods each under 7 loading conditions. To assess the biomechanical characteristics, the construct stiffness, fracture micromotion, and stress distribution on the implants were recorded and compared. The LLP-MLP method provided both lateral and medial support that reduced the stress on the LLP and the amount of displacement in the fracture region. In contrast, the LLP method resulted in more instability in the medial column and larger magnitudes of stress. In osteoporotic bone, the LLP was more inclined to fail than LLP-MLP. The LLP-MLP method provides a strong support for the medial column and increases the stability of the region surrounding the fracture. PMID:26469918

  13. Cross-sectional and longitudinal multimodal structural imaging in prodromal Huntington's disease.

    PubMed

    Harrington, Deborah L; Long, Jeffrey D; Durgerian, Sally; Mourany, Lyla; Koenig, Katherine; Bonner-Jackson, Aaron; Paulsen, Jane S; Rao, Stephen M

    2016-11-01

    Diffusivity in white-matter tracts is abnormal throughout the brain in cross-sectional studies of prodromal Huntington's disease. To date, longitudinal changes have not been observed. The present study investigated cross-sectional and longitudinal changes in white-matter diffusivity in relationship to the phase of prodromal Huntington's progression, and compared them with changes in brain volumes and clinical variables that track disease progression. Diffusion MRI profiles were studied for 2 years in 37 gene-negative controls and 64 prodromal Huntington's disease participants in varied phases of disease progression. To estimate the relative importance of diffusivity metrics in the prodromal phase, group effects were rank ordered relative to those obtained from analyses of brain volumes, motor, cognitive, and sensory variables. First, at baseline diffusivity was abnormal throughout all tracts, especially as individuals approached a manifest Huntington's disease diagnosis. Baseline diffusivity metrics in 6 tracts and basal ganglia volumes best distinguished among the groups. Second, group differences in longitudinal change in diffusivity were localized to the superior fronto-occipital fasciculus, most prominently in individuals closer to a diagnosis. Group differences were also observed in longitudinal changes of most brain volumes, but not clinical variables. Last, increases in motor symptoms across time were associated with greater changes in the superior fronto-occipital fasciculus diffusivity and corpus callosum, cerebrospinal fluid, and lateral ventricle volumes. These novel findings provide new insights into changes within 2 years in different facets of brain structure and their clinical relevance to changes in symptomatology that is decisive for a manifest Huntington's diagnosis. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  14. [Situs inversus of the fibula: medialized fibula].

    PubMed

    Atalar, Hakan; Turanlı, Sacit; Atik, O Şahap; Kaptan, Ahmet Yiğit; Ezgü, Fatih Süheyl

    2015-01-01

    Congenital extremity anomalies are caused by pathological changes during the development process of the embryo. Exposure to toxins during 4-12 weeks of pregnancy may lead to extremity anomalies. In this article, we present a girl patient born as one of triplets at the 31st week and fifth day of pregnancy with meningomyelocele, Arnold-Chiari type 2 malformation, developmental dysplasia of the right hip, hypothyroidism, and lower extremity anomaly. Mother had a history of antenatal usage of sodium valproate. Radiographic examination of the lower extremity showed medial location of the fibula.

  15. Medial patellofemoral ligament reconstruction in patellar instability

    PubMed Central

    Krishna Kumar, MS; Renganathan, Sankarram; Joseph, Clement J; Easwar, TR; Rajan, David V

    2014-01-01

    Background: Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea. Materials and Methods: 30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fixed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score. Results: The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation. Conclusion: MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension. PMID:25298558

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

    PubMed

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

    1982-01-01

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

  17. Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review.

    PubMed

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Kaleka, Camila Cohen; Camanho, Gilberto Luis; Arendt, Elizabeth A

    2018-03-01

    The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction

  18. Medial tibial stress syndrome: conservative treatment options.

    PubMed

    Galbraith, R Michael; Lavallee, Mark E

    2009-10-07

    Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004). Although often not serious, it can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS is multi-factorial and involves training errors and various biomechanical abnormalities. Few advances have been made in the treatment of MTSS over the last few decades. Current treatment options are mostly based on expert opinion and clinical experience. The purpose of this article is to review published literature regarding conservative treatment options for MTSS and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.

  19. The medial temporal-lobe amnesic syndrome.

    PubMed

    Milner, Brenda

    2005-09-01

    This article has attempted to show how early evidence of the existence of multiple memory systems in the brain arose from the study of a few patients with bilateral damage to the medial structures of the temporal lobe in the hippocampal region, as in the case of the now famous patient HM. Such patients exhibit a profound anterograde amnesia for the experiences of daily life, whereas previously acquired knowledge is well preserved and immediate or primary memory is intact, and other cognitive abilities, including language, perception, and reasoning also are unaffected by the lesion. Despite the seemingly global nature of HM's memory loss, it was possible to show by the appropriate choice of behavioral tasks that many implicit,procedural forms of learning were preserved, and these forms are now known to be mediated by different brain systems. The first major finding was the demonstration of normal acquisition of a motor skill by HM, although he remained unaware that he had done the task before. This finding was followed by the demonstration of preserved perceptual learning,and since then the examples of preserved learning in amnesia have multiplied. In addition, after many false starts, a convincing animal model has now been achieved, with convergent findings for human and nonhuman primates. Although considerable progress has been made since the early 1950s, many questions remain unanswered; particularly, the distinct contributions of the various medial temporal-lobe structures to memory processes and the interaction of these structures with other brain areas need to be clarified. As in the past, the solution of such problems will call for a multidisciplinary approach.

  20. Regional vulnerability of longitudinal cortical association connectivity: Associated with structural network topology alterations in preterm children with cerebral palsy.

    PubMed

    Ceschin, Rafael; Lee, Vince K; Schmithorst, Vince; Panigrahy, Ashok

    2015-01-01

    Preterm born children with spastic diplegia type of cerebral palsy and white matter injury or periventricular leukomalacia (PVL), are known to have motor, visual and cognitive impairments. Most diffusion tensor imaging (DTI) studies performed in this group have demonstrated widespread abnormalities using averaged deterministic tractography and voxel-based DTI measurements. Little is known about structural network correlates of white matter topography and reorganization in preterm cerebral palsy, despite the availability of new therapies and the need for brain imaging biomarkers. Here, we combined novel post-processing methodology of probabilistic tractography data in this preterm cohort to improve spatial and regional delineation of longitudinal cortical association tract abnormalities using an along-tract approach, and compared these data to structural DTI cortical network topology analysis. DTI images were acquired on 16 preterm children with cerebral palsy (mean age 5.6 ± 4) and 75 healthy controls (mean age 5.7 ± 3.4). Despite mean tract analysis, Tract-Based Spatial Statistics (TBSS) and voxel-based morphometry (VBM) demonstrating diffusely reduced fractional anisotropy (FA) reduction in all white matter tracts, the along-tract analysis improved the detection of regional tract vulnerability. The along-tract map-structural network topology correlates revealed two associations: (1) reduced regional posterior-anterior gradient in FA of the longitudinal visual cortical association tracts (inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, optic radiation, posterior thalamic radiation) correlated with reduced posterior-anterior gradient of intra-regional (nodal efficiency) metrics with relative sparing of frontal and temporal regions; and (2) reduced regional FA within frontal-thalamic-striatal white matter pathways (anterior limb/anterior thalamic radiation, superior longitudinal fasciculus and cortical spinal tract) correlated with

  1. Medial meniscus grafting restores normal tibiofemoral contact pressures.

    PubMed

    Nyland, John; Campbell, Kirk; Kalloub, Alaa; Strauss, Eric J; Kuban, Katrina; Caborn, David N M

    2018-03-01

    Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses in the affected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis. The current in vitro study utilized a porcine model to evaluate the effectiveness of segmental medial meniscal grafting following partial meniscectomy. The study hypothesis was that the procedure would normalize medial tibofemoral joint compartment pressure magnitudes, areas, and locations relative to an intact meniscus. Controlled laboratory study. Using pressure film, medial tibiofemoral joint compartment peak, and mean pressure magnitudes, peak pressure location and peak pressure area were determined using 12 potted, fresh frozen, porcine knee specimens. Data were collected at three different knee flexion angles (90°, 45°, and 0°) for three conditions: intact medial meniscus, following resection of the central third of the medial meniscus, and following segmental medial meniscal grafting. For each condition, the potted femur was positioned horizontally in a bench vise clamp, while a 20 pound (88.96 N) axial compression force was manually applied for a 60 s duration by the primary investigator through the base of the potted tibia using a digital force gauge. Loss of the central 1/3 of the medial meniscus resulted in significant increases in the mean and peak pressures of the medial tibiofemoral joint compartment and decreased peak pressure area. Segmental meniscal grafting of the central third defect closely recreated the contact pressures and loading areas of the native, intact medial meniscus. From a static, time zero biomechanical perspective, segmental medial meniscus grafting of a partially meniscectomized knee restored mean pressure, peak pressure, and mean peak contact pressure areas of the medial tibiofemoral joint compartment back to levels observed in the intact medial meniscus at different knee flexion angles. In

  2. A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion

    PubMed Central

    Murugavel, Murali; Cubon, Valerie; Putukian, Margot; Echemendia, Ruben; Cabrera, Javier; Osherson, Daniel

    2014-01-01

    Abstract The extent of structural injury in sports-related concussion (SRC) is central to the course of recovery, long-term effects, and the decision to return to play. In the present longitudinal study, we used diffusion tensor imaging (DTI) to assess white matter (WM) fiber tract integrity within 2 days, 2 weeks, and 2 months of concussive injury. Participants were right-handed male varsity contact-sport athletes (20.2±1.0 years of age) with a medically diagnosed SRC (no loss of consciousness). They were compared to right-handed male varsity non-contact-sport athletes serving as controls (19.9±1.7 years). We found significantly increased radial diffusivity (RD) in concussed athletes (n=12; paired t-test, tract-based spatial statistics; p<0.025) at 2 days, when compared to the 2-week postinjury time point. The increase was found in a cluster of right hemisphere voxels, spanning the posterior limb of the internal capsule (IC), the retrolenticular part of the IC, the inferior longitudinal fasciculus, the inferior fronto-occipital fasciculus (sagittal stratum), and the anterior thalamic radiation. Post-hoc, univariate, between-group (controls vs. concussed), mixed-effects analysis of the cluster showed significantly higher RD at 2 days (p=0.002), as compared to the controls, with a trend in the same direction at 2 months (p=0.11). Results for fractional anisotropy (FA) in the same cluster showed a similar, but inverted, pattern; FA was decreased at 2 days and at 2 months postinjury, when compared to healthy controls. At 2 weeks postinjury, no statistical differences between concussed and control athletes were found with regard to either RD or FA. These results support the hypothesis of increased RD and reduced FA within 72 h postinjury, followed by recovery that may extend beyond 2 weeks. RD appears to be a sensitive measure of concussive injury. PMID:24786666

  3. Percutaneous pin placement in the medial calcaneus: is anywhere safe?

    PubMed

    Casey, David; McConnell, Timothy; Parekh, Selene; Tornetta, Paul

    2002-01-01

    To redefine the medial calcaneal anatomic safe zone for pin placement with respect to reproducible palpable landmarks. Anatomic study. Medical school anatomy laboratory. Thirty-three fresh-frozen adult cadaveric feet were used. Three palpable anatomic landmarks were identified on each ankle and labeled as Point A (posteroinferior medial calcaneus), Point B (inferior medial malleolus), and Point C (navicular tuberosity). The medial neurovascular bundle was carefully dissected, and the medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, and the posterior tibial artery were identified. These structures were recorded at the point at which they transected a line from Point A to B and from Point A to C. Based on the findings of the first thirty-three feet, two pins were placed percutaneously into the medial calcaneus of ten additional feet. Pin 1 was placed one half the distance from Point A to B. Pin 2 was placed one third the distance from Point A to C. The neurovascular structures were then dissected and identified in relation to the pin position. The medial calcaneal, most posterior branch of the lateral plantar, and lateral plantar nerves are at significant risk for abutting the pins or being directly injured at the margins of these relative safe zones. The medial calcaneus provides a small window for safe percutaneous pin placement. Posterior to the halfway point from Point A to B and posterior to the one-third mark from Point A to C remain the relatively safest regions; a more posterior placement in the safe zone is safest. Careful blunt dissection and the use of cannulas may help to avoid neurovascular injury.

  4. The Medial Temporal Lobe and Recognition Memory

    PubMed Central

    Eichenbaum, H.; Yonelinas, A.R.; Ranganath, C.

    2007-01-01

    The ability to recognize a previously experienced stimulus is supported by two processes: recollection of the stimulus in the context of other information associated with the experience, and a sense of familiarity with the features of the stimulus. Although familiarity and recollection are functionally distinct, there is considerable debate about how these kinds of memory are supported by regions in the medial temporal lobes (MTL). Here, we review evidence for the distinction between recollection and familiarity and then consider the evidence regarding the neural mechanisms of these processes. Evidence from neuropsychological, neuroimaging, and neurophysiological studies of humans, monkeys, and rats indicates that different subregions of the MTL make distinct contributions to recollection and familiarity. The data suggest that the hippocampus is critical for recollection but not familiarity. The parahippocampal cortex also contributes to recollection, possibly via the representation and retrieval of contextual (especially spatial) information, whereas perirhinal cortex contributes to and is necessary for familiarity-based recognition. The findings are consistent with an anatomically guided hypothesis about the functional organization of the MTL and suggest mechanisms by which the anatomical components of the MTL interact to support of the phenomenology of recollection and familiarity. PMID:17417939

  5. Medial-sided Ankle Pain: Deltoid Ligament and Beyond.

    PubMed

    Crim, Julia

    2017-02-01

    Abnormalities of the medial ligaments and posterior tibial tendon can occur because of acute injury or chronic instability or malalignment. Medial ankle injuries may occur because of pronation or supination-external rotation injuries. Deltoid ligament injuries have a significant impact on lateral ankle instability but can be overlooked in patients with lateral ligament injuries. Posterior tibial tendon dysfunction is usually associated with spring ligament or flexor retinaculum injury. Tarsal tunnel syndrome, accessory flexor muscles, and subtalar coalition should be considered as well as ligament and tendon tears in differential diagnosis of chronic medial ankle pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The epidemiology of medial collateral ligament sprains in young athletes.

    PubMed

    Roach, Christopher J; Haley, Chad A; Cameron, Kenneth L; Pallis, Mark; Svoboda, Steven J; Owens, Brett D

    2014-05-01

    A medial collateral ligament (MCL) knee sprain is a prevalent injury in athletic populations that may result in significant time lost to injury. Remarkably little is known of the epidemiology of this injury. To define the incidence of MCL tears and to determine the demographic and athletic risk factors. Descriptive epidemiological study. A longitudinal cohort study was performed to examine the epidemiology of isolated MCL sprains at the United States Military Academy (USMA) between 2005 and 2009. Charts and radiographic studies were reviewed by an independent orthopaedic surgeon to identify all new isolated MCL sprains resulting in time lost to sport and activity that occurred within the study period. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated per 1000 person-years at risk and by sex, sport, and level of competition. The IR per 1000 athlete-exposures (AEs) was also determined. Incidence rate ratios (IRRs) and respective 95% CIs were calculated between male and female students, intercollegiate and intramural athletes, and male and female intercollegiate athletes involved in selected sports. Chi-square and Poisson regression analyses were used to examine the relationship between the variables of interest and the incidence of MCL sprains, with statistical significance set at P < .05. A total of 128 cadets sustained isolated MCL injuries during 17,606 student person-years from 2005 to 2009. This resulted in an IR of approximately 7.3 per 1000 person-years. Of the 128 injuries, 114 were in male athletes (89%) and 14 were in female athletes (11%). Male cadets had a 44% higher IR than did female cadets (7.60 vs 5.36, respectively), although this was not significant (P = .212). Of 5820 at-risk intercollegiate athletes, 59 (53 male, 6 female) sustained an isolated MCL sprain during 528,523 (407,475 male, 121,048 female) AEs for an overall IR of 10.14 per 1000 person-years and 0.11 per 1000 AEs. The IRR of MCL sprains of men compared with women

  7. Photocopy of photograph in Fitzsimons Army Medial Center Real Property ...

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

    Photocopy of photograph in Fitzsimons Army Medial Center Real Property Book (green cloth cover), south and west sides. - Fitzsimons General Hospital, Officers Quarters, Northeast Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  8. Medial epicanthoplasty using the "inside-out" technique.

    PubMed

    Seo, Jae Don; Kim, Ji Hoon; Pak, Chang Sik; Heo, Chan-Yeong

    2014-04-01

    The epicanthal fold, a skin remnant covering the medial canthal region, is especially common in Asians. Although numerous surgical techniques for the treatment of the epicanthal fold have been developed, the results.in terms of scars and a natural look remain controversial. In this regard, the authors have developed a new method for medial epicanthoplasty. From January 2005 to December 2011, medial epicanthoplasty was performed on 1132 patients using a technique in which the skin flap inside of the medial epicanthal fold is moved outward (the "Inside-Out" technique). Preoperative and postoperative (2 months) interepicanthal distance was measured. Satisfactory results were achieved in the majority of cases. While nine patients complained of visible scarring after the operation, the scar formation spontaneously resolved within 6 months. This new "Inside-Out" technique for the treatment of the epicanthal fold is easy, simple, and delivers good aesthetic results.

  9. Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique.

    PubMed

    Nitri, Marco; Chahla, Jorge; Civitarese, David; Bhatia, Sanjeev; Moulton, Samuel G; LaPrade, Christopher M; LaPrade, Robert F

    2016-08-01

    Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses. Improvement regarding the ability to repair and heal medial meniscus radial tears has the potential to result in enhanced preservation of the articular cartilage in the medial compartment of the knee. This technical description details a method for repairing radial tears of the medial meniscus using a transtibial 2-tunnel technique.

  10. Current developments concerning medial tibial stress syndrome.

    PubMed

    Craig, Debbie I

    2009-12-01

    Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in athletes who run. Studies have reported MTSS to occur in 4% to 20% of this population. It can be defined as an overuse injury that creates pain over an area covering the distal to middle third of the posteriomedial tibial border, which occurs during exercise and creates cyclic loading. Differential diagnosis includes ischemic disorders and stress fractures. Although the pathology of this injury is understood, the etiology is less agreed upon. This makes it difficult for clinicians to diagnose and treat this common injury. The purpose of this article is to present health care practitioners with the most current information regarding MTSS so they can better diagnose and treat this common injury. To this end, a literature review was conducted, with the most current results presented. The areas of etiological theories, imaging techniques, and treatment options for MTSS were searched. Five of the most prevalent etiological theories are presented with supporting evidence. Of the imaging tools available to the clinician, magnetic resonance imaging (MRI) and bone scintigraphy have comparable specificity and sensitivity. Clinicians should first make the clinical diagnosis of MTSS, however, because of high percentages of positive MRI scans in asymptomatic patients. There have been few randomized controlled trials investigating treatment options for athletes with MTSS. Those that have been performed rendered no significant findings, leading researchers to conclude that rest is equal to or better than other treatment options. Given the evidence, treatment suggestions for practitioners caring for athletes with MTSS are provided.

  11. Medial tibial stress syndrome: a critical review.

    PubMed

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  12. Medial collateral knee ligament healing. Combined medial collateral and anterior cruciate ligament injuries studied in rabbits.

    PubMed

    Woo, S L; Niyibizi, C; Matyas, J; Kavalkovich, K; Weaver-Green, C; Fox, R J

    1997-04-01

    We examined the histological appearance and biochemical properties of the healing medial collateral ligament (MCL) of a rabbit knee after combined MCL and anterior cruciate ligament (ACL) injury treated with ACL reconstruction and with or without MCL repair. By so doing, we hoped to understand better our previous bomechanical observations (Ohno et al. 1995) and possibly learn where to focus future investigation into improving the quality of the healing MCL. Ligaments were examined at 6 and 12 weeks of healing. We found healing of all ligaments with hypercellularity and fibroblast elongation along the axis of loading, as expected. Unexpected, however, was the finding of multiple osteophytes in both the repaired and nonrepaired specimens at the medial borders of the joint and at the MCL insertions. These were felt to affect possibly the biomechanics of the MCL by causing stress risers at the point where they undermine the ligament. Biochemically, we demonstrated a correlation between collagen content and hydroxypyridinium crosslinks and modulus of elasticity. While this implies that the modulus is dependent on collagen content and hydroxypyridinium crosslink density, modulus is also probably dependent on other factors such as collagen organization, type and internal structure. Overall, the detailed characterization and correlation between the histological, biochemical, and biomechanical properties of the healing MCL in the severe knee injury model provide insight into the functional behavior of the healing MCL.

  13. Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study.

    PubMed

    Steiger, V R; Brühl, A B; Weidt, S; Delsignore, A; Rufer, M; Jäncke, L; Herwig, U; Hänggi, J

    2017-08-01

    Social anxiety disorder (SAD) is characterized by fears of social and performance situations. Cognitive behavioral group therapy (CBGT) has in general positive effects on symptoms, distress and avoidance in SAD. Prior studies found increased cortical volumes and decreased fractional anisotropy (FA) in SAD compared with healthy controls (HCs). Thirty-three participants diagnosed with SAD attended in a 10-week CBGT and were scanned before and after therapy. We applied three neuroimaging methods-surface-based morphometry, diffusion tensor imaging and network-based statistics-each with specific longitudinal processing protocols, to investigate CBGT-induced structural brain alterations of the gray and white matter (WM). Surface-based morphometry revealed a significant cortical volume reduction (pre- to post-treatment) in the left inferior parietal cortex, as well as a positive partial correlation between treatment success (indexed by reductions in Liebowitz Social Anxiety Scale) and reductions in cortical volume in bilateral dorsomedial prefrontal cortex. Diffusion tensor imaging analysis revealed a significant increase in FA in bilateral uncinate fasciculus and right inferior longitudinal fasciculus. Network-based statistics revealed a significant increase of structural connectivity in a frontolimbic network. No partial correlations with treatment success have been found in WM analyses. For, we believe, the first time, we present a distinctive pattern of longitudinal structural brain changes after CBGT measured with three established magnetic resonance imaging analyzing techniques. Our findings are in line with previous cross-sectional, unimodal SAD studies and extent them by highlighting anatomical brain alterations that point toward the level of HCs in parallel with a reduction in SAD symptomatology.

  14. Secondary ossification centers in the development of the medial malleolus.

    PubMed

    LaMont, Lauren; Ladenhauf, Hannah N; Edobor-Osula, Folorunsho; Bogner, Eric; Do, Huong T; Green, Daniel W

    2015-01-01

    Accessory ossicles of the medial malleolus have been reported, however, these have not been linked to a pattern of development and are considered anomalies. Here, we describe a pattern of ossification of the medial malleolus in children including a secondary ossification center. Twenty anteroposterior (AP) and mortise x-rays of each sex and age from 4 to 12 were randomly selected from skeletally immature patients identified at our institution. X-rays were excluded if there was a cast or splint, fracture, hardware, or obvious tibial deformity. Each x-ray was evaluated and categorized to a 4-part stage of development. These stages were then applied to randomly selected AP hip to ankle films from the same age groups. Four distinct stages of medial malleolus ossification were identified on ankle x-rays. Stage 1 consists of the widening of the epiphysis that did not reach the medial border of the metaphysis. In stage 2, the epiphysis had widened medially to the level of the metaphysis, however, had not extended distally to the level of the dome of the talus. In stage 3, the proximal portion of the medial malleolus has ossified distal to the dome of the talus with ossification centers at this level identified. Stage 4 consisted of a completely fused ossification center extending distally to a mature medial malleolus. The stages were reconfirmed on AP standing hip to ankle to have a similar distribution, secondary ossification centers were more common in females aged 6 to -9 and males aged 8 to 11 years. The medial malleolus develops in predictable stages which may involve a secondary ossification center in the final stages of development. These findings were initially described on AP and mortise views, then confirmed on AP hip to ankle radiographs were evaluated to exclude potentially confounding ankle pain. These secondary ossification centers were seen at similar ages on both ankle and hip to ankle x-rays. Level III.

  15. Percutaneous pin placement in the medial calcaneus: is anywhere safe?

    PubMed

    Casey, David; McConnell, Timothy; Parekh, Selene; Tornetta, Paul

    2004-09-01

    To redefine the medical calcaneal anatomic safe zone for pin placement with respect to reproducible palpable landmarks. Anatomic study. Medical school anatomy laboratory. Thirty-three fresh-frozen adult cadaveric feet were used. Three palpable anatomic landmarks were identified on each ankle and labeled as Point A (posteroinferior medial calcaneus), Point B (inferior medial malleolus), and Point C (navicular tuberosity). The medial neurovascular bundle was carefully dissected, and the medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, and the posterior tibial artery were identified. These structures were recorded at the point at which they transected a line from Point A to B and from Point A to C. Based on the findings of the first thirty-three feet, two pins were placed percutaneously into the medial calcaneus of ten additional feet. Pin 1 was placed one half the distance from Point A to B. Pin 2 was placed one third the distance from Point A to C. The neurovascular structures were then dissected and identified in relation to the pin position. The medial calcaneal, most posterior branch of the lateral plantar, and lateral plantar nerves are at significant risk for abutting the pins or being directly injured at the margins of these relative safe zones. The medial calcaneus provides a small window for safe percutaneous pin placement. Posterior to the halfway point from Point A to B and posterior to the one-third mark from Point A to C remain the relatively safest regions; a more posterior placement in the safe zone is safest. Careful blunt dissection and the use of cannulas may help to avoid neurovascular injury.

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

    PubMed

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

    2016-05-01

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

  17. Cytoarchitecture and probability maps of the human medial orbitofrontal cortex.

    PubMed

    Henssen, Anton; Zilles, Karl; Palomero-Gallagher, Nicola; Schleicher, Axel; Mohlberg, Hartmut; Gerboga, Fatma; Eickhoff, Simon B; Bludau, Sebastian; Amunts, Katrin

    2016-02-01

    Previous architectonical studies of human orbitofrontal cortex (OFC) provided divergent maps regarding number, location, and extent of areas. To solve this controversy, an observer-independent cytoarchitectonical mapping of medial OFC (mOFC) was performed. Borders of cortical areas were detected in histological sections of ten human post-mortem brains using a quantitative, statistically testable method, and their stereotaxic localization and intersubject variability were determined. Three areas were identified: granular Fo1 mainly on the rostral Gyrus rectus and medial of the olfactory sulcus; granular to dysgranular Fo2, mainly on the posterior part of the ventromedial Gyrus rectus and the medial and lateral banks of the olfactory sulcus; granular Fo3 between the olfactory and medial or intermediate orbital sulci. Fo3 was bordered medially by Fo1 and Fo2 and laterally by the lateral OFC (lOFC). A cluster analysis of the cytoarchitectonical features of Fo1-Fo3, subgenual cingulate areas, BA12, lateral and medial areas of the frontopolar cortex, lOFC and areas of Broca's region demonstrated the cytoarchitectonical similarity between the mOFC areas in contrast to all other frontal areas. Probabilistic maps of mOFC areas show a considerable intersubject variability in extent and position in stereotaxic space, and provide spatial templates for anatomical localization of in vivo neuroimaging data via the JuBrain atlas and the Anatomy Toolbox. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Traumatic fracture of the medial coronoid process in 24 dogs.

    PubMed

    Tan, Desmond K; Canapp, Sherman O; Leasure, Christopher S; Dycus, David L; O'Donnell, Erica

    2016-07-19

    To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia. Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks. Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process. Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

  19. Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis

    PubMed Central

    2013-01-01

    Background Dynamic joint loading, particularly the external knee adduction moment (KAM), is an important surrogate measure for the medio-lateral distribution of force across the knee joint in people with knee osteoarthritis (OA). Foot motion may alter the load on the medial tibiofemoral joint and hence affect the KAM. Therefore, this study aimed to investigate the relationship between tibia, rearfoot and forefoot motion in the frontal and transverse planes and the KAM in people with medial compartment knee OA. Method Motion of the knee, tibia, rearfoot and forefoot and knee moments were evaluated in 32 patients with clinically and radiographically-confirmed OA, predominantly in the medial compartment. Pearson’s correlation coefficient was used to investigate the association between peak values of tibia, rearfoot and forefoot motion in the frontal and transverse planes and 1st peak KAM, 2nd peak KAM, and the knee adduction angular impulse (KAAI). Results Lateral tilt of the tibia was significantly associated with increased 1st peak KAM (r = 0.60, p < 0.001), 2nd peak KAM (r = 0.67, p = 0.001) and KAAI (r = 0.82, p = 0.001). Increased peak rearfoot eversion was significantly correlated with decreased 2nd peak KAM (r = 0.59, p < 0.001) and KAAI (r = 0.50, p = 0.004). Decreased rearfoot internal rotation was significantly associated with increased 2nd peak KAM (r = −0.44, p = 0.01) and KAAI (r = −0.38, p = 0.02), while decreased rearfoot internal rotation relative to the tibia was significantly associated with increased 2nd peak KAM (r = 0.43, p = 0.01). Significant negative correlations were found between peak forefoot eversion relative to the rearfoot and 2nd peak KAM (r = −0.53, p = 0.002) and KAAI (r = −0.51, p = 0.003) and between peak forefoot inversion and 2nd peak KAM (r = −0.54, p = 0.001) and KAAI (r = −0.48, p = 0.005). Conclusion Increased rearfoot

  20. Neuromuscular characteristics of individuals displaying excessive medial knee displacement.

    PubMed

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

    2012-01-01

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

  1. Anatomic basis of perforator flaps of medial vastus muscle.

    PubMed

    Zheng, Heping; Wang, Huaqiao; Zhang, Fahui; Yue, Suqin

    2008-01-01

    The purpose of this study was to elucidate anatomical features of perforating branch flaps based on the muscular branches of the medial vastus muscle and to seek a new, applicable technique that could be used in repairing soft tissue defects around human knees. In this study, the origin, the course, the branches, the distribution, and the distal anastomosis of the muscular branch of the medial vastus muscle were observed in 30 sides of adult cadaveric lower limb specimens with the adductor tubercle, the patella midpoint, and the inguinal ligament midpoint as the observation markers. The specimens had been perfused arterially with red gelatin before they were supplied. It was observed that the femoral artery gave constant muscular branches into the medial vastus muscle at the tip of the femoral triangle. The artery entered the muscle via the hilum and ran laterally downwards along the muscular bundle until it reached the lateral patella to anastomose with the arterial circle around the bone. Along its course, it also gave 1-3 (1/77%) musculocutaneous perforating branches (0.5-0.9 mm in diameter). It then extended vertically through the medial vastus muscle into the deep fascia and ran superficially to the overlying skin of the muscle. A flap based on the perforating branch of the medial vastus muscle could be harvested at a size of about 8.5 cm x 15.0 cm and might be transferred retrograde to repair the soft tissue defect around the knee.

  2. Lateral–Medial Dissociation in Orbitofrontal Cortex–Hypothalamus Connectivity

    PubMed Central

    Hirose, Satoshi; Osada, Takahiro; Ogawa, Akitoshi; Tanaka, Masaki; Wada, Hiroyuki; Yoshizawa, Yasunori; Imai, Yoshio; Machida, Toru; Akahane, Masaaki; Shirouzu, Ichiro; Konishi, Seiki

    2016-01-01

    The orbitofrontal cortex (OFC) is involved in cognitive functions, and is also closely related to autonomic functions. The OFC is densely connected with the hypothalamus, a heterogeneous structure controlling autonomic functions that can be divided into two major parts: the lateral and the medial. Resting-state functional connectivity has allowed us to parcellate the cerebral cortex into putative functional areas based on the changes in the spatial pattern of connectivity in the cerebral cortex when a seed point is moved from one voxel to another. In the present high spatial-resolution fMRI study, we investigate the connectivity-based organization of the OFC with reference to the hypothalamus. The OFC was parcellated using resting-state functional connectivity in an individual subject approach, and then the functional connectivity was examined between the parcellated areas in the OFC and the lateral/medial hypothalamus. We found a functional double dissociation in the OFC: the lateral OFC (the lateral orbital gyrus) was more likely connected with the lateral hypothalamus, whereas the medial OFC (the medial orbital and rectal gyri) was more likely connected with the medial hypothalamus. These results demonstrate the fundamental heterogeneity of the OFC, and suggest a potential neural basis of the OFC–hypothalamic functional interaction. PMID:27303281

  3. Polysegmental innervation of the medial paraspinal lumbar muscles.

    PubMed

    Kottlors, Michael; Glocker, Franz Xaver

    2008-02-01

    A retrospective analysis was performed in a nine month period of the electrophysiological data, imaging and clinical findings of patients with monoradicular disc herniation compressing either the L5 or the S1 nerve root. The primary purpose of the analysis was to determine the distribution of pathological spontaneous activity in the medial paraspinal muscles on electromyographic examination in monoradicular L5 and S1 nerve root compression syndromes. Anatomically, the medial paraspinal muscles receive their innervation from a single root while the iliocostalis muscles and the longissimus muscle are thought to be innervated by multiple nerve roots. In the analysis, in single nerve root lesion of the L5 or S1 nerve root, electromyography of the medial paraspinal muscles revealed pathological spontaneous activity one to three vertebrae cranial to the disc herniation with extension to the opposite side of the lesion. In conclusion, the medial paraspinal muscles might be thought to be innervated by one single nerve root on anatomical studies, electrophysiologically the extension of axonal lesion signs of one single lumbar nerve root is much broader. The widespread distribution of the L5 and S1 nerve root must be taken into consideration on electromyographic examination of the medial paraspinal muscles.

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

    PubMed

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

    2016-05-01

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

  5. Longitudinal joint study.

    DOT National Transportation Integrated Search

    2001-09-01

    In previous years there has been a problem with longitudinal joint : deterioration, due in part to poor construction techniques. : The degradation of the longitudinal joints has increased the cost of : maintaining these projects and caused unnecessar...

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

    PubMed

    Hussain, Qandeel

    2015-10-01

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

  7. Isolated medial foot compartment syndrome after ankle sprain.

    PubMed

    Cortina, Josep; Amat, Carles; Selga, Jordi; Corona, Pablo Salvador

    2014-03-01

    Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication. We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms. Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  8. Management of Dermoid Tumor in the Medial Canthal Area

    PubMed Central

    Kim, Nam Ju; Choung, Ho Kyung

    2009-01-01

    Dermoid tumors in the medial canthal area are rare, but when present they commonly adhere to the lacrimal canaliculi. Three patients presented with a mass in the medial canthal area. The authors performed excisional biopsies, and the masses were diagnosed as dermoid tumors. In two patients, canalicular lacerations were found after mass excision, which suggested that the masses had been firmly adherent to the lacrimal canaliculi. The lacerated canaliculi were repaired after bicanalicular silicone intubation. In the remaining patient, lacrimal silicone intubation was performed at the beginning of surgery, and the mass was successfully dissected from the canaliculi, leaving them intact. Excision of dermoid tumors in the medial canthal area requires careful dissection to avoid canalicular laceration. Bicanalicular silicone intubation at the beginning of surgery is helpful for the identification of the canaliculi and for the prevention of canalicular laceration during dermoid tumor excision. PMID:19794949

  9. Individuals' and groups' intentions in the medial prefrontal cortex.

    PubMed

    Chaminade, Thierry; Kawato, Mitsuo; Frith, Chris

    2011-11-16

    Functional MRI signal was recorded while participants perceived stimuli presented using moving dots. In two conditions of interest, the motion of dots depicted intentions: dots representing the joints of an agent performing an action, and dots representing individual agents behaving contingently. The finding of a common cluster in the posterior part of the medial frontal cortex involved in intentional action representation validates the hypothesis that perception of these two conditions requires a similar internal representation. A cluster responding to the behaving group only is found in the anterior medial frontal cortex. These results support a division of the medial frontal cortex according to social stimuli attributes, with anterior areas responding to higher-order group behaviours integrating the action of multiple individual agents. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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

    PubMed

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

    2016-05-01

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

  11. Reducing joint loading in medial knee osteoarthritis: shoes and canes.

    PubMed

    Kemp, Georgina; Crossley, Kay M; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S

    2008-05-15

    Increased medial knee loading is associated with a much higher risk of disease progression in knee osteoarthritis (OA). Interventions that can reduce medial knee joint load have the potential to slow disease progression over time. We evaluated the effects of shoes and a cane on knee load in people with knee OA. Forty people with medial knee OA underwent 3-dimensional gait analysis to measure their peak knee adduction moment, an indicator of medial knee joint load. Results when walking in bare feet were compared with those obtained when walking in their own usual shoes. Twenty participants also underwent testing using a cane, and results were compared with walking unaided. Compared with barefoot, walking in shoes was associated with a significant increase in the peak knee adduction moment (mean +/- SD N x m/BW x H% 3.49 +/- 0.84 versus 3.77 +/- 0.90; P < 0.001), although there was considerable individual variation. The use of a cane resulted in a 10% decrease in the knee adduction moment (mean +/- SD N x m/BW x H% 3.76 +/- 0.95 versus 3.38 +/- 0.68; P = 0.001). Wearing shoes increases medial knee joint load compared with walking barefoot. Given the variable response to shoes observed, further research is required to ascertain which shoe types might be optimal for those with knee OA. The use of a cane significantly reduces medial knee loading and has the potential to reduce the risk of disease progression in knee OA.

  12. Compartmental endoscopic surgical anatomy of the medial intraconal orbital space.

    PubMed

    Bleier, Benjamin S; Healy, David Y; Chhabra, Nipun; Freitag, Suzanne

    2014-07-01

    Surgical management of intraconal pathology represents the next frontier in endoscopic endonasal surgery. Despite this, the medial intraconal space remains a relatively unexplored region, secondary to its variable and technically demanding anatomy. The purpose of this study is to define the neurovascular structures in this region and introduce a compartmentalized approach to enhance surgical planning. This study was an institutional review board (IRB)-exempt endoscopic anatomic study in 10 cadaveric orbits. After dissection of the medial intraconal space, the pattern and trajectory of the oculomotor nerve and ophthalmic arterial arborizations were analyzed. The position of all vessels as well as the length of the oculomotor trunk and branches relative to the sphenoid face were calculated. A mean of 1.5 arterial branches were identified (n = 15; range, 1-4) at a mean of 8.8 mm from the sphenoid face (range, 4-15 mm). The majority of the arteries (n = 7) inserted adjacent to the midline of medial rectus. The oculomotor nerve inserted at the level of the sphenoid face and arborized with a large proximal trunk 5.5 ± 1.1 mm in length and multiple branches extending 13.2 ± 2.7 mm from the sphenoid face. The most anterior nerve and vascular pedicle were identified at 17.0 and 15.0 mm from the sphenoid face, respectively. The neurovascular supply to the medial rectus muscle describes a varied but predictable pattern. This data allows the compartmentalization of the medial intraconal space into 3 zones relative to the neurovascular supply. These zones inform the complexity of the dissection and provide a guideline for safe medial rectus retraction relative to the fixed landmark of the sphenoid face. © 2014 ARS-AAOA, LLC.

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

    PubMed

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

    2017-08-01

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

  14. Medial approach to the subtalar joint: anatomy, indications, technique tips.

    PubMed

    Knupp, Markus; Zwicky, Lukas; Lang, Tamara Horn; Röhm, Julian; Hintermann, Beat

    2015-06-01

    The medial approach to the subtalar joint allows good visualization of the articular surfaces. Compared with the lateral approach, advantages are found particularly in flatfoot correction, in which the single-incision technique can be used for corrective fusions of rigid flatfoot deformity. Union rates are comparable with the traditional lateral approach; however, wound healing problems occur less frequently. Avascular necrosis of the talus is a rare but serious complication, although frequency seems to be independent of the approach chosen. Clinical studies showed no increased morbidity when comparing the medial to the lateral approach. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Blends of canal surfaces from polyhedral medial transform representations

    PubMed Central

    Bastl, Bohumír; Jüttler, Bert; Lávička, Miroslav; Schulz, Tino

    2011-01-01

    We present a new method for constructing G1 blending surfaces between an arbitrary number of canal surfaces. The topological relation of the canal surfaces is specified via a convex polyhedron and the design technique is based on a generalization of the medial surface transform. The resulting blend surface consists of trimmed envelopes of one- and two-parameter families of spheres. Blending the medial surface transform instead of the surface itself is shown to be a powerful and elegant approach for blend surface generation. The performance of our approach is demonstrated by several examples. PMID:22298912

  16. Medial Temporal Lobe Structures Contribute to On-Line Processing

    ERIC Educational Resources Information Center

    Warren, David

    2009-01-01

    For the last five decades, the medial temporal lobes have been generally understood to facilitate enduring representation of certain kinds of information. In particular, knowledge about the relations among items and concepts appears to rely on that region of the brain. Recent results suggest that those same structures also play a subtle role in…

  17. Medial Temporal Lobe Volume Predicts Elders' Everyday Memory

    PubMed Central

    Bailey, Heather R.; Zacks, Jeffrey M.; Hambrick, David Z.; Zacks, Rose T.; Head, Denise; Kurby, Christopher A.; Sargent, Jesse Q.

    2013-01-01

    Deficits in memory for everyday activities are common complaints among healthy and demented older adults. The medial temporal lobes and dorsolateral prefrontal cortex are both affected by aging and early-stage Alzheimer's disease, and are known to influence performance on laboratory memory tasks. We investigated whether the volume of these structures predicts everyday memory. Cognitively healthy older adults and older adults with mild Alzheimer's-type dementia watched movies of everyday activities and completed memory tests on the activities. Structural MRI was used to measure brain volume. Medial temporal but not prefrontal volume strongly predicted subsequent memory. Everyday memory depends on segmenting activity into discrete events during perception, and medial temporal volume partially accounted for the relationship between performance on the memory tests and performance on an event-segmentation task. The everyday-memory measures used in this study involve retrieval of episodic and semantic information as well as working memory updating. Thus, the current findings suggest that during perception, the medial temporal lobes support the construction of event representations that determine subsequent memory. PMID:23630222

  18. Medial Temporal Lobe Memory in Childhood: Developmental Transitions

    ERIC Educational Resources Information Center

    Townsend, Elise L.; Richmond, Jenny L.; Vogel-Farley, Vanessa K.; Thomas, Kathleen

    2010-01-01

    The medial temporal lobes (MTL) support declarative memory and mature structurally and functionally during the postnatal years in humans. Although recent work has addressed the development of declarative memory in early childhood, less is known about continued development beyond this period of time. The purpose of this investigation was to explore…

  19. Medial Prefrontal Cortex Lesions Abolish Contextual Control of Competing Responses

    ERIC Educational Resources Information Center

    Haddon, J. E.; Killcross, A. S.

    2005-01-01

    There is much debate as to the extent and nature of functional specialization within the different subregions of the prefrontal cortex. The current study was undertaken to investigate the effect of damage to medial prefrontal cortex subregions in the rat. Rats were trained on two biconditional discrimination tasks, one auditory and one visual, in…

  20. Tibial Bone Density in Athletes With Medial Tibial Stress Syndrome: A Controlled Study

    PubMed Central

    Özgürbüz, Cengizhan; Yüksel, Oğuz; Ergün, Metin; İşlegen, Çetin; Taskiran, Emin; Denerel, Nevzad; Karamizrak, Oğuz

    2011-01-01

    Medial tibial stress syndrome (MTSS) is a common overuse injury of the lower extremity predominantly observed in weight bearing activities. Knowledge about the pathological lesions and their pathophysiology is still limited. Only a single study was found to have investigated tibial bone density in the pain region, revealing lower density in athletes with long standing (range, 5-120 month) MTSS. In a follow-up study, bone density was determined to return to normal levels after recovery. The purpose of the present study was to investigate tibial bone density in athletes with shorter MTSS history (range, 3-10 weeks). A total of 11 athletes (7 males, 4 females) diagnosed with medial tibial stress syndrome were included in the study. The control group consisted of 11 regularly exercising individuals (7 males, 4 females). Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. Total calcium intake was calculated by evaluating detailed nutrition history. No statistically significant differences were found in the tibial, femoral and vertebral bone densities between the groups. No statistically significant difference was found among groups, considering for calcium intake. Tibial bone densities were not lower in athletes with MTSS of 5.0 weeks mean duration (range, 3-10 weeks) compared to the healthy control group. Longitudinal studies with regular tibial bone density measurements in heavily trained athletes are necessary to investigate tibial density alterations in MTSS developing athletes during the course of the symptoms. Key points Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. No differences were found between the MTSS group (MTSS history 3-10 weeks) and the healthy athletes group. PMID:24149568

  1. Relationship of medial temporal lobe atrophy, APOE genotype, and cognitive reserve in preclinical Alzheimer's disease.

    PubMed

    Soldan, Anja; Pettigrew, Corinne; Lu, Yi; Wang, Mei-Cheng; Selnes, Ola; Albert, Marilyn; Brown, Timothy; Ratnanather, J Tilak; Younes, Laurent; Miller, Michael I

    2015-07-01

    This study evaluated the utility of baseline and longitudinal magnetic resonance imaging (MRI) measures of medial temporal lobe brain regions collected when participants were cognitively normal and largely in middle age (mean age 57 years) to predict the time to onset of clinical symptoms associated with mild cognitive impairment (MCI). Furthermore, we examined whether the relationship between MRI measures and clinical symptom onset was modified by apolipoprotein E (ApoE) genotype and level of cognitive reserve (CR). MRI scans and measures of CR were obtained at baseline from 245 participants who had been followed for up to 18 years (mean follow-up 11 years). A composite score based on reading, vocabulary, and years of education was used as an index of CR. Cox regression models showed that lower baseline volume of the right hippocampus and smaller baseline thickness of the right entorhinal cortex predicted the time to symptom onset independently of CR and ApoE-ɛ4 genotype, which also predicted the onset of symptoms. The atrophy rates of bilateral entorhinal cortex and amygdala volumes were also associated with time to symptom onset, independent of CR, ApoE genotype, and baseline volume. Only one measure, the left entorhinal cortex baseline volume, interacted with CR, such that smaller volumes predicted symptom onset only in individuals with lower CR. These results suggest that MRI measures of medial temporal atrophy, ApoE-ɛ4 genotype, and the protective effects of higher CR all predict the time to onset of symptoms associated with MCI in a largely independent, additive manner during the preclinical phase of Alzheimer's disease. © 2015 Wiley Periodicals, Inc.

  2. Dynamic Changes in Acetylcholine Output in the Medial Striatum during Place Reversal Learning

    ERIC Educational Resources Information Center

    Ragozzino, Michael E.; Choi, Daniel

    2004-01-01

    The present studies explored the role of the medial striatum in learning when task contingencies change. Experiment 1 examined whether the medial striatum is involved in place reversal learning. Testing occurred in a modified cross-maze across two consecutive sessions. Injections of the local anesthetic, bupivacaine, into the medial striatum, did…

  3. Longitudinal Multistage Testing

    ERIC Educational Resources Information Center

    Pohl, Steffi

    2013-01-01

    This article introduces longitudinal multistage testing (lMST), a special form of multistage testing (MST), as a method for adaptive testing in longitudinal large-scale studies. In lMST designs, test forms of different difficulty levels are used, whereas the values on a pretest determine the routing to these test forms. Since lMST allows for…

  4. Conducting Longitudinal Research.

    ERIC Educational Resources Information Center

    Bronner, Michael

    2002-01-01

    Suggests that longitudinal research can provide more depth and allow for reflection on and confirmation of results. Advises researchers to prepare for longitudinal studies by building on research history, carefully designing instruments, considering costs, and making a plan for data treatment. Outlines a sequence of steps for conducting research…

  5. Medial foot pain in a runner: a case presentation.

    PubMed

    Miller, Levi K; Harrast, Mark A

    2013-09-01

    A 27-year-old runner presented to our sports medicine clinic with 4 months of medial foot pain after an eversion ankle sprain. Initial radiographs were negative for fracture. Her symptoms improved but plateaued after 1 month. She was unable to continue running and noticed a new prominence at her right medial foot. Results of a physical examination showed pes planus, a prominent navicular in her right foot and mild weakness of inversion at the right ankle. Magnetic resonance imaging showed bone edema adjacent to a navicular synchondrosis, which confirmed a diagnosis of type 2 accessory navicular with synchondrosis injury. The patient was treated conservatively with a progressive rehabilitation course. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  6. Working memory and left medial temporal cortical thickness.

    PubMed

    Pastura, Giuseppe; Kubo, Tadeu Takao Almodovar; Regalla, Maria Angélica; Mesquita, Cíntia Machado; Coutinho, Gabriel; Gasparetto, Emerson Leandro; Figueiredo, Otávio; Mattos, Paulo; Araújo, Alexandra Prüfer de Queiroz Campos

    2016-10-01

    To perform a pilot study to investigate the association between working memory and cortical thickness in a sample of attention deficit/hyperactivity disorder (ADHD) children. Seventeen children aged 7-10 years diagnosed with ADHD and 16 healthy children underwent a magnetic resonance scan for cortical thickness measurements. Data was correlated with working memory performance using the Backwards Digit Span subtest of the Wechsler Intelligence Scale for Children. Working memory impairment, evidenced by lower scores on the Backwards Digit Span, was observed in patients with ADHD compared to healthy controls. There was a direct correlation between working memory and cortical thickness of the left medial temporal lobe (Spearman's correlation coefficient: 0.499; p < 0.005). Our data suggests, for the first time, a correlation between working memory, evaluated by the Backwards Digit Span, and left medial temporal cortical thickness.

  7. REHABILITATION FOLLOWING MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION FOR PATELLAR INSTABILITY

    PubMed Central

    Prohaska, Daniel

    2017-01-01

    Patellar instability is a common problem seen by physical therapists, athletic trainers and orthopedic surgeons. Although following an acute dislocation, conservative rehabilitation is usually the first line of defense; refractory cases exist that may require surgical intervention. Substantial progress has been made in the understanding of the medial patellofemoral ligament (MPFL) and its role as the primary stabilizer to lateral patellar displacement. Medial patellofemoral ligament disruption is now considered to be the essential lesion following acute patellar dislocation due to significantly high numbers of ruptures following this injury. Evidence is now mounting that demonstrates the benefits of early reconstruction with a variety of techniques. Recently rehabilitation has become more robust and progressive due to our better understanding of soft tissue reconstruction and repair techniques. The purpose of this manuscript is to describe the etiology of patellar instability, the anatomy and biomechanics and examination of patellofemoral instability, and to describe surgical intervention and rehabilitation following MPFL rupture. Level of Evidence 5 PMID:28593102

  8. Downregulation of the posterior medial frontal cortex prevents social conformity.

    PubMed

    Klucharev, Vasily; Munneke, Moniek A M; Smidts, Ale; Fernández, Guillén

    2011-08-17

    We often change our behavior to conform to real or imagined group pressure. Social influence on our behavior has been extensively studied in social psychology, but its neural mechanisms have remained largely unknown. Here we demonstrate that the transient downregulation of the posterior medial frontal cortex by theta-burst transcranial magnetic stimulation reduces conformity, as indicated by reduced conformal adjustments in line with group opinion. Both the extent and probability of conformal behavioral adjustments decreased significantly relative to a sham and a control stimulation over another brain area. The posterior part of the medial frontal cortex has previously been implicated in behavioral and attitudinal adjustments. Here, we provide the first interventional evidence of its critical role in social influence on human behavior.

  9. Endoscopic modified medial maxillectomy for odontogenic cysts and tumours.

    PubMed

    Nakayama, Tsugihama; Otori, Nobuyoshi; Asaka, Daiya; Okushi, Tetsushi; Haruna, Shin-ichi

    2014-12-01

    Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri- or postoperative complications, and no incidences of recurrence. Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

  10. The operative outcomes of displaced medial-end clavicle fractures.

    PubMed

    Sidhu, Verinder S; Hermans, Deborah; Duckworth, David G

    2015-11-01

    Nonoperative treatment of displaced medial clavicle fractures often leads to poor functional outcomes and painful nonunions. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures. We investigated 27 patients undergoing operative fixation of a medial clavicle fracture; 24 had an acute, displaced fracture and 3 had fixation for nonunions. Preoperative radiographs or computed tomography scans were obtained, and data collected included age, sex, mechanism of injury, and fixation method. Follow-up included physical examination and radiographs for assessment of union; Disabilities of the Arm, Shoulder, and Hand scores at 12 months; and the recording of complications. The median age was 37 years (interquartile range, 17-47 years). There were 26 male patients and one female patient included, with 7 physeal injuries and 20 adult injuries. The most common mechanism of fracture was vehicular accident (n = 15). Three patients had operations for nonunions and 2 for a periprosthetic fracture medial to an existing plate. The fracture was fixed with plate and screws in 19 cases and with transosseous sutures in 8 cases. The median Disabilities of the Arm, Shoulder, and Hand score at 12 months was 0.4 (interquartile range, 0-5.0), with a union rate of 100% at 12 months. All patients had full shoulder range of motion at final follow-up and were able to return to preinjury occupational activities. There were no significant complications. Operative fixation of displaced medial clavicle fractures results in anatomic reconstruction and excellent functional outcomes, even in the setting of fixation performed for symptomatic nonunion. Early intervention can minimize the risk of painful nonunion. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  11. Predictors of Subjective Outcome After Medial Unicompartmental Knee Arthroplasty.

    PubMed

    Zuiderbaan, Hendrik A; van der List, Jelle P; Chawla, Harshvardhan; Khamaisy, Saker; Thein, Ran; Pearle, Andrew D

    2016-07-01

    Unexplainable pain after medial unicompartmental knee arthroplasty (UKA) remains a leading cause for revision surgery. Therefore, the aim of this study is to identify the patient-specific variables that may influence subjective outcomes after medial UKA to optimize results. Retrospectively, we analyzed 104 consecutive medial UKA patients. The evaluated parameters consisted of age, body mass index, gender, preoperative radiographic severity of the various knee compartments, and preoperative and postoperative mechanical axis alignments. At an average of 2.3-year follow-up, our data demonstrate that body mass index, gender, and preoperative severity among the various knee compartments do not influence Western Ontario and McMaster Universities Arthritis Index (WOMAC) results. Preoperatively, patients aged <65 years had inferior WOMAC stiffness (4.6 vs 2.9, P = .001), pain (9.7 vs 7.6, P = .041), and total (37.2 vs 47.6, P = .028) scores vs patients aged ≥65 years. Postoperatively, only the difference on the WOMAC stiffness subscale remained significant between both age groups, in favor of patients aged ≥65 years (1.0 vs 1.5, P = .035). A postoperative varus mechanical axis alignment of 1°-4° correlated to significantly superior WOMAC pain (P = .03), function (P = .04), and total (P = .04) scores compared to a varus of ≤1° or ≥4°. Our data suggest that greater pain relief can be expected in patients aged <65 years and that a postoperative lower limb alignment of 1°-4° varus should be pursued. Taking these factors into consideration will help to maximize clinical outcomes, fulfill patient expectations after medial UKA, and subsequently minimize revision rates. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [Irreducible knee dislocation by medial capsulo-ligament incarceration].

    PubMed

    Chirpaz-Cerbat, J-M; Rossi, J; Mélère, G; Martinez, T

    2004-09-01

    Irreducible dislocation of the knee is exceptional. Incarceration of the capsulo-ligamentary elements in the inter-condylar notch is a particular causal mechanism. We report four new cases and review the literature to describe the diagnostic and therapeutic approach. Between January 2001 and January 2002, four patients underwent surgery after trauma (wind surf, ski accidents) producing an irreducible knee dislocation. Mean patient age was 53 years and mean follow-up was 16 months. The IKDC classification was used to assess outcome. Physical examination revealed characteristic signs: a groove facing the medial joint line with signs of cutaneous suffering just above and a fold line behind the medial condyle. Orthopedic reduction failed. Surgery was performed in all cases and revealed incarceration of the entire capsulo-ligamentary structure in the intercondylar notch with the medial condyle in an extra-articular position. After surgical reduction, healing was achieved in all cases without cutaneous necrosis. The mean subjective IKDC score was 53.9. Orthopedic reduction is impossible in about 4% of all cases of knee dislocation. Clinical signs are characteristic when the medial capsulo-ligamentary structures are incarcerated in the intercondylar notch; the anatomic injury is almost always the same. Vasculonervous complications are exceptional but an emergency arteriography should be obtained to rule out an infra-clinical intimal lesion. Cutaneous necrosis is a specific complication of irreducible dislocation. Early and complete reduction is required to prevent necrosis. Arthroscopic management raises the risk of compartment syndrome since peripheral lesions are not healed. Satisfactory functional recovery requires associated repair of the cruciate ligaments. This type of irreducible dislocation of the knee is a specific clinical entity. It usually results from postero-lateral rotation but may exceptionally occur after lateral dislocation. A groove associated with a

  13. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction.

    PubMed

    Ventura, Alberto; Legnani, Claudio; Terzaghi, Clara; Iori, Stefano; Borgo, Enrico

    2017-03-01

    The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency. Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components. KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p < 0.001). Regarding AKSS, improvement was noted both in the objective score and in the functional one (p < 0.001). There was no clinical evidence of instability in any of the knees as evaluated with clinical laxity testing. No pathologic radiolucent lines were observed around the components. In one patient signs of osteoarthritis in the lateral compartment were observed 28 months after surgery. UKA combined with ACL reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components. IV.

  14. The dorsal tectal longitudinal column (TLCd): a second longitudinal column in the paramedian region of the midbrain tectum.

    PubMed

    Aparicio, M-Auxiliadora; Saldaña, Enrique

    2014-03-01

    The tectal longitudinal column (TLC) is a longitudinally oriented, long and narrow nucleus that spans the paramedian region of the midbrain tectum of a large variety of mammals (Saldaña et al. in J Neurosci 27:13108-13116, 2007). Recent analysis of the organization of this region revealed another novel nucleus located immediately dorsal, and parallel, to the TLC. Because the name "tectal longitudinal column" also seems appropriate for this novel nucleus, we suggest the TLC described in 2007 be renamed the "ventral tectal longitudinal column (TLCv)", and the newly discovered nucleus termed the "dorsal tectal longitudinal column (TLCd)". This work represents the first characterization of the rat TLCd. A constellation of anatomical techniques was used to demonstrate that the TLCd differs from its surrounding structures (TLCv and superior colliculus) cytoarchitecturally, myeloarchitecturally, neurochemically and hodologically. The distinct expression of vesicular amino acid transporters suggests that TLCd neurons are GABAergic. The TLCd receives major projections from various areas of the cerebral cortex (secondary visual mediomedial area, and granular and dysgranular retrosplenial cortices) and from the medial pretectal nucleus. It densely innervates the ipsilateral lateral posterior and laterodorsal nuclei of the thalamus. Thus, the TLCd is connected with vision-related neural centers. The TLCd may be unique as it constitutes the only known nucleus made of GABAergic neurons dedicated to providing massive inhibition to higher order thalamic nuclei of a specific sensory modality.

  15. Case report: comprehensive management of medial tibial stress syndrome.

    PubMed

    Krenner, Bernard John

    2002-01-01

    Activity or exercise-induced leg pain is a common complication among competitive and "weekend warrior" athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of "shin splints," one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. "Active" rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness.

  16. Outcome of surgical treatment of medial tibial stress syndrome.

    PubMed

    Yates, Ben; Allen, Mike J; Barnes, Mike R

    2003-10-01

    Medial tibial stress syndrome is a common chronic sports injury characterized by exercise-induced pain along the posteromedial border of the tibia. The reported outcomes of surgical treatment of this condition have varied. Of seventy-eight patients who underwent surgery for medial tibial stress syndrome, forty-six (thirty-one men and fifteen women) returned for follow-up. The outcomes of the surgery were determined by comparing preoperative and postoperative pain levels as indicated on a visual analog pain scale and ascertaining the ability of the athletes to return to presymptom levels of exercise. The mean duration of postoperative follow-up was thirty months (range, six to sixty-three months). Surgery significantly reduced pain levels (p < 0.001) by an average of 72% as indicated on the visual analog pain scale. An excellent result was achieved in 35% of the limbs; a good result, in 34%; a fair result, in 22%; and a poor result, in 9%. Despite the success with regard to pain reduction, for a variety of reasons only nineteen (41%) of the athletes fully returned to their presymptom sports activity. Surgery can significantly reduce the pain associated with medial tibial stress syndrome. Despite this reduction in pain, athletes should be counseled that a full uninhibited return to sports is not always achieved.

  17. Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome.

    PubMed

    Çırpar, Meriç; Özüak, Cem Seyfi; Oktaş, Birhan; Canbeyli, İbrahim Deniz

    2017-08-01

    This study aims to compare partial medial epicondylectomy (PMe) and distal medial epicondylectomy (DMe) techniques in terms of sensory and motor improvements, functional results and complications. The study included a total of 59 cubital tunnel syndrome patients (37 males, 22 females; mean age 42.3 years; range 23 to 80 years). Of the patients, DMe was applied on 30 and PMe was applied on 29. Patients were evaluated with Wilson Krout scores, Semmes-Weinstein Monofilament (SWM) test, and grip and pinch strength measurements preoperatively and at postoperative third, sixth, and 12th months. Both groups' pre- and postoperative intragroup and intergroup results were compared. Wilson Krout scores in postoperative checks were better with DMe compared to PMe. The improvement in SWM test scores was statistically significant for only DMe. The improvement in grip strength, lateral pinch and terminal pinch measurements in DMe group was significant at postoperative third month. In PMe group, significant improvement for these measurements was obtained at postoperative sixth month. The only complication observed with DMe was tenderness developing over the medial epicondyle. Painful subluxation of the nerve associated with paresthesia was detected in four patients in PMe group. Compared to PMe, DMe offers more satisfactory subjective results. Motor functional recovery occurs earlier with DMe. DMe appears to have lower complication rates.

  18. [The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation].

    PubMed

    Yokota, Jun-Ichi; Amakusa, Yayoi; Tomita, Yutaka; Takahashi, Shin-Ichi

    2003-02-01

    A-38-year-old man suddenly developed nausea, vomiting and vertigo during chiropractic neck manipulation. This was followed by right hemiplegia, right deep sensory disturbance and left hypoglossal nerve palsy, consistent with the medial medullary infarction (Dejerine syndrome). The MRI revealed infarction at left medial part of the medulla. The vertebral angiogram and MRA showed marked narrowing of the left vertebral artery. X-rays of the cervical spine showed no spondylosis, dislocation nor osteolysis of the odontoid process. The serological studies, including lupus anticoagulant, protein C, and protein S gave normal results. Although vascular accidents involving the brain stem after chiropractic neck manipulation have been reported since Pratt-Thomas and Berger, previous reports are still rare. In them lateral medullary infarction (Wallenberg syndrome) is probably the most common case. On the other hand, medial medullary syndrome (Dejerine syndrome) is absolutely rare. To our knowledge, the only one report has been made by Watanabe and his colleagues before our present case. The mechanism was suggested that rotation and tilting of the neck stretches and compresses the vertebral artery at the cervical joint causing injury to the vessel, with an intimal tearing, dissection, and pseudoaneurysm formation. Consequently, the present case may be caused by injury to the left vertebral artery with an intimal tearing during neck manipulation sufficient to cause disection and subsequent infarction of the brain stem.

  19. Medial vestibular connections with the hypocretin (orexin) system

    NASA Technical Reports Server (NTRS)

    Horowitz, Seth S.; Blanchard, Jane; Morin, Lawrence P.

    2005-01-01

    The mammalian medial vestibular nucleus (MVe) receives input from all vestibular endorgans and provides extensive projections to the central nervous system. Recent studies have demonstrated projections from the MVe to the circadian rhythm system. In addition, there are known projections from the MVe to regions considered to be involved in sleep and arousal. In this study, afferent and efferent subcortical connectivity of the medial vestibular nucleus of the golden hamster (Mesocricetus auratus) was evaluated using cholera toxin subunit-B (retrograde), Phaseolus vulgaris leucoagglutinin (anterograde), and pseudorabies virus (transneuronal retrograde) tract-tracing techniques. The results demonstrate MVe connections with regions mediating visuomotor and postural control, as previously observed in other mammals. The data also identify extensive projections from the MVe to regions mediating arousal and sleep-related functions, most of which receive immunohistochemically identified projections from the lateral hypothalamic hypocretin (orexin) neurons. These include the locus coeruleus, dorsal and pedunculopontine tegmental nuclei, dorsal raphe, and lateral preoptic area. The MVe itself receives a projection from hypocretin cells. CTB tracing demonstrated reciprocal connections between the MVe and most brain areas receiving MVe efferents. Virus tracing confirmed and extended the MVe afferent connections identified with CTB and additionally demonstrated transneuronal connectivity with the suprachiasmatic nucleus and the medial habenular nucleus. These anatomical data indicate that the vestibular system has access to a broad array of neural functions not typically associated with visuomotor, balance, or equilibrium, and that the MVe is likely to receive information from many of the same regions to which it projects.

  20. Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty.

    PubMed

    Heyse, Thomas J; El-Zayat, Bilal F; De Corte, Ronny; Scheys, Lennart; Chevalier, Yan; Fuchs-Winkelmann, Susanne; Labey, Luc

    2014-01-01

    Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this. Six fresh frozen full leg cadaver specimens were prepared and mounted in a kinematic rig with six degrees of freedom for the knee joint. Three motion patterns were applied with the native knee and after sequential implantation of medial UKA and patellofemoral joint replacement (PFJ): passive flexion-extension, open chain extension, and squatting. During the loaded motions, quadriceps and hamstrings muscle forces were applied. Infrared cameras continuously recorded the trajectories of marker frames rigidly attached to femur, tibia and patella. Prior computer tomography allowed identification of coordinate frames of the bones. Strains in the collateral ligaments were calculated from insertion site distances. UKA led to a less adducted and internally rotated tibia and a more strained medial collateral ligament (MCL). Addition of a patellofemoral replacement led to a more posterior position of both femoral condyles, a more dorsally located tibiofemoral contact point and higher MCL strain with squatting. In comparison to UKA modular BKA leads to a more dorsal tibial contact point, a medial femoral condyle being located more posteriorly, and more MCL strain. Mainly the changes to the trochlear anatomy as introduced by PFJ may account for these differences. © 2014 Elsevier B.V. All rights reserved.

  1. Continuous Medial Representation of Brain Structures Using the Biharmonic PDE

    PubMed Central

    Yushkevich, Paul A.

    2009-01-01

    A new approach for constructing deformable continuous medial models for anatomical structures is presented. Medial models describe geometrical objects by first specifying the skeleton of the object and then deriving the boundary surface corresponding to the skeleton. However, an arbitrary specification of a skeleton will not be “Valid” unless a certain set of sufficient conditions is satisfied. The most challenging of these is the non-linear equality constraint that must hold along the boundaries of the manifolds forming the skeleton. The main contribution of this paper is to leverage the biharmonic partial differential equation as a mapping from a codimension-0 subset of Euclidean space to the space of skeletons that satisfy the equality constraint. The PDE supports robust numerical solution on freeform triangular meshes, providing additional flexibility for shape modeling. The approach is evaluated by generating continuous medial models for a large dataset of hippocampus shapes. Generalizations to modeling more complex shapes and to representing branching skeletons are demonstrated. PMID:19059348

  2. Medial malleolar fractures: a biomechanical study of fixation techniques.

    PubMed

    Fowler, T Ty; Pugh, Kevin J; Litsky, Alan S; Taylor, Benjamin C; French, Bruce G

    2011-08-08

    Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures. Also, the AO group recommends tension-band fixation of small avulsion type fractures of the medial malleolus that are unacceptable for screw fixation. A well-documented complication of this technique is prominent symptomatic implants and secondary surgery for implant removal. Replacing stainless steel 18-gauge wire with FiberWire suture could theoretically decrease symptomatic implants. Therefore, a second goal was to biomechanically compare these 2 tension-band constructs. Using a tibial Sawbones model, 2 bicortical screws were compared with 2 unicortical cancellous screws on a servohydraulic test frame in offset axial, transverse, and tension loading. Second, tension-band fixation using stainless steel wire was compared with FiberWire under tensile loads. Bicortical screw fixation was statistically the stiffest construct under tension loading conditions compared to unicortical screw fixation and tension-band techniques with FiberWire or stainless steel wire. In fact, unicortical screw fixation had only 10% of the stiffness as demonstrated in the bicortical technique. In a direct comparison, tension-band fixation using stainless steel wire was statistically stiffer than the FiberWire construct. Copyright 2011, SLACK Incorporated.

  3. Volition and conflict in human medial frontal cortex

    PubMed Central

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

    2009-01-01

    Summary Controversy surrounds the role of human medial frontal cortex in controlling actions[1-5]. Although damage to this area leads to severe difficulties in spontaneously initiating actions[6], the precise mechanisms underlying such ‘volitional’ deficits remain to be established. Previous studies have implicated the medial frontal cortex in conflict monitoring[7-10] and the control of voluntary action[11, 12], suggesting that these key processes are functionally related or share neural substrates. Here we combine a novel behavioural paradigm with functional imaging of the oculomotor system to reveal for the first time a functional subdivision of the pre-supplementary motor area (pre-SMA) into anatomically distinct areas responding exclusively to volition or to conflict. We also demonstrate that activity in the supplementary eye field (SEF) distinguishes between success and failure in changing voluntary action plans during conflict, suggesting a role for the SEF in implementing the resolution of conflicting actions. We propose a functional architecture of human medial frontal cortex that incorporates the generation of action plans and the resolution of conflict. PMID:15668167

  4. Bilateral medial medullary stroke: a challenge in early diagnosis.

    PubMed

    Torabi, Amir M

    2013-01-01

    Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Early diagnosis is crucial. Here, I present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Initial brain magnetic resonance imaging (MRI) that was done in the acute phase was read as normal. Other possibilities were excluded by lumbar puncture and MRI of cervical spine. MR of C-spine showed lesion at medial medulla; therefore a second MRI of brain was requested, showed characteristic "heart appearance" shape at diffusion weighted (DWI), and confirmed bilateral medial medullary stroke. Retrospectively, a vague-defined hyperintense linear DWI signal at midline was noted in the first brain MRI. Because of the symmetric and midline pattern of this abnormal signal and similarity to an artifact, some radiologists or neurologists may miss this type of stroke. Radiologists and neurologists must recognize clinical and MRI findings of this rare type of stroke, which early treatment could make a difference in patient outcome. The abnormal DWI signal in early stages of this type of stroke may not be a typical "heart appearance" shape, and other variants such as small dot or linear DWI signal at midline must be recognized as early signs of stroke. Also, MRI of cervical spine may be helpful if there is attention to brainstem as well.

  5. Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis

    PubMed Central

    Torabi, Amir M.

    2013-01-01

    Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Early diagnosis is crucial. Here, I present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Initial brain magnetic resonance imaging (MRI) that was done in the acute phase was read as normal. Other possibilities were excluded by lumbar puncture and MRI of cervical spine. MR of C-spine showed lesion at medial medulla; therefore a second MRI of brain was requested, showed characteristic “heart appearance” shape at diffusion weighted (DWI), and confirmed bilateral medial medullary stroke. Retrospectively, a vague-defined hyperintense linear DWI signal at midline was noted in the first brain MRI. Because of the symmetric and midline pattern of this abnormal signal and similarity to an artifact, some radiologists or neurologists may miss this type of stroke. Radiologists and neurologists must recognize clinical and MRI findings of this rare type of stroke, which early treatment could make a difference in patient outcome. The abnormal DWI signal in early stages of this type of stroke may not be a typical “heart appearance” shape, and other variants such as small dot or linear DWI signal at midline must be recognized as early signs of stroke. Also, MRI of cervical spine may be helpful if there is attention to brainstem as well. PMID:24198988

  6. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release.

    PubMed

    Atoun, Ehud; Debbi, Ronen; Lubovsky, Omri; Weiler, Andreas; Debbi, Eytan; Rath, Ehud

    2013-02-01

    Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.

  7. Posterolateral dislocation of the elbow joint. Relationship to medial instability.

    PubMed

    Eygendaal, D; Verdegaal, S H; Obermann, W R; van Vugt, A B; Pöll, R G; Rozing, P M

    2000-04-01

    Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative changes in the elbow joint, ectopic calcification, or neurological deficits. As the medial collateral ligament complex can be completely disrupted during dislocation, we evaluated the association between the long-term results of treatment of simple posterolateral dislocation of the elbow and the presence of persistent medial or valgus elbow instability. Fifty patients who had a mean age of thirty-three years (range, eighteen to fifty-eight years) had closed reduction of a posterolateral dislocation of the elbow without associated fractures. The extremity was immobilized in an above-the-elbow plaster cast for three weeks. After a mean duration of follow-up of nine years (range, six to thirteen years), forty-one patients were evaluated with an interview, a physical examination, and radiographs made while a valgus load was applied to the elbow. The average score according to the system of The Hospital for Special Surgery was 91 points (range, 49 to 100 points), and thirty-one patients described their elbow function as good or excellent. Twenty-four patients had evidence of medial instability on radiographs made while a valgus load was applied to the elbow. Twenty-one patients had signs of degeneration of the joint, and twenty-five patients had ectopic ossification. Magnetic resonance imaging combined with arthrography was performed for the first twenty patients; eight had evidence of rupture of the medial collateral ligament, seven had generalized degenerative changes of the cartilage, and four had a chondral defect of the capitellum. (The study could not be completed for the remaining patient.) Medial instability on radiographs was correlated with signs of degeneration (p = 0.001), ectopic

  8. Human Connectome-Based Tractographic Atlas of the Brainstem Connections and Surgical Approaches.

    PubMed

    Meola, Antonio; Yeh, Fang-Cheng; Fellows-Mayle, Wendy; Weed, Jared; Fernandez-Miranda, Juan C

    2016-09-01

    The brainstem is one of the most challenging areas for the neurosurgeon because of the limited space between gray matter nuclei and white matter pathways. Diffusion tensor imaging-based tractography has been used to study the brainstem structure, but the angular and spatial resolution could be improved further with advanced diffusion magnetic resonance imaging (MRI). To construct a high-angular/spatial resolution, wide-population-based, comprehensive tractography atlas that presents an anatomical review of the surgical approaches to the brainstem. We applied advanced diffusion MRI fiber tractography to a population-based atlas constructed with data from a total of 488 subjects from the Human Connectome Project-488. Five formalin-fixed brains were studied for surgical landmarks. Luxol Fast Blue-stained histological sections were used to validate the results of tractography. We acquired the tractography of the major brainstem pathways and validated them with histological analysis. The pathways included the cerebellar peduncles, corticospinal tract, corticopontine tracts, medial lemniscus, lateral lemniscus, spinothalamic tract, rubrospinal tract, central tegmental tract, medial longitudinal fasciculus, and dorsal longitudinal fasciculus. Then, the reconstructed 3-dimensional brainstem structure was sectioned at the level of classic surgical approaches, namely supracollicular, infracollicular, lateral mesencephalic, perioculomotor, peritrigeminal, anterolateral (to the medulla), and retro-olivary approaches. The advanced diffusion MRI fiber tracking is a powerful tool to explore the brainstem neuroanatomy and to achieve a better understanding of surgical approaches. CN, cranial nerveCPT, corticopontine tractCST, corticospinal tractCTT, central tegmental tractDLF, dorsal longitudinal fasciculusHCP, Human Connectome ProjectML, medial lemniscusMLF, medial longitudinal fasciculusRST, rubrospinal tractSTT, spinothalamic tract.

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

    PubMed

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

    2011-08-01

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

  10. Longitudinal joint treatment.

    DOT National Transportation Integrated Search

    2006-03-01

    Maine highways have been showing signs of longitudinal joint failure for a number of years. In an effort : to reduce the amount of joint failures the Maine Department of Transportation (MDOT) is currently : evaluating two projects. One project is mon...

  11. Longitudinal Magnification Drawing Mistake

    NASA Astrophysics Data System (ADS)

    Rabal, Héctor; Cap, Nelly; Trivi, Marcelo

    2004-01-01

    Lateral magnification in image formation by positive lenses, mirrors, and dioptrics is usually appropriately developed in most optics textbooks.1-9 However, the image of a three-dimensional object occupies a three-dimensional region of space. The optical system affects both the transverse and the longitudinal dimensions of the object and, in general, does it in different ways. The magnification in the direction of the optical axis (the longitudinal magnification) is seldom treated. In several texts, the concept of longitudinal magnification is not even considered. Symmetrical objects (such as arrows) are used and their images appear laterally inverted. It is not shown how a longitudinally nonsymmetric object is imaged. One of the few books where this subject is well treated is in the textbook by Hecht.10 We have repeatedly verified in our classes that there is some confusion related to this subject. Students tend to believe that the image is longitudinally symmetric with respect to the lens optic center. Some prestigious texts commit the same mistake. In addition, a very nice optics book,11 a catalogue of optical hardware,12 a worldwide scientific magazine,13 a paper in an optics journal,14 and a Spanish encyclopedia,15 for example, have also been found to contain this error in drawing the image of a three-dimensional object formed by a positive lens. In this paper we suggest that the teaching of longitudinal magnification should be done with some care and we include a figure showing a properly drawn image.

  12. Medial orbital wall landmarks in three different North American populations.

    PubMed

    Mehta, Milap P; Perry, Julian D

    2015-04-01

    We sought to measure the medial orbital wall foramina distances in two previously unstudied populations, to describe a new bony medial wall feature, and to validate the accuracy of a new coordinate measurement device within the orbit. Dried, well-preserved, complete human skulls without orbital defects were studied. Age, gender, birthplace, ethnicity, and laterality of the orbit were recorded for each skull. Supranumerary ethmoidal foramina were recorded, and the fronto-ethmoidal groove depth was measured. The distances between the anterior lacrimal crest (ALC) - anterior ethmoidal foramen (AEF), AEF - posterior ethmoidal foramen (PEF), and PEF - optic canal (OC) were measured first by surgical ruler and wire and then by the Microscribe coordinate measurement device. One hundred and forty-six orbits were studied. Fifty-seven orbits were of European or Caucasian descent, 68 orbits of African American descent, 2 orbits of West African descent, 11 orbits of Eskimo descent, and 8 orbits of unknown origin. No significant differences existed between the manual and Microscribe measurements for the ALC-AEF, AEF-PEF, and PEF-OF distances (p < 0.0001). A significant frontoethmoidal groove was observed in 27/146 (19%) orbits, in 6/57 (11%) Caucasian orbits, in 17/70 (24%) African American orbits, and in 4/11 (36%) Eskimo orbits. Supranumerary ethmoidal foramina were found in 50/146 orbits (34.2%) and in 17/27 (63%) orbits with a significant frontoethmoidal grooves. No significant differences in medial wall foramina distances exist between African American and Caucasian orbits; however, a frontoethmoidal groove occurs more commonly in African American orbits. This groove often occurs in the presence of supernumerary ethmoidal foramina. The Microscribe coordinate measurement system represents a valid tool to measure distances within the orbit.

  13. Medial sural artery perforator flap in head and neck reconstruction.

    PubMed

    Özkan, Heval Selman; İrkören, Saime; Aydın, Osman Enver; Eryılmaz, Aylin; Karaca, Hüray

    2016-12-01

    Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.

  14. Heel reconstruction with a medial plantar V-Y flap.

    PubMed

    Roblin, Paul; Healy, Ciaran M J

    2007-03-01

    Full-thickness defects to the plantar surface of the foot present a challenge to the reconstructive surgeon. Skin grafts and a variety of flap procedures have been described to resurface this site, but not all achieve a return to normal foot function. For the plantar surface of the heel, the previously described medial plantar flap can produce successful results. However, this method leaves a donor site, which requires skin grafting. This is a report of a modification of the medial plantar flap into a V-Y configuration that allows direct closure of the donor site. Three defects of the plantar surface of the heel were resurfaced: case 1, a spina bifida patient with a 45-mm-wide debrided pressure sore; and cases 2 and 3, patients with defects resulting from wide excisions of melanomas that were 47 and 57 mm wide, respectively. Patients in cases 2 and 3 were reviewed at 1 year for mobility, gait, and sensation in the flap. The patients in cases 2 and 3 were able to attain full, unrestricted mobility and objectively near-normal sensation of the resurfaced skin. In the patient in case 1, a problematic pressure sore was healed after an intermediate period of wound dehiscence, with a robust, bulky flap. This modified flap retains the advantages of the traditional medial plantar flap while minimizing its donor-site problems. It has permitted satisfactory long-term functional results, optimizing restoration of foot function, and is a useful option that can be considered for resurfacing the problematic plantar surface of the heel.

  15. Neuromuscular Exercise post Partial Medial Meniscectomy: Randomized Controlled Trial.

    PubMed

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

    2015-08-01

    This study aimed to evaluate the effects of a 12-wk, home-based, physiotherapist-guided neuromuscular exercise program on the knee adduction moment (an indicator of mediolateral knee load distribution) in people with a medial arthroscopic partial meniscectomy (APM) within the past 3-12 months. An assessor-blinded, randomized controlled trial including people age 30-50 yr with no to mild pain after medial APM was conducted. Participants were randomly allocated to either a 12-wk neuromuscular exercise program that targeted neutral lower limb alignment or a control group with no exercise. The exercise program included eight individual sessions with one of seven physiotherapists in private clinics, together with home exercises. Primary outcomes were the peak external knee adduction moment during normal-paced walking and during one-leg sit-to-stand. Secondary outcomes included additional measures of knee joint load distribution, patient-reported outcomes, maximal knee and hip muscle strength, and physical function measures. Of 62 randomized participants, 60 (97%) completed the trial. There were no significant between-group differences in the change in peak knee adduction moment during normal-paced walking (mean difference (95% confidence interval), 0.22 (-0.11 to 0.55) N·m/body weight × height %, P =0.19) or during one-leg sit-to-stand (-0.01 (-0.33 to 0.31) N·m/body weight × height %, P = 0.95). There were also no significant between-group differences for any of the secondary outcomes. In patients 3-12 months after a medial APM, a neuromuscular exercise program did not alter the peak knee adduction moment, a key predictor of osteoarthritis structural disease progression. (Australia and New Zealand Clinical Trials Registry, #ACTRN12612000542897.).

  16. Modulating Phonation Through Alteration of Vocal Fold Medial Surface Contour

    PubMed Central

    Mau, Ted; Muhlestein, Joseph; Callahan, Sean; Chan, Roger W.

    2012-01-01

    Objectives 1. To test whether alteration of the vocal fold medial surface contour can improve phonation. 2. To demonstrate that implant material properties affect vibration even when implant is deep to the vocal fold lamina propria. Study Design Induced phonation of excised human larynges. Methods Thirteen larynges were harvested within 24 hours post-mortem. Phonation threshold pressure (PTP) and flow (PTF) were measured before and after vocal fold injections using either calcium hydroxylapatite (CaHA) or hyaluronic acid (HA). Small-volume injections (median 0.0625 mL) were targeted to the infero-medial aspect of the thyroarytenoid (TA) muscle. Implant locations were assessed histologically. Results The effect of implantation on PTP was material-dependent. CaHA tended to increase PTP, whereas HA tended to decrease PTP (Wilcoxon test P = 0.00013 for onset). In contrast, the effect of implantation on PTF was similar, with both materials tending to decrease PTF (P = 0.16 for onset). Histology confirmed implant presence in the inferior half of the vocal fold vertical thickness. Conclusions Taken together, these data suggested the implants may have altered the vocal fold medial surface contour, potentially resulting in a less convergent or more rectangular glottal geometry as a means to improve phonation. An implant with a closer viscoelastic match to vocal fold cover is desirable for this purpose, as material properties can affect vibration even when the implant is not placed within the lamina propria. This result is consistent with theoretical predictions and implies greater need for surgical precision in implant placement and care in material selection. PMID:22865592

  17. Medial tibial pain: a dynamic contrast-enhanced MRI study.

    PubMed

    Mattila, K T; Komu, M E; Dahlström, S; Koskinen, S K; Heikkilä, J

    1999-09-01

    The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.

  18. Correction of flexible pes planus deformity: medial column stabilization procedure.

    PubMed

    Lepow, G M; Sands, M R

    1989-07-01

    A review of five distinct medial column stabilization procedures sets forth criteria specific to certain presentations of pes planus deformity. The importance of considering the manifestation of the condition and its implications with regard to the overall health of the particular patient cannot be overemphasized. The collective goal of all such corrective procedures is identical; it is the variable factors particular to a specific presentation that dictate the preferred corrective action. The course selected by a physician with respect to surgical correction of flexible pes planus must be determined by taking both the procedure and the presentation of the condition under advisement.

  19. Farey Sequences and the Planar Euclidean Medial Axis Test Mask

    NASA Astrophysics Data System (ADS)

    Hulin, Jérôme; Thiel, Édouard

    The Euclidean test mask {T}(r) is the minimum neighbourhood sufficient to detect the Euclidean Medial Axis of any discrete shape whose inner radius does not exceed r. We establish a link between {T}(r) and the well-known Farey sequences, which allows us to propose two new algorithms. The first one computes {T}(r) in time {O}(r^4) and space {O}(r^2). The second one computes for any vector overrightarrow{v} the smallest r for which overrightarrow{v} in{T}(r), in time {O}(r^3) and constant space.

  20. Dynamic and static knee alignment at baseline predict structural abnormalities on MRI associated with medial compartment knee osteoarthritis after 2 years.

    PubMed

    Mahmoudian, Armaghan; van Dieёn, Jaap H; Bruijn, Sjoerd M; Baert, Isabel A C; Faber, Gert S; Luyten, Frank P; Verschueren, Sabine M P

    2017-09-01

    Dynamic and static varus alignment, both, have been reported as risk factors associated with structural progression of knee osteoarthritis. However the association of none of the static and dynamic alignment with structural, clinical, and functional progression associated with knee osteoarthritis has not been assessed yet in a longitudinal study. Forty-seven women with early and established medial knee osteoarthritis were evaluated. Static and dynamic alignment as well as MRI detected structural features, clinical, and functional characteristics of patients were assessed at baseline and at 2 years follow-up. Associations between baseline static and dynamic alignment with structural, functional, and clinical characteristics at the time of entry, as well as the changes over 2 years were evaluated. Both static and dynamic varus alignment at baseline were significantly associated with osteoarthritis related tibio-femoral joint structural abnormalities detected on MRI, at the time of entry. Only the magnitude of varus thrust at baseline was predictive of the changes in the presence of meniscal maceration over two years. None of the static or dynamic measures of knee joint alignment were associated with clinical characteristics associated with medial knee osteoarthritis. The key finding of this study is that both frontal plane dynamic and static alignment, are associated with structural abnormalities in patients with medial knee osteoarthritis. Copyright © 2017. Published by Elsevier B.V.

  1. A geometric morphometric analysis of the medial tibial condyle of African hominids.

    PubMed

    Sylvester, Adam D

    2013-10-01

    Although the hominid knee has been heavily scrutinized, shape variation of the medial tibial condyle has yet to be described. Humans, chimpanzees, and gorillas differ in the shape of their medial femoral condyles and in their capacity for external and internal rotation of the tibia relative to the femur. I hypothesize that these differences should be reflected in the shape of the medial tibial condyle of these hominids. Here I use geometric morphometric techniques to uncover shape differences between the medial tibial condyles of humans, chimpanzees, and gorillas. Humans are distinguished from the other two species by having a much more oval-shaped medial tibial condyle, while those of chimpanzees and gorillas are more triangular in outline. Gorillas (especially males) are distinguished by having more concavely-curved condyles (mediolateral direction), which is interpreted as an effect of heavy loading through the medial compartment of the knee in conjunction with differences in the degree of arboreality. Copyright © 2013 Wiley Periodicals, Inc.

  2. Medial Prefrontal Cortex Lesions Abolish Contextual Control of Competing Responses

    PubMed Central

    Haddon, J.E; Killcross, A.S

    2005-01-01

    There is much debate as to the extent and nature of functional specialization within the different subregions of the prefrontal cortex. The current study was undertaken to investigate the effect of damage to medial prefrontal cortex subregions in the rat. Rats were trained on two biconditional discrimination tasks, one auditory and one visual, in two different contexts. At test, they received presentations of audiovisual compounds of these training stimuli in extinction. These compounds had dictated either the same (congruent trials) or different (incongruent trials) responses during training. In sham-operated controls, contextual cues came to control responding to conflicting information provided by incongruent stimulus compounds. Experiment 1 demonstrated that this contextual control of responding was not evident in individual rats with large amounts of damage that included the prelimbic and cingulate subregions of the prefrontal cortex. Experiment 2 further dissociated the result of Experiment 1, demonstrating that lesions specific to the anterior cingulate cortex were sufficient to produce a deficit early on during presentation of an incongruent stimulus compound but that performance was unimpaired as presentation progressed. This early deficit suggests a role for the anterior cingulate cortex in the detection of response conflict, and for the medial prefrontal cortex in the contextual control of competing responses, providing evidence for functional specialization within the rat prefrontal cortex. PMID:16596976

  3. Medial Orbitofrontal Cortex Is Associated with Fatigue Sensation

    PubMed Central

    Tajima, Seiki; Yamamoto, Shigeyuki; Tanaka, Masaaki; Kataoka, Yosky; Iwase, Masao; Yoshikawa, Etsuji; Okada, Hiroyuki; Onoe, Hirotaka; Tsukada, Hideo; Kuratsune, Hirohiko; Ouchi, Yasuomi; Watanabe, Yasuyoshi

    2010-01-01

    Fatigue is an indispensable bioalarm to avoid exhaustive state caused by overwork or stresses. It is necessary to elucidate the neural mechanism of fatigue sensation for managing fatigue properly. We performed H2 15O positron emission tomography scans to indicate neural activations while subjects were performing 35-min fatigue-inducing task trials twice. During the positron emission tomography experiment, subjects performed advanced trail-making tests, touching the target circles in sequence located on the display of a touch-panel screen. In order to identify the brain regions associated with fatigue sensation, correlation analysis was performed using statistical parametric mapping method. The brain region exhibiting a positive correlation in activity with subjective sensation of fatigue, measured immediately after each positron emission tomography scan, was located in medial orbitofrontal cortex (Brodmann's area 10/11). Hence, the medial orbitofrontal cortex is a brain region associated with mental fatigue sensation. Our findings provide a new perspective on the neural basis of fatigue. PMID:21188225

  4. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    PubMed

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects. Copyright © 2011 Wiley-Liss, Inc.

  5. Cognition and medial frontal cortex in health and disease

    PubMed Central

    Nachev, Parashkev

    2009-01-01

    Purpose of review Recent work on the role of medial frontal cortex in cognition and its involvement in neurological disorders is critically reviewed. Recent findings The highly influential notion of conflict monitoring by the anterior cingulate has been called into question by monkey single-cell neurophysiology and lesion studies in monkeys and humans. An alternative role for this region in adapting behaviour in response to changing demands over time is gaining support. By contrast, the more dorsally placed pre-supplementary motor area and supplementary eye field have been implicated in direct executive control in situations of response conflict. Although more rostral medial areas have been linked to complex cognitive operations involving references to the self, conceptual obstacles make the evidence difficult to interpret. The role of orbitofrontal cortex in guiding action based on value has been reinforced. Summary This area continues to generate both interest and controversy. A few striking discrepancies between data from functional imaging and interventional techniques illustrate the hazards of drawing strong conclusions from merely correlative evidence. More broadly, a case can be made for tempering the empirical enthusiasm here with a little more theoretical restraint. PMID:17102698

  6. Classifying medial rectus muscle attachment in consecutive exotropia.

    PubMed

    Jung, Jae Ho; Leske, David A; Holmes, Jonathan M

    2016-06-01

    To evaluate interexaminer agreement in classifying medial rectus muscle attachment in patients with consecutive exotropia. A series of intraoperative photographs of 26 eyes in 25 patients who underwent surgery for consecutive exotropia were retrospectively studied. Two examiners independently classified the medial rectus attachment as either normal, stretched scar, slipped muscle, or lost muscle. Agreement between examiners was evaluated using the weighted kappa (κ) statistic, and causes of disagreement were assessed. Agreement was found in 15 of 26 eyes (58%), signifying "moderate" agreement (κ = 0.41). Approximately two-thirds of the disagreements, 7 of 11 eyes (64%), were between stretched scar and slipped muscle, with characteristics of each entity being present in the same muscle. The clinical distinction between stretched scar and slipped muscle appears to be obscure. We propose that they should be considered a single entity, which could be referred to as "abnormal scleral attachment." Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  7. Medial prefrontal cortex role in recognition memory in rodents.

    PubMed

    Morici, Juan Facundo; Bekinschtein, Pedro; Weisstaub, Noelia V

    2015-10-01

    The study of the neurobiology of recognition memory, defined by the integration of the different components of experiences that support recollection of past experiences have been a challenge for memory researches for many years. In the last twenty years, with the development of the spontaneous novel object recognition task and all its variants this has started to change. The features of recognition memory include a particular object or person ("what"), the context in which the experience took place, which can be the arena itself or the location within a particular arena ("where") and the particular time at which the event occurred ("when"). This definition instead of the historical anthropocentric one allows the study of this type of episodic memory in animal models. Some forms of recognition memory that require integration of different features recruit the medial prefrontal cortex. Focusing on findings from spontaneous recognition memory tasks performed by rodents, this review concentrates on the description of previous works that have examined the role that the medial prefrontal cortex has on the different steps of recognition memory. We conclude that this structure, independently of the task used, is required at different memory stages when the task cannot be solved by a single item strategy. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. MEDIAL FOOT LOADING ON ANKLE AND KNEE BIOMECHANICS.

    PubMed

    Mitchell, Lyneil C J; Ford, Kevin R; Minning, Stephen; Myer, Gregory D; Mangine, Robert E; Hewett, Timothy E

    2008-08-01

    BACKGROUND: The incidence of anterior cruciate ligament (ACL) injuries among females continues at disproportionate rates compared to males, with research indicating inconclusive multifactorial causality. Data from previous retrospective studies suggest an effect of abnormal foot and ankle biomechanics on pathology at the knee, including the ACL. OBJECTIVE: To determine if a relationship exists between plantar foot loading patterns during normal gait and high risk biomechanics purported to increase risk of ACL injury. METHODS: Dynamic barefoot plantar pressure distribution was measured on 33 female collegiate soccer players. Groups were divided according to their predominant gait loading pattern (medial or lateral). Three dimensional (3-D) motion analysis was conducted during drop vertical jumps to assess vertical ground reaction force and discrete angle and joint moment variables of the lower extremities. RESULTS: No significant differences occured in sagittal or coronal plane knee joint kinematics and kinetics between the medial and lateral loading groups. DISCUSSION: Dynamic foot and ankle biomechanics during gait do not appear to be related to lower extremity kinematics or kinetics during landing in collegiate female soccer players. CONCLUSION: The exact cause of the abnormal differences in female landing biomechanics has not been irrefutably defined. This study suggests no effect of foot and ankle biomechanics exists on the landing mechanics of female soccer players.

  9. Medial Foot Loading on Ankle and Knee Biomechanics

    PubMed Central

    Mitchell, Lyneil C.J.; Ford, Kevin R.; Minning, Stephen; Myer, Gregory D.; Mangine, Robert E.

    2008-01-01

    Background The incidence of anterior cruciate ligament (ACL) injuries among females continues at disproportionate rates compared to males, with research indicating inconclusive multifactorial causality. Data from previous retrospective studies suggest an effect of abnormal foot and ankle bio-mechanics on pathology at the knee, including the ACL. Objective To determine if a relationship exists between plantar foot loading patterns during normal gait and high risk biomechanics purported to increase risk of ACL injury. Methods Dynamic barefoot plantar pressure distribution was measured on 33 female collegiate soccer players. Groups were divided according to their predominant gait loading pattern (medial or lateral). Three dimensional (3-D) motion analysis was conducted during drop vertical jumps to assess vertical ground reaction force and discrete angle and joint moment variables of the lower extremities. Results No significant differences occured in sagittal or coronal plane knee joint kinematics and kinetics between the medial and lateral loading groups. Discussion Dynamic foot and ankle biomechanics during gait do not appear to be related to lower extremity kinematics or kinetics during landing in collegiate female soccer players. Conclusion The exact cause of the abnormal differences in female landing biomechanics has not been irrefutably defined. This study suggests no effect of foot and ankle biomechanics exists on the landing mechanics of female soccer players. PMID:20379384

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

    PubMed

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

    1986-12-01

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

  11. Kinematics of partial and total ruptures of the medial collateral ligament of the elbow.

    PubMed

    Eygendaal, D; Olsen, B S; Jensen, S L; Seki, A; Söjbjerg, J O

    1999-01-01

    In this study the kinematics of partial and total ruptures of the medial collateral ligament of the elbow are investigated. After selective transection of the medial collateral ligament of 8 osteoligamentous intact elbow preparations was performed, 3-dimensional measurements of angular displacement, increase in medial joint opening, and translation of the radial head were examined during application of relevant stress. Increase in joint opening was significant only after complete transection of the anterior part of the medial collateral ligament was performed. The joint opening was detected during valgus and internal rotatory stress only. After partial transection of the anterior bundle of the medial collateral ligament was performed, there was an elbow laxity to valgus and internal rotatory force, which became significant after transection of 100% of the anterior bundle of the medial collateral ligament and was maximum between 70 degrees to 90 degrees of flexion. No radial head movement was seen after partial or total transection of the anterior bundle of the medial collateral ligament was performed. In conclusion, this study indicates that valgus or internal rotatory elbow instability should be evaluated at 70 degrees to 90 degrees of flexion. Detection of partial ruptures in the anterior bundle of the medial collateral ligament based on medial joint opening and increased valgus movement is impossible.

  12. A comparison of subtalar joint motion during anticipated medial cutting turns and level walking using a multi-segment foot model.

    PubMed

    Jenkyn, T R; Shultz, R; Giffin, J R; Birmingham, T B

    2010-02-01

    The weight-bearing in-vivo kinematics and kinetics of the talocrural joint, subtalar joint and joints of the foot were quantified using optical motion analysis. Twelve healthy subjects were studied during level walking and anticipated medial turns at self-selected pace. A multi-segment model of the foot using skin-mounted marker triads tracked four foot segments: the hindfoot, midfoot, lateral and medial forefoot. The lower leg and thigh were also tracked. Motion between each of the segments could occur in three degrees of rotational freedom, but only six inter-segmental motions were reported in this study: (1) talocrural dorsi-plantar-flexion, (2) subtalar inversion-eversion, (3) frontal plane hindfoot motion, (4) transverse plane hindfoot motion, (5) forefoot supination-pronation twisting and (6) the height-to-length ratio of the medial longitudinal arch. The motion at the subtalar joint during stance phase of walking (eversion then inversion) was reversed during a turning task (inversion then eversion). The external subtalar joint moment was also changed from a moderate eversion moment during walking to a larger inversion moment during the turn. The kinematics of the talocrural joint and the joints of the foot were similar between these two tasks. During a medial turn, the subtalar joint may act to maintain the motions in the foot and talocrural joint that occur during level walking. This is occurring despite the conspicuously different trajectory of the centre of mass of the body. This may allow the foot complex to maintain its function of energy absorption followed by energy return during stance phase that is best suited to level walking. Copyright 2009 Elsevier B.V. All rights reserved.

  13. Comparison of Medial and Lateral Meniscus Root Tears.

    PubMed

    Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

    2015-01-01

    The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years) and 30 years (range: 14-62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in

  14. Effect of chemical stimulation of the medial frontal lobe on the micturition reflex in rats.

    PubMed

    Nishijima, Saori; Sugaya, Kimio; Kadekawa, Katsumi; Ashitomi, Katsuhiro; Yamamoto, Hideyuki

    2012-03-01

    We assessed the influence of the medial frontal lobe on micturition after chemical stimulation. We also examined the relation between the medial frontal lobe and the rostral pontine reticular formation, which has a strong inhibitory effect on micturition. A total of 35 female rats underwent continuous cystometry. Bladder activity changes were examined after physiological saline, glutamate, the glutamate receptor antagonist MK-801, noradrenaline or the adrenergic α-1 receptor antagonist naftopidil was injected in the medial frontal lobe. When glutamate was injected in the medial frontal lobe, MK-801 was also injected in the rostral pontine reticular formation. Glutamate injection in the medial frontal lobe prolonged the interval between bladder contractions while injection of the glutamate antagonist MK-801 shortened the interval. Glutamate injection in the medial frontal lobe just after MK-801 injection in the ipsilateral rostral pontine reticular formation also prolonged the interval between bladder contractions. However, after prior injection of MK-801 in the bilateral rostral pontine reticular formation glutamate injection in the medial frontal lobe did not influence cystometric parameters. Noradrenaline injection in the medial frontal lobe shortened the interval between bladder contractions while injection of its antagonist naftopidil prolonged the interval. Medial frontal lobe neurons excited by glutamate inhibited the micturition reflex via activation of the rostral pontine reticular formation by glutamatergic projection while medial frontal lobe neurons excited by noradrenaline facilitated the micturition reflex. Thus, the medial frontal lobe may be an important integration center for the initiation of micturition and urine storage mechanisms. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. Consecutive exotropia: why does it happen, and can medial rectus advancement correct it?

    PubMed Central

    Leon, Bhambi Gesite-de; Demer, Joseph L.

    2014-01-01

    Purpose To investigate whether consecutive exotropia following medial rectus muscle recession is associated with muscle slippage and to assess the effectiveness of treating the condition with medial rectus advancement. Methods The records of patients with consecutive exotropia after medial rectus recession were reviewed to determine medial rectus muscle insertion location at the time of advancement surgery. Measurements before and after medial rectus advancement were compared. Success was defined as alignment within 10Δ of orthotropia. The dose effect of medial rectus advancement was determined by nonlinear regression. Results A total of 20 patients were included. The mean age (± standard deviation) at time of surgery was 19 ± 19 years (range, 1.1–65.4). The mean preoperative exotropia was 28Δ ± 16Δ (range, 12Δ–60Δ). Medial rectus slippage of 2.5 ± 1.7 mm (range, 1.0–5.0 mm) was found in 14 patients (36%) who had previously undergone medial rectus recession. Surgery corrected about 4Δ of exotropia per mm total medial rectus advancement. Although 95% of patients were aligned successfully immediately after surgery, averaging 2Δ ± 4Δ esotropia, there was significant late exodrift, averaging 17Δ at final follow-up. At final follow-up, 1.6 ± 1.8 (range, 0.10–6.2) years after surgery, 50% of patients maintained alignment within 10Δ of orthotropia (mean, 3Δ ± 4Δ exotropia); the rest experienced recurrent exotropia of 25Δ ± 8Δ. Conclusions Medial rectus slippage is common in consecutive exotropia. Medial rectus advancement effectively treated consecutive exotropia, whether or not there was muscle slippage. It is however, associated with late exodrift; hence patients should be warned about potential for further XT recurrence. PMID:25454022

  16. Risk factors and prognostic indicators for medial tibial stress syndrome.

    PubMed

    Moen, M H; Bongers, T; Bakker, E W; Zimmermann, W O; Weir, A; Tol, J L; Backx, F J G

    2012-02-01

    The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee flexion and extension, dorsal and plantar ankle flexion, hallux flexion and extension, subtalar eversion and inversion, maximal calf girth, lean calf girth, standing foot angle and navicular drop test. After multivariate regression decreased hip internal range of motion, increased ankle plantar flexion and positive navicular drop were associated with MTSS. A higher body mass index was associated with a longer duration to full recovery. For other prognostic indicators, no relationship was found. © 2010 John Wiley & Sons A/S.

  17. Snapping knee caused by the thickening of the medial hamstrings.

    PubMed

    de la Hera Cremades, B; Escribano Rueda, L; Lara Rubio, A

    We report a case of symptomatic subluxation of the semitendinosus and gracilis over the medial condyle of the tibia caused by the thickening of its tendons. Snapping was reproduced on active extension. Clinical examination and, above all, dynamic ultrasound were the key for the diagnosis because other imaging tests were normal. Due to failure of conservative treatment with physiotherapy and infiltrations, surgery was undertaken, involving desinsertion and excision of distal 8cm segment of the semitendinosus and gracilis tendons. At the present time (6 months postoperatively), the patient is symptom-free and has returned to the previous normal life activities. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Proactive and reactive control by the medial frontal cortex.

    PubMed

    Stuphorn, Veit; Emeric, Erik E

    2012-01-01

    Adaptive behavior requires the ability to flexibly control actions. This can occur either proactively to anticipate task requirements, or reactively in response to sudden changes. Recent work in humans has identified a network of cortical and subcortical brain region that might have an important role in proactive and reactive control. However, due to technical limitations, such as the spatial and temporal resolution of the BOLD signal, human imaging experiments are not able to disambiguate the specific function(s) of these brain regions. These limitations can be overcome through single-unit recordings in non-human primates. In this article, we describe the behavioral and physiological evidence for dual mechanisms of control in response inhibition in the medial frontal cortex of monkeys performing the stop signal or countermanding task.

  19. Plantar and medial heel pain: diagnosis and management.

    PubMed

    Lareau, Craig R; Sawyer, Gregory A; Wang, Joanne H; DiGiovanni, Christopher W

    2014-06-01

    Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  20. Myositis ossificans traumatica of temporalis and medial pterygoid muscle

    PubMed Central

    Reddy, Shyam Prasad D; Prakash, Ajay P; Keerthi, M; Rao, Brahmaji J

    2014-01-01

    Myositis ossificans is a rare disease that is characterized by bone deposition in the muscle or soft tissues. Myositis ossificans of the masticatory muscles is an uncommon finding. The condition is benign and results in heterotopic bone formation in the muscles of mastication, usually producing limitation of opening of the jaws. It is important to know the exact cause of the limitation of opening of the jaws for successful treatment. Computed tomographic scan and panoramic radiographs along with histological findings are essential diagnostic aids for evaluating conditions such as myositis ossificans. A rare case of myositis ossificans traumatica of temporalis and medial pterygoid muscle is presented here along with the discussion of clinical, radiological and histological features. The present case emphasizes not only on the importance of considering myositis ossificans in the differential diagnosis of limitation of opening of the jaws but also on the improvement of the overall mouth opening and treatment results. PMID:25328311

  1. Distinct white matter injury associated with medial temporal lobe atrophy in Alzheimer's versus semantic dementia.

    PubMed

    Bejanin, Alexandre; Desgranges, Béatrice; La Joie, Renaud; Landeau, Brigitte; Perrotin, Audrey; Mézenge, Florence; Belliard, Serge; de La Sayette, Vincent; Eustache, Francis; Chételat, Gaël

    2017-04-01

    This study aims at further understanding the distinct vulnerability of brain networks in Alzheimer's disease (AD) versus semantic dementia (SD) investigating the white matter injury associated with medial temporal lobe (MTL) atrophy in both conditions. Twenty-six AD patients, twenty-one SD patients, and thirty-nine controls underwent a high-resolution T1-MRI scan allowing to obtain maps of grey matter volume and white matter density. A statistical conjunction approach was used to identify MTL regions showing grey matter atrophy in both patient groups. The relationship between this common grey matter atrophy and white matter density maps was then assessed within each patient group. Patterns of grey matter atrophy were distinct in AD and SD but included a common region in the MTL, encompassing the hippocampus and amygdala. This common atrophy was associated with alterations in different white matter areas in AD versus SD, mainly including the cingulum and corpus callosum in AD, while restricted to the temporal lobe - essentially the uncinate and inferior longitudinal fasciculi - in SD. Complementary analyses revealed that these relationships remained significant when controlling for global atrophy or disease severity. Overall, this study provides the first evidence that atrophy of the same MTL region is related to damage in distinct white matter fibers in AD and SD. These different patterns emphasize the vulnerability of distinct brain networks related to the MTL in these two disorders, which might underlie the discrepancy in their symptoms. These results further suggest differences between AD and SD in the neuropathological processes occurring in the MTL. Hum Brain Mapp 38:1791-1800, 2017. © 2017 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Longitudinal discharge laser baffles

    DOEpatents

    Warner, Bruce E.; Ault, Earl R.

    1994-01-01

    The IR baffles placed between the window and the electrode of a longitudinal discharge laser improve laser performance by intercepting off-axis IR radiation from the laser and in doing so reduce window heating and subsequent optical distortion of the laser beam.

  3. Longitudinal discharge laser baffles

    DOEpatents

    Warner, B.E.; Ault, E.R.

    1994-06-07

    The IR baffles placed between the window and the electrode of a longitudinal discharge laser improve laser performance by intercepting off-axis IR radiation from the laser and in doing so reduce window heating and subsequent optical distortion of the laser beam. 1 fig.

  4. Reversed Procrastination by Focal Disruption of Medial Frontal Cortex.

    PubMed

    Jha, Ashwani; Diehl, Beate; Scott, Catherine; McEvoy, Andrew W; Nachev, Parashkev

    2016-11-07

    An enduring puzzle in the neuroscience of voluntary action is the origin of the remarkably wide dispersion of the reaction time distribution, an interval far greater than is explained by synaptic or signal transductive noise [1, 2]. That we are able to change our planned actions-a key criterion of volition [3]-so close to the time of their onset implies decision-making must reach deep into the execution of action itself [4-6]. It has been influentially suggested the reaction time distribution therefore reflects deliberate neural procrastination [7], giving alternative response tendencies sufficient time for fair competition in pursuing a decision threshold that determines which one is behaviorally manifest: a race model, where action selection and execution are closely interrelated [8-11]. Although the medial frontal cortex exhibits a sensitivity to reaction time on functional imaging that is consistent with such a mechanism [12-14], direct evidence from disruptive studies has hitherto been lacking. If movement-generating and movement-delaying neural substrates are closely co-localized here, a large-scale lesion will inevitably mask any acceleration, for the movement itself could be disrupted. Circumventing this problem, here we observed focal intracranial electrical disruption of the medial frontal wall in the context of the pre-surgical evaluation of two patients with epilepsy temporarily reversing such hypothesized procrastination. Effector-specific behavioral acceleration, time-locked to the period of electrical disruption, occurred exclusively at a specific locus at the ventral border of the pre-supplementary motor area. A cardinal prediction of race models of voluntary action is thereby substantiated in the human brain. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Longitudinal joint specifications and performance.

    DOT National Transportation Integrated Search

    2012-08-01

    Deterioration of longitudinal joints is widely recognized as one of the major factors contributing to failure of asphalt pavements. Finding : ways to improve the durability of longitudinal joints will lead to improved service lives and lower life cyc...

  6. Increased medial foot loading during drop jump in subjects with patellofemoral pain.

    PubMed

    Rathleff, Michael S; Richter, Camilla; Brushøj, Christoffer; Bencke, Jesper; Bandholm, Thomas; Hölmich, Per; Thorborg, Kristian

    2014-10-01

    To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain. This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat. The primary outcome showed that individuals with patellofemoral pain had a 22% higher medial-to-lateral peak force during drop jump, (p=0.03). Secondary outcomes showed 32% higher medial-to-lateral peak force during single leg squat (p=0.01) and 19-23% higher medial-to-lateral mean force during drop jump and single leg squat (p=0.02-0.04). These findings indicate that individuals with patellofemoral pain display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot loading. III.

  7. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.

    PubMed

    Yates, Ben; White, Shaun

    2004-01-01

    To identify the incidence of medial tibial stress syndrome (MTSS) in a group of naval recruits undergoing a 10-week basic training period and to determine potential risk factors. One hundred and twenty-four recruits (84 men and 40 women) were followed prospectively during basic training. Anthropometric and lower limb biomechanical data were recorded at the start of the program along with injury history and previous sporting activity for the 3 months prior to enlisting. Recruits were monitored during training for development of medial tibial strees syndrome and were asked to complete an exit interview at the end of the program. Forty recruits (22 men and 18 women) developed medial tibial stress syndrome, giving an incidence of 35%. A significant relationship existed between gender and medial tibial stress syndrome (P =.012), with female recruits more likely to develop medial tibial stress syndrome than male recruits (53% vs 28%). A risk estimate revealed a relative risk of 2.03. The biomechanical results indicated a more pronated foot type (P =.002) in the medial tibial stress syndrome group when compared to the control group. A risk estimate established that recruits with a more pronated foot type had a relative risk of 1.70. Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation. Findings of a higher incidence of medial tibial stress syndrome among female recruits require further investigation.

  8. Medial Frontal Event-Related Potentials and Reward Prediction: Do Responses Matter?

    ERIC Educational Resources Information Center

    Martin, Laura E.; Potts, Geoffrey F.

    2011-01-01

    Medial frontal event-related potentials (ERPs) following rewarding feedback index outcome evaluation. The majority of studies examining the feedback related medial frontal negativity (MFN) employ active tasks during which participants' responses impact their feedback, however, the MFN has been elicited during passive tasks. Many of the studies…

  9. Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study.

    PubMed

    Van Overschelde, Philippe; Pinskerova, Vera; Koch, Peter P; Fornasieri, Christophe; Fucentese, Sandro

    2017-01-01

    To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant's sagittal stability is mainly dependent on its medial ball-in-socket design.

  10. Supinated forearm is correlated with the onset of medial epicondylitis in professional slalom water-skiers

    PubMed Central

    Rosa, Donato; Di Donato, Sigismondo Luca; Balato, Giovanni; D’Addona, Alessio; Schonauer, Fabrizio

    2016-01-01

    Summary Background prolonged and laborious activities involving wrists and forearms has been long associated with the onset of epicondylitis. Slalom water-skiing can be included in this category. The purpose of the study is to analyse the correlation between the pronated or supinated position of forearms during water-skiing practice and the presence respectively of lateral and medial epicondylitis. Methods sixty-six pro and semi-pro slalom water-skiers were enrolled in the study. A questionnaire was submitted to each athlete. Diagnosis of lateral or medial epicondylitis was made through anamnesis and clinical exam by an expert orthopaedic surgeon. Chi-squared were performed for categorical variables, and Mann-Whitney U test for continuous ones. Results from 116 upper limbs examined, we observed 15 (12.9%) cases of lateral epicondylitis, 30 (25.9%) cases of medial epicondylitis, 10 (8.6%) were affected by both lateral and medial epicondylitis. Lateral and medial epicondylitis were associated (95% C.I.=2,489–26,355; P=<0,001) and the supinated position was correlated with medial epicondylitis (95% C.I.=1,529–9,542; P=0.003). Conclusion slalom water-skiing can be considered a high-risk sport for epicondylitis. In slalom water-skiers there is a correlation between development of lateral and medial epicondylitis in the same upper limb. Supinated position of forearms is strongly associated with the diagnosis of medial epicondylitis. PMID:27331043

  11. Reconstructive options for the medial canthus and eyelids following tumor excision

    PubMed Central

    Czyz, Craig N.; Cahill, Kenneth V.; Foster, Jill A.; Michels, Kevin S.; Clark, Cooper M.; Rich, Nicole E.

    2010-01-01

    General principles provide the framework for eyelid and periorbital reconstruction following tumor excision. Eyelid tumors involving the medial canthus region and/or lacrimal system add to the complexity of reconstructive planning. The nature of the tumor, patient and tissue factors, and surgeon preference guide repair design choices. Reconstructive considerations and options following medial canthal tumor resection are described. PMID:23960904

  12. Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate

    PubMed Central

    Tírico, Luís Eduardo Passarelli; Demange, Marco Kawamura; Bonadio, Marcelo Batista; Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Pécora, José Ricardo

    2015-01-01

    Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy. PMID:26870647

  13. Behavioral effects of chronically elevated corticosterone in subregions of the medial prefrontal cortex.

    PubMed

    Croteau, Joshua D; Schulkin, Jay; Shepard, Jack D

    2017-01-01

    The medial prefrontal cortex is a key mediator of behavioral aspects of the defense response. Since chronic exposure to elevated glucocorticoids alters the dendritic structure of neurons in the medial prefrontal cortex, such exposure may alter behavioral responses to danger as well. We examined the effects of chronically elevated corticosterone in discrete regions of the medial prefrontal cortex on exploration of the elevated plus-maze. Chronically elevated corticosterone in the prelimbic or infralimbic cortices reduced open arm exploration. This effect was specific to the ventral regions of the medial prefrontal cortex as corticosterone had no effect on plus-maze exploration when administered into the anterior cingulate cortex. Taken together, these findings demonstrate clear regional differences for the effects of corticosterone in the medial prefrontal cortex. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Experimental Demonstration of Longitudinal Magnification

    ERIC Educational Resources Information Center

    Razpet, Nada; Susman, Katarina; Cepic, Mojca

    2009-01-01

    We describe an experiment which enables the observation of longitudinal magnification for the real image of a three-dimensional (3D) object formed by a converging lens. The experiment also shows the absence of longitudinal inversion. Possible reasons for misconceptions with respect to real images and longitudinal inversions are discussed and a…

  15. Effects of clonidine and phentolamine infused into the medial preoptic area and medial basal hypothalamus of the guinea pig.

    PubMed

    Malik, K F; Morrell, J I; Feder, H H

    1993-01-01

    In ovariectomized (OVX) female guinea pigs sequential administration of estradiol and then progesterone (P) is usually necessary to induce the sexually receptive lordosis posture. Systemic administration of alpha-adrenergic agonists can induce lordosis in OVX guinea pigs primed with estradiol benzoate (EB) alone and facilitate lordosis in OVX females primed with EB and P. In this study, we examined the regional specificity of this regulation by infusing the alpha-adrenergic agonist clonidine (CLON) or the alpha-adrenergic antagonist phentolamine (PHEN) into discrete brain areas. CLON, infused in the medial basal hypothalamus (MBH) of EB-primed females, increased the percentage of females showing lordosis 15-45 min after infusion (p < 0.05) and also increased the number of seconds females held the lordosis posture 15 min to approximately 2.0 h after infusion (by as much as 65% at 15 min p < 0.001). CLON infused in the medial preoptic area (MPOA) of EB primed females had no effect on lordosis except at 4.0 h after infusion when it increased the number of seconds females held the lordosis posture (p < 0.05). In EB + P primed females, PHEN infused into the MBH transiently reduced the number of seconds EB + P primed females held lordosis from 30 min to approximately 2.0 h after infusion (by as much as 64% at 1.0 h; p < 0.01). Conversely, PHEN infused into the MPOA of EB + P primed females transiently increased the number of seconds females held lordosis from 15 min to 2.0 h after infusion (maximum difference 64%; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Relationship of medial temporal lobe atrophy, APOE genotype, and cognitive reserve in preclinical Alzheimer’s disease

    PubMed Central

    Soldan, Anja; Pettigrew, Corinne; Lu, Yi; Wang, Mei-Cheng; Selnes, Ola; Albert, Marilyn; Brown, Timothy; Ratnanather, J. Tilak; Younes, Laurent; Miller, Michael I.

    2015-01-01

    This study evaluated the utility of baseline and longitudinal MRI measures of medial temporal lobe brain regions collected when participants were cognitively normal and largely in middle age (mean age 57 years) to predict the time to onset of clinical symptoms associated with mild cognitive impairment (MCI). Furthermore, we examined whether the relationship between MRI measures and clinical symptom onset was modified by Apolipoprotein E (ApoE) genotype and level of cognitive reserve (CR). MRI scans and measures of CR were obtained at baseline from 245 participants who had been followed for up to 18 years (mean follow-up 11 years). A composite score based on reading, vocabulary, and years of education was used as an index of CR. Cox regression models showed that lower baseline volume of the right hippocampus and smaller baseline thickness of the right entorhinal cortex predicted the time to symptom onset independently of CR and ApoE-ε4 genotype, which also predicted the onset of symptoms. The atrophy rates of bilateral entorhinal cortex and amygdala volumes were also associated with time to symptom onset, independent of CR, ApoE genotype, and baseline volume. Only one measure, the left entorhinal cortex baseline volume, interacted with CR, such that smaller volumes predicted symptom onset only in individuals with lower CR. These results suggest that MRI measures of medial temporal atrophy, ApoE-ε4 genotype, and the protective effects of higher CR all predict the time to onset of symptoms associated with MCI in a largely independent, additive manner during the preclinical phase of AD. PMID:25879865

  17. Postoperative change in the length and extrusion of the medial meniscus after anterior cruciate ligament reconstruction.

    PubMed

    Narazaki, Shinji; Furumatsu, Takayuki; Tanaka, Takaaki; Fujii, Masataka; Miyazawa, Shinichi; Inoue, Hiroto; Shimamura, Yasunori; Saiga, Kenta; Ozaki, Toshifumi

    2015-12-01

    The medial meniscus is a secondary stabilizer of anterior tibial translation in anterior cruciate ligament (ACL)-deficient knees. ACL reconstruction effectively restores an increased anterior tibial translation in the ACL-deficient knee. However, knee osteoarthritis sometimes develops in ACL-reconstructed patients during a long-term follow-up period. We hypothesized that the medial meniscal position would be different between the ACL-deficient and reconstructed knees. The aim of this study was to investigate pre-operative and postoperative location of the medial meniscus in patients who underwent ACL reconstruction. ACL-reconstructed knees (28 knees) and normal knees (27 knees) were investigated. Medial tibial plateau length (MTPL) and medial tibial plateau width (MTPW) were determined using radiographic images. Magnetic resonance imaging (MRI)-based medial meniscal length (MML), medial meniscal width (MMW), and medial meniscal extrusion (MME) were measured. Postoperative change in the MML, MMW, and MME were evaluated and compared with those in normal knees. No significant differences between the ACL-deficient (pre-operative) and normal groups were noted. The ACL-reconstructed (postoperative) group showed an increase in the MML, in the percentage of the MML (%MML = 100 MML/MTPL), and in the MME. Significant differences between postoperative and normal groups were observed in the MML, %MML, and MME. MMW and MMW percentage (100 MMW/MTPW) were similar in all groups. The anteroposterior length and radial extrusion of the medial meniscus increased after ACL reconstruction. Transposition of the medial meniscus may be a possible cause of developing further degenerative knee joint disorders after ACL reconstruction.

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

    PubMed Central

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

    2015-01-01

    We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular–transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular–transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular–transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm2; the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm2. Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular–transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest). PMID:26889348

  19. Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

    PubMed

    Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

    2014-10-01

    Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Effect of total-contact orthosis on medial longitudinal arch and lower extremities in flexible flatfoot subjects during walking.

    PubMed

    Prachgosin, Tulaya; Leelasamran, Wipawan; Smithmaitrie, Pruittikorn; Chatpun, Surapong

    2017-12-01

    Total-contact orthosis (TCO) is one kind of foot orthosis (FO) that is used to adjust biomechanics in flexible flatfoot. To determine the effects of a TCO on the MLA moment, MLA deformation angle and lower limb biomechanics. Cross-sectional study. Seven-flatfoot and thirteen-normal foot subjects were recruited by footprint and radiographs. The biomechanics of subjects with normal foot (NF), flatfoot with shoe only (FWOT) and flatfoot with TCO (FWT) were collected in a 3D motion analysis laboratory and force plates. The MLA and lower limb biomechanics in each condition during specific sub-phases of stance were analyzed. The NF had larger MLA eversion moment after shod walking ( p = 0.001). The FWT condition compared with the FWOT condition had a significantly larger peak MLA upward moment ( p = 0.035) during pre-swing, larger peak knee external rotation angle ( p = 0.040) during mid stance, smaller peak knee extension moment during terminal stance ( p = 0.035) and a larger ground reaction force in the anterior-posterior direction during early stance ( p < 0.05). Our study found positive effects from the customized TCOs which included an increased TCO angle that led to a decreased peak MLA moment in the frontal plane in flexible flatfoot subjects during walking. Clinical relevance Lower limb biomechanics is different from normal in subjects with flexible flatfoot. The design of a TCO affects MLA, ankle and knee biomechanics and may be used to clinically correct biomechanical changes in flexible flatfoot.

  1. The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners.

    PubMed

    Nakhaee, Z; Rahimi, A; Abaee, M; Rezasoltani, A; Kalantari, K Khademi

    2008-06-01

    Usually the rate of lower extremity's injuries in sports such as running is known to be correlated with the height of foot arches. Foot pressure measurement studies have shown controversial results in this issue, mainly due to the complexity of the foot structure. This study aimed to investigate if any relationship exists between the MLA height and the ankle/knee injuries in professional runners. It was also aimed to find out any association between the foot pressure patterns and the clinical navicular drop test in the subjects. Forty-seven professional runners were participated in this study and using the clinical navicular drop test, they were categorized into normal, low and high arch foot subjects. Using an Emed pedography platform (Novel, Germany), the maximum force, peak pressure and the contact area of their feet were studied in both static (single limb support) and dynamic conditions. The results of this study showed no strong correlation between the height of MLA and the rate of the ankle/knee injuries (P=0.58). The correlation between the clinical navicular drop test and the modified arch index (MAI) was between 0.32 in static and 0.57 in dynamic tests. The results of this study conveyed that having a lower or higher than a normal MLA is not a definite risk factor for sports-related injuries. This might be due to the complexity of the foot structure and its ability to accommodate with new situations routinely occurs in sport. Furthermore, although a high correlation was not found between the clinical navicular drop test and the foot pressure indices, due to the clinical entity of this test, the obtained association is relatively good. A significant correlation was found between the foot pressure distribution in single limb support (static) and the dynamic conditions, which provides an extrapolation of the results of this type static condition tests to the dynamic conditions.

  2. Longitudinal interdisciplinary neuroscience curriculum.

    PubMed

    Gopalan, Priya; Azzam, Pierre N; Travis, Michael J; Schlesinger, Abigail; Lewis, David A

    2014-04-01

    Enhancing neuroscience education during psychiatry residency training requires the organization of comprehensive and longitudinal pedagogy in various aspects of clinical neuroscience. This process can be complex, and limited structured guidance is available for how to implement such a curriculum. The authors' principal goal was to develop a longitudinal interdisciplinary neuroscience curriculum that spans 4 years, promotes collaboration of educators from multiple departments, and can be generalized to other psychiatry programs. The authors implemented a 4-year curriculum in a stepwise manner during psychiatry residency training. They obtained feedback and used it for improvement. Positive feedback was given for the curriculum, with improvement to scores across 2 years. Development of a clinical neuroscience curriculum at the authors' program provides a potential framework for implementation in other psychiatry residency programs.

  3. Severe pes planovalgus successfully treated in a patient with mutilating rheumatoid arthritis using a new surgical approach involving medial malleolar resection and medial displacement of the talus: A case report.

    PubMed

    Matsumoto, Takumi; Nakamura, Ichiro; Juji, Takuo; Ito, Katsumi

    2017-11-01

    We report the case of a 56-year-old female with mutilating rheumatoid arthritis, who developed severe pes planovalgus. The foot was successfully reconstructed through a combination of osteotomies, including medial displacement of the talus accompanied by resection of the medial malleolus. This maneuver enabled a ∼1-cm medial displacement of the hindfoot while minimizing the adverse effect on forefoot rotation.

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

    PubMed

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

    2017-12-28

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

  5. Location and tension of the medial palpebral ligament.

    PubMed

    Hwang, Kun; Huan, Fan; Nam, Yong Seok; Han, Seung Ho; Kim, Dae Joong

    2013-11-01

    The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi.

  6. Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis.

    PubMed

    Gerbrands, T A; Pisters, M F; Theeven, P J R; Verschueren, S; Vanwanseele, B

    2017-01-01

    To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Isometric behavior of the reconstructed medial patellofemoral ligament using two different femoral pulleys: a cadaveric study.

    PubMed

    Triantafillopoulos, Ioannis K; Panagopoulos, Andreas; van Niekerk, Louw

    2007-09-01

    Several techniques have been described for reconstructing the medial patellofemoral ligament (MPFL). However, the anatomy of the medial patellar retinaculum and the isometry of both intact and reconstructed MPFL remain controversial. The purpose of this study was to investigate the isometric behavior of the reconstructed MPFL when two different pulleys are used for the reconstruction. Eight anatomical knees were dissected and the medial patellar retinaculum and MPFL were studied. A pilot technique for the reconstruction of the MPFL using a semitendinosus autograft was developed. A "dynamic" femoral fixation was chosen which utilized two different pulleys: the medial intermuscular septum (MIS) at the adductor's tendon insertion and the posterior third of the medial collateral ligament (MCL). The isometric behavior of the reconstructed MPFL and the stability of both pulleys were investigated. The MPFL was a thickened, band-like condensation of the superficial MPR layer extending from the MFE to the medial border of the patella. The reconstructed MPFL demonstrated the most isometric behavior when the MCL was used as a pulley. The average difference in graft length during knee flexion from 0 degrees to 90 degrees when the MCL or MIS were used as a pulley was 1 mm and 4 mm, respectively. The MIS pulley was more stable but less isometric than the MCL pulley. "Dynamic" MPFL reconstruction with a semitendinosus tendon autograft can restore patellofemoral stability without excessive soft-tissue dissection or implantation of hardware at the medial epicondyle, which can lead to symptoms of its own.

  8. [THREE-DIMENSIONAL VISUALIZATION RECONSTRUCTION OF MEDIAL SURAL ARTERY PERFORATOR FLAP BASED ON DIGITAL TECHNOLOGY].

    PubMed

    Qing, Liming; Hu, Yihe; Tang, Juyu; Wu, Panfeng; Yu, Fang; Liang, Jieyu

    2014-06-01

    To explore the feasibility of three-dimensional (3-D) visualization reconstruction of the medial sural artery perforator flap based on digital technology. A series of Dicom images were obtained from three healthy adult volunteers by dual source CT angiography. Then the Mimics software was used to construct the medial sural artery model and measure the indexes, including the starting position of medial sural artery, external diameters of vascular pedicle, the number of perforators, location perforated deep fascia, and the maximum pedicle length of perforators based on medial sural artery perforator flap. The 3-D visualization reconstruction models were successfully finished with Mimics software, which can clearly display the distribution, travel, and perforating point. Thirteen perforators were found in 6 legs, which started at the popliteal artery with a mean external diameter of 2.3 mm (range, 1.9-2.7 mm). Each specimen had 1-3 perforators, which located at the site of 6.2-15.0 cm distal to popliteal crease and 2.5-4.2 cm from posterior midline. The maximum pedicle length of medial sural artery perforator flap was 10.2-13.8 cm (mean, 11.8 cm). The 3-D visualization reconstruction models based on digital technology can provide dynamic visualization of the anatomy of the medial sural artery for individualized design of the medial sural artery perforator flap.

  9. Risk factors for medial meniscal injury in association with cranial cruciate ligament rupture.

    PubMed

    Hayes, G M; Langley-Hobbs, S J; Jeffery, N D

    2010-12-01

    To determine the significant risk factors for medial meniscal injury in naturally occurring cranial cruciate ligament rupture and to quantify the risk using multivariate analysis. A retrospective case control study was performed of dogs that had undergone surgery for cranial cruciate ligament rupture. Data recorded included patient signalment (age, breed and sex), the duration of the lameness, the extent of the cranial cruciate ligament rupture (complete or partial) and the condition of the medial meniscus. Logistic regression was used to analyse the relationship between these variables and tears in the medial meniscus. One hundred and sixty-one of 443 stifles (36·3%) in 366 dogs had a medial meniscal tear. The risk of a medial meniscal tear was increased by 12·9 times in association with complete cranial cruciate ligament rupture (OR 12·9; 95% CI 6·8 to 24·2), by approximately 2·6% for each additional week of lameness (OR 1·026; 95% CI 1·009 to 1·043) and by approximately 1·4% for each additional kilogram of bodyweight (OR 1·014; 95% CI 1·000 to 1·028). Golden retrievers and Rottweilers were at increased risk and West Highland white terriers were at reduced risk of medial meniscal tears compared with Labrador retrievers. To minimise the risk of medial meniscal tears, surgical stabilisation should not be unnecessarily delayed. © 2010 British Small Animal Veterinary Association.

  10. The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial.

    PubMed

    Jones, Richard K; Chapman, Graham J; Parkes, Matthew J; Forsythe, Laura; Felson, David T

    2015-11-01

    Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three-dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc.

  11. The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial

    PubMed Central

    Chapman, Graham J.; Parkes, Matthew J.; Forsythe, Laura.; Felson, David T.

    2015-01-01

    ABSTRACT Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015. PMID:25991385

  12. The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability.

    PubMed

    Stephen, Joanna M; Lumpaopong, Punyawan; Dodds, Alexander L; Williams, Andy; Amis, Andrew A

    2015-01-01

    Tibial tuberosity (TT) transfer is a common procedure to treat patellofemoral instability in patients with elevated TT-trochlear groove (TG) distances. However, the effects of TT lateralization or medialization on patellar stability, kinematics, and contact mechanics remain unclear. Progressive medialization and lateralization will have increasingly adverse effects on patellofemoral joint kinematics, contact mechanics, and stability. Controlled laboratory study. Eight fresh-frozen cadaveric knees were placed on a testing rig, with a fixed femur and tibia mobile through 90° of flexion. Individual quadriceps heads and the iliotibial band were separated and loaded with 205 N in anatomic directions using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0°, 10°, 20°, 30°, 60°, and 90° of flexion using pressure-sensitive film behind the patella and an optical tracking system. The intact knee was measured with and without a 10-N patellar lateral displacement load, and recordings were repeated after TT transfer of 5, 10, and 15 mm medially and laterally. Statistical analysis used repeated-measures analysis of variance, Bonferroni post hoc analysis, and Pearson correlations. Tibial tuberosity lateralization significantly elevated lateral joint contact pressures, increased lateral patellar tracking, and reduced patellar stability (P<.048). There was a significant correlation between mean lateral contact pressure and the TT position (r=0.810, P<.001) at 10°. Tibial tuberosity medialization reduced lateral contact pressures (P<.002) and did not elevate peak medial contact pressures (P>.11). Progressive TT lateralization elevated lateral contact pressures, increased lateral patellar tracking, and reduced patellar stability. Medial contact pressure and tracking did alter with progressive TT medialization, but the changes were smaller. Lateral patellofemoral joint contact pressures increased with progressive lateralization

  13. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players.

    PubMed

    Xu, Huan; Wang, Pin; Ye, Zhuo'er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  14. Functional Loss With Displacement of Medial Epicondyle Humerus Fractures: A Computer Simulation Study.

    PubMed

    Edmonds, Eric W; Santago, Anthony C; Saul, Katherine R

    2015-01-01

    Assessment and management of the medial humeral epicondyle fracture remains controversial, with conflicting reports of displacement direction and consequent functional deficits unclear. The purpose of this study was to define biomechanically likely directions of medial epicondyle fracture displacement and to determine possible changes in muscle function related to that displacement. A 3-dimensional computer model of the upper extremity was used to simulate the consequences of medial epicondyle fracture displacements from 1 to 20 mm in the anterior, medial, and inferior directions relative to the humerus with the elbow at 90-degree flexion and neutral forearm rotation (a replication of accepted positions for clinical strength testing). Muscle length and force were calculated following displacement. Maximum isometric wrist flexion moments were calculated over the full range of wrist motion based on known force-generating properties of the muscles. Anterior displacement resulted in shortened muscles and reduced wrist flexion moment, with a decrease in strength averaging 2% for every 1 mm of anterior fragment displacement at neutral wrist position (maximum decrease of 39% with 20 mm displacement). In contrast, displacement in the medial and inferior directions resulted in stretched muscles and increased wrist flexion moments and therefore are not biomechanically likely. Computer simulation of a medial epicondyle fracture suggests that anterior displacement could result in a dramatic loss of initial muscle strength and function. Medial displacement is unlikely to occur in vivo due to consequential muscle lengthening, suggesting that alternatives to the historical use of AP radiographs to assess displacement of this fracture are needed. Our work provides a biomechanical explanation for anterior displacement of medial epicondyle fractures observed radiographically and motivates alternative methods of fracture assessment. A functional basis for determining acceptable

  15. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players

    PubMed Central

    Xu, Huan; Wang, Pin; Ye, Zhuo’er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  16. Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy.

    PubMed

    Akamatsu, Y; Sotozawa, M; Kobayashi, H; Kusayama, Y; Kumagai, K; Saito, T

    2016-11-01

    To assess which tibial slope measurements on knee, whole leg radiographs and three-dimensional reconstructed computed tomography (CT) were useful in clinical practice before and after opening wedge high tibial osteotomy. Medial and lateral tibial slopes on knee, whole leg radiographs and three-dimensional reconstructed CT were measured in 50 patients with knee osteoarthritis. To investigate the intraobserver reproducibility and interobserver reliability for each medial and lateral tibial slope on knee, whole leg radiographs and CT, the measurements were repeated twice by two observers. The statistical differences between the medial and lateral tibial slopes obtained by the three methods, and the differences and correlation coefficients for the medial and lateral tibial slopes between knee or whole leg radiographs and CT were calculated. The reproducibility and reliability of medial and lateral tibial slopes on CT were superior to those on whole leg or knee radiographs. The medial and lateral tibial slopes on whole leg radiographs had better reproducibility and reliability than those on knee radiographs. The mean medial tibial slopes on knee, whole leg radiographs and CT were 9.3 ± 3.4°, 12.3 ± 4.3° and 11.0 ± 3.9°, respectively. The mean lateral tibial slopes were 7.9 ± 3.1°, 9.6 ± 3.6° and 9.3 ± 2.9°, respectively. The medial tibial slopes on knee, whole leg radiographs and CT were significantly higher than the lateral tibial slopes (p < 0.01 for all). Tibial slope measurements using CT required time and specialized software. Therefore, measurements of the medial tibial slope using the long tibial axis on whole leg radiographs were more reproducible and reliable and could be an alternative to CT in clinical practice. III.

  17. Morphological features of the medial superior olive in autism.

    PubMed

    Kulesza, Randy J; Mangunay, Kathleen

    2008-03-20

    Autism is a psychosocial disorder clinically characterized by social difficulties, impairment in communication skills and repetitive behavioral patterns. Despite the increasing reported incidence of autism, the neurobiology of this disorder is poorly understood. However, researchers have uncovered numerous structural anomalies in the brainstem, cerebellum and forebrain of autistic individuals and there is substantial support for the association of hearing deficits with autism. In an effort to discover an anatomical correlate for the functional auditory deficits found in autism, we examined the SOC, a group of brainstem nuclei that function in sound source localization, in post-mortem brain tissue from autistic individuals. The neurons of the medial superior olive (MSO), an SOC nucleus, display a precise geometric organization essential for detection of timing differences between the two ears. We examined the architecture of the MSO in five autistic brains (ages 8 to 32 years) and two age-matched controls (ages 26 and 29 years) and found a significant disruption in the morphology of MSO neurons in autistic brains, involving cell body shape and orientation. The results from this study provide evidence on the cellular level that may help to explain the hearing difficulties associated with autism.

  18. The role of the medial prefrontal cortex in social categorization.

    PubMed

    Molenberghs, Pascal; Morrison, Samantha

    2014-03-01

    Group membership is an important aspect of our everyday behavior. Recently, we showed that existing relevant in-group labels increased activation in the medial prefrontal cortex (MPFC) compared with out-group labels, suggesting a role of the MPFC in social categorization. However, the question still remains whether this increase in MPFC activation for in-group representation is solely related with previous experience with the in-group. To test this, we randomly assigned participants to a red or blue team and in a subsequent functional magnetic resonance imaging experiment they categorized red and blue team words as belonging to either the in-group or the out-group. Results showed that even under these minimal conditions increased activation was found in the MPFC when participants indicated that they belonged to a group, as compared with when they did not. This effect was found to be associated with the level of group identification. These results confirm the role of MPFC in social categorization.

  19. Role of the medial prefrontal cortex in coping and resilience.

    PubMed

    Maier, Steven F; Watkins, Linda R

    2010-10-08

    The degree of behavioral control that an organism has over an aversive event is well known to modulate the behavioral and neurochemical consequences of exposure to the event. Here we review recent research that suggests that the experience of control over a potent stressor alters how the organism responds to future aversive events as well as to the stressor being controlled. More specifically, subjects that have experienced control show blunted behavioral and neurochemical responses to subsequent stressors occurring days to months later. Indeed, these subjects respond as if a later uncontrollable stressor is actually controllable. Further, we review research indicating that the stress resistance induced by control depends on control-induced activation of ventral medial prefrontal cortical (vmPFC) inhibitory control over brainstem and limbic structures. Furthermore, there appears to be plasticity in these circuits such that the experience of control alters the vmPFC in such a way that later uncontrollable stressors now activate the vmPFC circuitry, leading to inhibition of stress-responsive limbic and brainstem structures, i.e., stressor resistance. This controllability-induced proactive stressor resistance generalizes across very different stressors and may be involved in determining individual difference in reactions to traumatic events. Copyright © 2010 Elsevier B.V. All rights reserved.

  20. Anterior medial prefrontal cortex implements social priming of mimicry

    PubMed Central

    Hamilton, Antonia F. de C.

    2015-01-01

    The neural and cognitive mechanisms by which primed constructs can impact on social behavior are poorly understood. In the present study, we used functional magnetic resonance imaging (fMRI) to explore how scrambled sentence priming can impact on mimicry behavior. Sentences involving pro/antisocial events from a first/third-person point of view were presented in short blocks, followed by a reaction-time assessment of mimicry. Behavioral results showed that both prosociality and viewpoint impact on mimicry, and fMRI analysis showed this effect is implemented by anterior medial prefrontal cortex (amPFC). We suggest that social primes may subtly modulate processing in amPFC in a manner linked to the later behavior, and that this same region also implements the top-down control of mimicry responses. This priming may be linked to processing of self-schemas in amPFC. Our findings demonstrate how social priming can be studied with fMRI, and have important implications for our understanding of the underlying mechanisms of prime-to-behavior effects as well as for current theories in social psychology. PMID:25009194

  1. Medial PFC Damage Abolishes the Self-reference Effect

    PubMed Central

    Philippi, Carissa L.; Duff, Melissa C.; Denburg, Natalie L.; Tranel, Daniel; Rudrauf, David

    2012-01-01

    Functional neuroimaging studies suggest that the medial PFC (mPFC) is a key component of a large-scale neural system supporting a variety of self-related processes. However, it remains unknown whether the mPFC is critical for such processes. In this study, we used a human lesion approach to examine this question. We administered a standard trait judgment paradigm [Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., & Heatherton, T. F. Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785–794, 2002] to patients with focal brain damage to the mPFC. The self-reference effect (SRE), a memory advantage conferred by self-related processing, served as a measure of intact self-processing ability. We found that damage to the mPFC abolished the SRE. The results demonstrate that the mPFC is necessary for the SRE and suggest that this structure is important for self-referential processing and the neural representation of self. PMID:21942762

  2. False positives to confusable objects predict medial temporal lobe atrophy.

    PubMed

    Kivisaari, Sasa L; Monsch, Andreas U; Taylor, Kirsten I

    2013-09-01

    Animal models agree that the perirhinal cortex plays a critical role in object recognition memory, but qualitative aspects of this mnemonic function are still debated. A recent model claims that the perirhinal cortex is required to recognize the novelty of confusable distractor stimuli, and that damage here results in an increased propensity to judge confusable novel objects as familiar (i.e., false positives). We tested this model in healthy participants and patients with varying degrees of perirhinal cortex damage, i.e., amnestic mild cognitive impairment and very early Alzheimer's disease (AD), with a recognition memory task with confusable and less confusable realistic object pictures, and from whom we acquired high-resolution anatomic MRI scans. Logistic mixed-model behavioral analyses revealed that both patient groups committed more false positives with confusable than less confusable distractors, whereas healthy participants performed comparably in both conditions. A voxel-based morphometry analysis demonstrated that this effect was associated with atrophy of the anteromedial temporal lobe, including the perirhinal cortex. These findings suggest that also the human perirhinal cortex recognizes the novelty of confusable objects, consistent with its border position between the hierarchical visual object processing and medial temporal lobe memory systems, and explains why AD patients exhibit a heightened propensity to commit false positive responses with inherently confusable stimuli. Copyright © 2013 Wiley Periodicals, Inc.

  3. Troubleshooting the Femoral Attachment During Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Burrus, M. Tyrrell; Werner, Brian C.; Conte, Evan J.; Diduch, David R.

    2015-01-01

    The medial patellofemoral ligament (MPFL) has been recognized as an important soft tissue restraint in preventing lateral patellar translation. As many patients with acute or chronic patellar instability will have a deficient MPFL, reconstruction of this ligament is becoming more common. Appropriately, significant research has been undertaken regarding graft biomechanics and techniques, as intraoperative errors in graft placement often result in poor patient outcomes. Although the research has not answered all of the dilemmas encountered during reconstruction, publications consistently emphasize the importance of re-establishing an anatomic femoral attachment. The purpose of this study was to briefly review the current literature on MPFL reconstruction. Graft selection and patellar graft attachment and fixation are discussed, but the main focus is the femoral attachment as this is where most errors are seen and, unfortunately, where getting it right appears to matter the most. Using a sawbones knee model, the concepts of an MPFL graft that is “high and tight” or “low and loose” are presented, with the goal of providing physicians with intraoperative tools to adjust an incorrectly placed femoral MPFL attachment. This model is also used to justify the recommendation of graft fixation in 30° to 45° of knee flexion. PMID:26535373

  4. Regulation and Possible Functions of Kisspeptin in the Medial Amygdala.

    PubMed

    Stephens, Shannon B Z; Kauffman, Alexander S

    2017-01-01

    Kisspeptin, encoded by the Kiss1 gene, is required for reproduction. Humans and mice lacking kisspeptin or its receptor, Kiss1r, have impairments in reproductive physiology and fertility. In addition to being located in the hypothalamus in the anteroventral periventricular and arcuate nuclei, kisspeptin neurons are also present in several extra-hypothalamic regions, such as the medial amygdala (MeA). However, while there has been a significant focus on the reproductive roles of hypothalamic kisspeptin neurons, the regulation and function(s) of MeA and other extra-hypothalamic kisspeptin neurons have received far less attention. This review summarizes what is currently known about the regulation, development, neural projections, and potential functions of MeA kisspeptin neurons, as well as kisspeptin signaling directly within the MeA, with emphasis on data gathered from rodent models. Recent data are summarized and compared between rodent species and also between males and females. In addition, critical gaps in knowledge and important future directions are discussed.

  5. Regulation and Possible Functions of Kisspeptin in the Medial Amygdala

    PubMed Central

    Stephens, Shannon B. Z.; Kauffman, Alexander S.

    2017-01-01

    Kisspeptin, encoded by the Kiss1 gene, is required for reproduction. Humans and mice lacking kisspeptin or its receptor, Kiss1r, have impairments in reproductive physiology and fertility. In addition to being located in the hypothalamus in the anteroventral periventricular and arcuate nuclei, kisspeptin neurons are also present in several extra-hypothalamic regions, such as the medial amygdala (MeA). However, while there has been a significant focus on the reproductive roles of hypothalamic kisspeptin neurons, the regulation and function(s) of MeA and other extra-hypothalamic kisspeptin neurons have received far less attention. This review summarizes what is currently known about the regulation, development, neural projections, and potential functions of MeA kisspeptin neurons, as well as kisspeptin signaling directly within the MeA, with emphasis on data gathered from rodent models. Recent data are summarized and compared between rodent species and also between males and females. In addition, critical gaps in knowledge and important future directions are discussed. PMID:28824550

  6. Neural activity in macaque medial frontal cortex represents others' choices.

    PubMed

    Falcone, Rossella; Cirillo, Rossella; Ferraina, Stefano; Genovesio, Aldo

    2017-10-04

    Predicting the behavior of others is a fundamental skill in primate social life. We tested the role of medial frontal cortex in the prediction of other agents' behavior in two male macaques, using a monkey-human interactive task in which their actor-observer roles were intermixed. In every trial, the observer monitored the actor's choice to reject it for a different one when he became the actor on the subsequent trial. In the delay period preceding the action, we identified neurons modulated by the agent's identity, as well as a group of neurons encoding the agent's future choice, some of which were neurons that showed differential patterns of activity between agents. The ability of these neurons to flexibly move from 'self-oriented' to 'other-oriented' representations could correspond to the "other side of the coin" of the simulative mirroring activity. Neurons that changed coding scheme, together with neurons exclusively involved in the prediction of the other agent's choice, show a neural substrate for predicting or anticipating others' choices beyond simulation.

  7. Vocalic lengthening and medial coda omission in phonological disorders.

    PubMed

    Maldonade, Irani Rodrigues; Mota, Helena Bolli

    2010-01-01

    phonological disorders. to verify the occurrence of vocalic lengthening, through acoustic analysis, in a group of 16 children (8 boys and 8 girls) with evolutive phonological disorders (EPD), who did not present in their speech /R/ and /S/ medial codas; to verify the occurrence percentage of lengthening and omission strategies in the two types of coda. recordings of 16 children obtained through the presentation of a picture album representing the 18 pairs of words that contrast the syllabic structures (C)VC and CV. After transcribing the recordings, the pairs of words were submitted to acoustical analysis using PRAAT, version 4.4.16. Vowel duration was measured in both types of syllables. Statistical analysis was performed and the significance test (q-square) was applied considering p<0.05. although lengthening was not perceptually detected, it occurred in 93.75% of the analyzed samples. The q-square test indicated that the occurrence of lengthening is highly significant. Regarding the /R/ coda, results indicated 95.52% of lengthenings and 4.48% of omissions. For the /S/ coda, results indicated 12.5% of lengthenings and 87.5% of omissions. No significant statistical difference was observed between genders. acoustic analysis identified both vocalic lengthening and omission. Vocalic lengthening was more frequent in the /R/ coda; omission was more frequent in the /S/ coda. The child who presents lengthening seems to have the knowledge of the structure (C)VC and, therefore, is closer to the production of the target-phoneme.

  8. Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa.

    PubMed

    Bernardoni, Fabio; Geisler, Daniel; King, Joseph A; Javadi, Amir-Homayoun; Ritschel, Franziska; Murr, Julia; Reiter, Andrea M F; Rössner, Veit; Smolka, Michael N; Kiebel, Stefan; Ehrlich, Stefan

    2018-02-01

    In their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices and overexercising) that may originate in altered decision making and learning. In this functional magnetic resonance imaging study, we employed computational modeling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female patients with AN and 36 age-matched healthy volunteers (12-24 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model that captures interindividual variability in learning under uncertainty. Behaviorally, patients displayed an increased learning rate specifically after punishments. At the neural level, hemodynamic correlates for the learning rate, expected value, and prediction error did not differ between the groups. However, activity in the posterior medial frontal cortex was elevated in AN following punishment. Our findings suggest that the neural underpinning of feedback learning is selectively altered for punishment in AN. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. Map reading, navigating from maps, and the medial temporal lobe.

    PubMed

    Urgolites, Zhisen J; Kim, Soyun; Hopkins, Ramona O; Squire, Larry R

    2016-12-13

    We administered map-reading tasks in which participants navigated an array of marks on the floor by following paths on hand-held maps that made up to nine turns. The burden on memory was minimal because the map was always available. Nevertheless, because the map was held in a fixed position in relation to the body, spatial computations were continually needed to transform map coordinates into geographical coordinates as participants followed the maps. Patients with lesions limited to the hippocampus (n = 5) performed similar to controls at all path lengths (experiment 1). They were also intact at executing single moves to an adjacent location, even when trials began by facing in a direction that put the map coordinates and geographical coordinates into conflict (experiment 2). By contrast, one patient with large medial temporal lobe (MTL) lesions performed poorly overall in experiment 1 and poorly in experiment 2 when trials began by facing in the direction that placed the map coordinates and geographical coordinates in maximal conflict. Directly after testing, all patients were impaired at remembering factual details about the task. The findings suggest that the hippocampus is not needed to carry out the spatial computations needed for map reading and navigating from maps. The impairment in map reading associated with large MTL lesions may depend on damage in or near the parahippocampal cortex.

  10. Effects of Response Force Parameters on Medial-Frontal Negativity

    PubMed Central

    Armbrecht, Anne-Simone; Gibbons, Henning; Stahl, Jutta

    2013-01-01

    The response-related medial-frontal activity (MFN) is often supposed to reflect action-monitoring and error-processing activity. The present force-production task was designed to investigate the effects of two response parameters (i.e., peak response force and time-to-peak, TTP) on the MFN separately. In a 2 × 2 design (high vs. low target force and short vs. long TTP), 22 participants had to produce isometric force pulses to match one of four conditions (e.g., a high target force with a long TTP). Significant main effects of both target force and target TTP were revealed. As previously shown, the MFN amplitude was higher in the high target-force condition than in the low target-force condition. Contrary to the initial expectations, a long TTP had the effect of reducing the MFN amplitude. There was no error-specific effect on the MFN. The force-unit monitoring model (FUMM) is suggested to account for the force- and TTP- specific variations of MFN amplitude, latency and slope. PMID:23349950

  11. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome.

    PubMed

    Rathleff, Michael S; Kelly, Luke A; Christensen, Finn B; Simonsen, Ole H; Kaalund, Søren; Laessoe, Uffe

    2012-01-01

    Medial tibial stress syndrome (MTSS) is a common diagnosis. Several studies have demonstrated that excessive static navicular drop (ND) is related to the diagnosis. However, no studies have yet investigated ND and the velocity of ND during dynamic conditions. The aim of this study was to evaluate ND characteristics in patients with MTSS in dynamic and static conditions. In a case-control study, 14 patients diagnosed as having MTSS were included from an orthopedic outpatient clinic. A control group consisting of 14 healthy participants was matched regarding age, sex, and typical sporting activity. Navicular drop was evaluated during treadmill walking by a two-dimensional video analysis. Static foot posture, static ND, dynamic ND (dND), and velocity of dND were compared. The two groups were comparable in relation to age, sex, height, weight, and foot size. No significant difference was found in static foot posture. Static ND showed a mean difference of 1.7 mm between the groups (P = .08). During treadmill walking, patients with MTSS had, on average, a 1.5-mm-larger dND (P =.004) and a 2.4-mm/sec-larger mean velocity of dND (P = .03). Patients with MTSS display a larger ND and a higher ND velocity during treadmill walking. Increased ND velocity may be important to this condition. Future studies should include velocity of dND to investigate the mechanisms of dND in relation to overuse injuries.

  12. Medial amygdalar aromatase neurons regulate aggression in both sexes

    PubMed Central

    Unger, Elizabeth K.; Burke, Kenneth J.; Yang, Cindy F.; Bender, Kevin J.; Fuller, Patrick M.; Shah, Nirao M.

    2014-01-01

    SUMMARY Aromatase-expressing neuroendocrine neurons in the vertebrate male brain synthesize estradiol from circulating testosterone. This locally produced estradiol controls neural circuits underlying courtship vocalization, mating, aggression, and territory marking in male mice. How aromatase-expressing neuronal populations control these diverse estrogen-dependent male behaviors is poorly understood, and the function, if any, of aromatase-expressing neurons in females is unclear. Using targeted genetic approaches, we show that aromatase-expressing neurons within the male posterodorsal medial amygdala (MeApd) regulate components of aggression but not other estrogen-dependent male-typical behaviors. Remarkably, aromatase-expressing MeApd neurons in females are specifically required for components of maternal aggression, which we show is distinct from intermale aggression in pattern and execution. Thus, aromatase-expressing MeApd neurons control distinct forms of aggression in the two sexes. Moreover, our findings indicate that complex social behaviors are separable in a modular manner at the level of genetically identified neuronal populations. PMID:25620703

  13. Transient medial prefrontal perturbation reduces false memory formation.

    PubMed

    Berkers, Ruud M W J; van der Linden, Marieke; de Almeida, Rafael F; Müller, Nils C J; Bovy, Leonore; Dresler, Martin; Morris, Richard G M; Fernández, Guillén

    2017-03-01

    Knowledge extracted across previous experiences, or schemas, benefit encoding and retention of congruent information. However, they can also reduce specificity and augment memory for semantically related, but false information. A demonstration of the latter is given by the Deese-Roediger-McDermott (DRM) paradigm, where the studying of words that fit a common semantic schema are found to induce false memories for words that are congruent with the given schema, but were not studied. The medial prefrontal cortex (mPFC) has been ascribed the function of leveraging prior knowledge to influence encoding and retrieval, based on imaging and patient studies. Here, we used transcranial magnetic stimulation (TMS) to transiently perturb ongoing mPFC processing immediately before participants performed the DRM-task. We observed the predicted reduction in false recall of critical lures after mPFC perturbation, compared to two control groups, whereas veridical recall and recognition memory performance remained similar across groups. These data provide initial causal evidence for a role of the mPFC in biasing the assimilation of new memories and their consolidation as a function of prior knowledge. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Single-cell recordings in the human medial temporal lobe

    PubMed Central

    Rey, Hernan G; Ison, Matias J; Pedreira, Carlos; Valentin, Antonio; Alarcon, Gonzalo; Selway, Richard; Richardson, Mark P; Quian Quiroga, Rodrigo

    2015-01-01

    Recordings from individual neurons in patients who are implanted with depth electrodes for clinical reasons have opened the possibility to narrow down the gap between neurophysiological studies in animals and non-invasive (e.g. functional magnetic resonance imaging, electroencephalogram, magnetoencephalography) investigations in humans. Here we provide a description of the main procedures for electrode implantation and recordings, the experimental paradigms used and the main steps for processing the data. We also present key characteristics of the so-called ‘concept cells’, neurons in the human medial temporal lobe with selective and invariant responses that represent the meaning of the stimulus, and discuss their proposed role in declarative memory. Finally, we present novel results dealing with the stability of the representation given by these neurons, by studying the effect of stimulus repetition in the strength of the responses. In particular, we show that, after an initial decay, the response strength reaches an asymptotic value after approximately 15 presentations that remains above baseline for the whole duration of the experiment. PMID:25163775

  15. Spatiotemporal gait compensations following medial collateral ligament and medial meniscus injury in the rat: correlating gait patterns to joint damage.

    PubMed

    Kloefkorn, Heidi E; Jacobs, Brittany Y; Loye, Ayomiposi M; Allen, Kyle D

    2015-10-14

    After transection of the medial collateral ligament and medial meniscus (MCLT + MMT) in the rat, focal cartilage lesions develop over 4-6 weeks; however, sham surgery (MCLT alone) does not result in cartilage damage over a similar period. Thus, comparison of MCLT + MMT with the MCLT sham group offers an opportunity to investigate behavioral modifications related to focal cartilage and meniscus damage in the rat. MCLT or MCLT + MMT surgery was performed in the right knees of male Lewis rats, with spatiotemporal gait patterns and hind limb sensitivity assessed at 1, 2, 4, and 6 weeks postsurgery (n = 8 rats per group per time point, n = 64 total). After the animals were euthanized, Histology was performed to assess joint damage. MCLT + MMT animals had unilateral gait compensations at early time points, but by week 6 bilateral gait compensations had developed in both the MCLT sham and MCLT + MMT groups. Conversely, heightened tactile sensitivity was detected in both MCLT sham and MCLT + MMT animals at week 1, but only the MCLT + MMT animals maintained heightened sensitivity to week 6. Cartilage lesions were found in the MCLT + MMT group but not in the MCLT sham group. Correlations could be identified between joint damage and gait changes in MCLT + MMT animals; however, the same gait changes were found with MCLT sham animals despite a lack of joint damage. Combined, our data highlight a common conundrum in osteoarthritis (OA) research: Some behavioral changes correlate to cartilage damage in the OA group, but the same changes can be identified in non-OA controls. Of the behavioral changes detected, allodynia was maintained in MCLT + MMT animals but not in the MCLT sham group. However, the correlation between cartilage damage and hind limb sensitivity is relatively weak (R = -0.4498), and the range of sensitivity measures overlaps between groups. The factors driving gait abnormalities in MCLT and MCLT + MMT animals also remain uncertain. The gait modifications are

  16. Proton magnetic resonance spectroscopy of the medial prefrontal cortex in patients with deficit schizophrenia: preliminary report.

    PubMed

    Delamillieure, P; Fernandez, J; Constans, J M; Brazo, P; Benali, K; Abadie, P; Vasse, T; Thibaut, F; Courthéoux, P; Petit, M; Dollfus, S

    2000-04-01

    Proton magnetic resonance spectroscopy (1H-MRS) was used to study medial prefrontal metabolic impairments in schizophrenic patients with the deficit syndrome. The subjects were 22 schizophrenic patients categorized as deficit (N=5) or nondeficit (N=17) and 21 healthy subjects. (1)H-MRS was performed for the right and the left medial prefrontal cortex. The patients with the deficit syndrome had significantly lower ratios of N-acetylaspartate to creatine plus phosphocreatine than did the healthy subjects or nondeficit patients. As N-acetylaspartate levels could reflect neuronal density and/or viability, this finding suggests a neuronal loss in the medial prefrontal cortex of deficit patients.

  17. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results.

    PubMed Central

    Bonasia, D. E.; Bruzzone, M.; Dettoni, F.; Marmotti, A.; Blonna, D.; Castoldi, F.; Gasparetto, F.; D'Elicio, D.; Collo, G.; Rossi, R.

    2012-01-01

    Injuries of the posteromedial corner of the knee are relatively common. These can be isolated or combined with other ligament lesions. In some cases the treatment of postero-medial corner injuries is controversial. After a brief description of the anatomy and biomechanics of the medial side of the knee, this paper reviews the indications for isolated and multiligamentous medial/posteromedial corner injuries both in the acute and in the chronic setting. In addition, the most common surgical techniques for repair and reconstruction are described in addition to outcomes based upon a review of the literature. PMID:23576938

  18. Bilateral superior rectus transposition for congenital exotropia associated with anomalous medial rectus muscles.

    PubMed

    Kodsi, Sylvia R

    2015-10-01

    Superior rectus transposition to the lateral rectus insertion without inferior rectus transposition has been used to correct esotropic deviations secondary to Duane syndrome and abducens nerve palsy. This is usually combined with an augmented posterior fixation suture of the superior rectus muscle to the lateral rectus muscle and ipsilateral medial rectus recession. We report a child with a large-angle congenital exotropia who was found to have anomalous medial rectus muscles bilaterally. Bilateral superior rectus transposition to the medial rectus insertion with bilateral lateral rectus recessions achieved good ocular alignment in primary position. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  19. An animal model of recognition memory and medial temporal lobe amnesia: History and current issues

    PubMed Central

    Clark, Robert E.; Squire, Larry R.

    2010-01-01

    The medial temporal lobe includes a system of anatomically connected structures that are essential for declarative memory (conscious memory for facts and events). A prominent form of declarative memory is recognition memory (the ability to identify a recently encountered item as familiar). Recognition memory has been frequently assessed in humans and in the experimental animal. This article traces the successful development of an animal model of human medial temporal lobe amnesia, which eventually identified the structures in the medial temporal lobe important for memory. Attention is given to two prominent behavioral paradigms (delayed nonmatching to sample and tests of spontaneous novelty preference). PMID:20144894

  20. Neuronal Pentraxin 2 Predicts Medial Temporal Atrophy and Memory Decline Across the Alzheimer’s Disease Spectrum

    PubMed Central

    Swanson, Ashley; Willette, AA

    2016-01-01

    Chronic neuroinflammation is thought to potentiate medial temporal lobe (MTL) atrophy and memory decline in Alzheimer’s disease (AD). It has become increasingly important to find novel immunological biomarkers of neuroinflammation or other processes that can track AD development and progression. Our study explored which pro- or anti-inflammatory cerebrospinal fluid (CSF) biomarkers best predicted AD neuropathology over 24 months. Using Alzheimer’s Disease Neuroimaging Initiative data (N=285), CSF inflammatory biomarkers from mass spectrometry and multiplex panels were screened using stepwise regression, followed up with 50%/50% model retests for validation. Neuronal Pentraxin 2 (NPTX2) and Chitinase-3-like-protein- 1 (C3LP1), biomarkers of glutamatergic synaptic plasticity and microglial activation respectively, were the only consistently significant biomarkers selected. Once these biomarkers were selected, linear mixed models were used to analyze their baseline and longitudinal associations with bilateral MTL volume, memory decline, global cognition, and established AD biomarkers including CSF amyloid and tau. Higher baseline NPTX2 levels corresponded to less MTL atrophy [R2= .287, p<.001] and substantially less memory decline [R2=.560, p<.001] by month 24. Conversely, higher C3LP1 modestly predicted more MTL atrophy [R2=.083, p<.001], yet did not significantly track memory decline over time. In conclusion, NPTX2 is a novel pro-inflammatory cytokine that predicts AD-related outcomes better than any immunological biomarker to date, substantially accounting for brain atrophy and especially memory decline. C3LP1 as the microglial biomarker, by contrast, performed modestly and did not predict longitudinal memory decline. This research may advance the current understanding of AD etiopathogenesis, while expanding early diagnostic techniques through the use of novel pro-inflammatory biomarkers, such as NPTX2. Future studies should also see if NPTX2 causally affects

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

    PubMed

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

    2017-09-28

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

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

    PubMed

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

    2015-09-01

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

  3. Cross-sectional and longitudinal associations between circulating leptin and knee cartilage thickness in older adults.

    PubMed

    Stannus, Oliver P; Cao, Yuelong; Antony, Benny; Blizzard, Leigh; Cicuttini, Flavia; Jones, Graeme; Ding, Changhai

    2015-01-01

    To investigate cross-sectional and longitudinal associations between serum leptin levels and knee cartilage thickness in older adults. A prospective cohort of 163 randomly selected subjects (mean 63 years, range 52-78, 46% women) was studied. Knee cartilage thickness at medial tibial, lateral tibial, femoral and patellar sites was determined using T1-weighted fat-suppressed MRI. Serum leptin levels were measured by radioimmunoassay. Radiographic osteoarthritis, body fat (%), trunk fat (%), weight and height were measured, and body mass index (BMI) was calculated. Cross-sectionally, serum levels of leptin were negatively associated with femoral (β: -0.013, 95% CI -0.022 to -0.003), medial tibial (β: -0.009, 95% CI -0.018 to -0.001), lateral tibial (β: -0.012, 95% CI -0.021 to -0.003) and patellar (β: -0.014, 95% CI -0.026 to -0.002) cartilage thickness after adjustment for covariates. Moreover, BMI, trunk fat and total body fat were negatively associated with cartilage thickness, and the significant associations disappeared after further adjustment for leptin. Longitudinally, both baseline leptin and change in leptin were associated with greater changes in medial tibial cartilage thickness (β: -0.004, 95% CI -0.007 to -0.001 and β: -0.009, 95% CI -0.018 to -0.001, respectively) in multivariable analyses. Serum levels of leptin are independently and consistently associated with reduced cartilage thickness cross-sectionally and longitudinally. In addition, the associations between adiposity measures and cartilage thickness are mediated by leptin, suggesting leptin may play a key role in cartilage thinning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    PubMed

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

    2015-09-01

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

  5. Medial thigh pain: An unusual presentation of giant calculi in sigmoid neobladder

    PubMed Central

    Abrol, Nitin; Gupta, Narmada; Kumar, Rajeev

    2011-01-01

    Calculi in a neobladder usually present with irritative lower urinary tract symptoms, flank pain, and haematuria. We report a case of giant stones in a sigmoid neobladder, who presented with medial thigh pain. PMID:21814323

  6. Anatomic dissection of the tibialis posterior muscle and its correlation to medial tibial stress syndrome.

    PubMed

    Saxena, A; O'Brien, T; Bunce, D

    1990-01-01

    The authors attempt to redefine the anatomic origin of the tibialis posterior muscle, and correlate it with the location of medial tibial stress syndrome that occurs in the lower third of the tibia. Contrary to what is commonly described, the authors show on all ten dissected specimens, that the origin of the tibialis posterior does include a portion of the lower third of the tibia. The mean distance from tibialis posterior's origin to the medial malleolus was only 7.77 cm. In addition, to further explain lower leg pain, the authors investigated the crossing point of tibialis posterior and flexor digitorum longus; a mean distance for this to occur in the same ten specimens was 8.16 cm. proximal to the medial malleolus. These findings provide insight to anatomic reasons behind biomechanical factors responsible for medial tibial stress syndrome. This is also important to consider when performing surgery for a deep compartment syndrome.

  7. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty.

    PubMed

    Collier, Matthew B; Eickmann, Thomas H; Sukezaki, Fumio; McAuley, James P; Engh, Gerard A

    2006-09-01

    The investigators reviewed 245 fixed-bearing unicondylar arthroplasties that one surgeon performed as treatment of medial compartment osteoarthritis between 1988 and 1997 using a variety of cemented metal-backed tibial components and gamma-irradiated-in-air polyethylene bearings. Multivariate statistical analysis was used to evaluate how the event of revision was influenced by 3 patient factors, 3 implant factors, and 7 factors assessed from preoperative and early postoperative radiographs. Five factors were statistically associated with revision: (younger) patient age, (thinner) tibial component initial thickness, (longer) polyethylene shelf age, (lesser) angular reduction of medial tibial plateau varus, and (more varus) postoperative hip-knee-ankle angle. Besides illustrating deleterious consequences of using gamma-irradiated-in-air polyethylene in medial unicompartmental arthroplasty, our results support reducing varus angulation of the medial tibial plateau and knee at surgery.

  8. Biomechanical validation of medial pie-crusting for soft-tissue balancing in knee arthroplasty.

    PubMed

    Mihalko, William M; Woodard, Erik L; Hebert, Casey T; Crockarell, John R; Williams, John L

    2015-02-01

    Balancing a varus knee is traditionally accomplished by releasing the medial soft-tissue sleeve off the tibia. Recently, "pie-crusting" (PC) medial structures has been described. In a biomechanical cadaver study we compared PC to traditional release (TR) to determine their effects on flexion and extension gaps. PC was done in five specimens along the anterior half of the medial soft-tissue sleeve and five along the posterior half, followed by a traditional release. In 90° flexion, valgus laxity after TR was significantly greater than after PC alone. PC of the anterior or posterior aspect of the medial soft-tissue sleeve can effect changes more in flexion than in extension, respectively. Complete TR did not provide more gap opening than PC in extension, but produced more effect in flexion. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Recruitment of the Rhesus soleus and medial gastrocnemius before, during and after spaceflight

    NASA Technical Reports Server (NTRS)

    Roy, R. R.; Hodgson, J. A.; Aragon, J.; Day, M. K.; Kozlovskaya, I.; Edgerton, V. R.

    1996-01-01

    Electromyograms were recorded from the soleus and medial gastrocnemius muscles and tendon force from the medial gastrocnemius muscle of 2 juvenile Rhesus monkeys before, during and after Cosmos flight 2229 and of ground control animals. Recording sessions were made while the Rhesus were performing a foot pedal motor task. Preflight testing indicated normal patterns of recruitment between the soleus and medial gastrocnemius, i.e. a higher level of recruitment of the soleus compared to the medial gastrocnemius during the task. Recording began two days into the spaceflight and showed that the media gastrocnemius was recruited preferentially over the soleus. This observation persisted throughout the flight and for the 2 week period of postflight testing. These data indicate a significant change in the relative recruitment of slow and fast extensor muscles under microgravity conditions. The appearance of clonic-like activity in one muscle of each Rhesus during flight further suggests a reorganization in the neuromotor system in a microgravity environment.

  10. The effect of medial meniscectomy on strain distribution in the proximal part of the tibia.

    PubMed

    Bourne, R B; Finlay, J B; Papadopoulos, P; Andreae, P

    1984-12-01

    The tibiae of five fresh adult human cadaver legs (amputated proximal to the knee) were instrumented with twenty-five strain-gauge rosettes and were tested in axial compression, simulating single-limb stance, at loads of as much as 2450 newtons. We compared the status of the normal knee, with menisci intact, with the status of the same knee after partial or total medial meniscectomy. The resultant changes in strain on the cortical bone of the tibia indicated that medial meniscectomy caused reduced compressive strains on the whole of the lateral aspect of the tibia, while on the medial aspect compressive strains were increased at all levels beyond seventy millimeters distal to the joint-line; however, within fifty millimeters of the joint-line on the medial aspect, there was a significant reduction of compressive strains.

  11. Surgical treatment of symptomatic discoid medial meniscus in childhood: a case report.

    PubMed

    Kalenderer, Onder; Türken, Mehmet Aykut; Agus, Haluk

    2012-07-01

    If the meniscus has a spherical shape and not a semilunary structure, it is called as discoid meniscus. This anomaly is generally seen in the lateral meniscus; however, it is rare in the medial meniscus. Although the discoid meniscus is usually asymptomatic in children and adolescents, it could present as a meniscal tear. An 11-year-old boy was admitted to our hospital with right knee pain and lack of extension of the knee joint. He was diagnosed as discoid medial meniscus. On physical examination, we observed tenderness at the knee joint line with an effusion of the knee and a restriction during the extension movement of the knee joint. McMurray test was positive. Conventional radiograms revealed widening of the medial joint line and cupping of the medial tibial plateau. Magnetic resonance imaging indicated a discoid meniscus image at sagittal slices. In this case, after the arthroscopic partial menisectomy, we obtained an excellent result at 2 years follow-up.

  12. Medial tibial stress syndrome: evidence-based prevention.

    PubMed

    Craig, Debbie I

    2008-01-01

    Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40. Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Studies were identified by searching MEDLINE (1966-2000), Current Contents (1996-2000), Biomedical Collection (1993-1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed

  13. Medial Tibial Stress Syndrome: Evidence-Based Prevention

    PubMed Central

    Craig, Debbie I

    2008-01-01

    Reference: Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32–40. Clinical Question: Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Data Sources: Studies were identified by searching MEDLINE (1966–2000), Current Contents (1996–2000), Biomedical Collection (1993–1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Study Selection: Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. Data Extraction: A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Main Results: Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. Conclusions: No current evidence supports any single prevention method for MTSS. The most

  14. Contributing factors to medial tibial stress syndrome: a prospective investigation.

    PubMed

    Hubbard, Tricia J; Carpenter, Erica Mullis; Cordova, Mitchell L

    2009-03-01

    To conduct a prospective, multisite, cohort study investigating the possible risk factors for medial tibial stress syndrome (MTSS) in college athletes. One hundred and forty-six healthy, collegiate athletes from NCAA Division I and Division II institutions participated in the study. Subjects first completed a health history questionnaire to establish previous history of injury and underwent a physical examination to assess their ankle/foot strength, ankle/foot range of motion, tibial varum, and navicular drop before the start of their respective athletic season. Athletes were instructed to report to a certified athletic trainer if they developed pain on their tibia. If MTSS was present, subjects were then placed into the symptomatic group. Independent t-tests and chi-square analyses were used to determine whether differences existed between MTSS and healthy athletes for the continuous and the discrete dependent variables, respectively. The significant dependent variables were then used in the discriminant function analysis. Twenty-nine subjects developed MTSS during this study. Athletes that had been participating in athletic activity for fewer than 5 yr were significantly more likely to develop MTSS (P = 0.002). Additionally, athletes with a previous history of MTSS (P = 0.0001), a previous history of stress fracture (P = 0.039), and the use of orthotics (P = 0.031) were more likely to develop MTSS compared with those who did not develop MTSS. This study established that the factors most influencing MTSS development were previous history of MTSS and stress fracture, years of running experience, and orthotic use. These data demonstrate the importance of establishing a thorough history before the start of the season so that athletes who might be at risk for MTSS development can be identified.

  15. Tinnitus, Medial Olivocochlear System, and Music Exposure in Adolescents.

    PubMed

    Hinalaf, María; Maggi, Ana L; Hüg, Mercedes X; Kogan, Pablo; Villalobo, Jorge Pérez; Biassoni, Ester C

    2017-01-01

    The most common cause of tinnitus is the exposure to noise; in the case of adolescents, music is the main sound source they are exposed to. Currently, one of the hypotheses about the genesis of tinnitus is related to the deterioration in the functioning of the medial olivocochlear system (MOCS). The aim of this study was to determine the presence or absence of tinnitus in adolescents with normal hearing and to relate it to: (a) the functioning of the MOCS, by the contralateral suppression of the transient evoked otoacoustic emissions (TEOAEs) and (b) the musical general exposure (MGE). A cross-sectional descriptive correlational study was conducted. The sample was composed by adolescents with ages between 14 and 15. Two questionnaires were administered, one in relation to the subjective report of tinnitus and the other in relation to recreational activities to know the MGE. The results showed that the amplitude of frequencies (1000, 1500, 2000, and 3000 Hz) and global amplitude of TEOAEs, with and without acoustic contralateral stimulation, were higher in the group without tinnitus, with a statistically significant difference (P < 0.05). The suppressive effect was higher in the group without tinnitus; however, there was no statistically significant difference. Contrastingly, a significant association (P < 0.05) between exposure to music and tinnitus was observed; 72.41% of the adolescents with high exposure to music had tinnitus. The results of the present investigation provide a contribution to the hypothesis of "the participation of the MOCS." Furthermore, a high MGE can be considered a risk factor for the onset of tinnitus.

  16. Medial Frontal White and Gray Matter Contributions to General Intelligence

    PubMed Central

    Bouix, Sylvain; Kubicki, Marek

    2014-01-01

    The medial orbitofrontal cortex (mOFC) and rostral anterior cingulate cortex (rACC) are part of a wider neural network that plays an important role in general intelligence and executive function. We used structural brain imaging to quantify magnetic resonance gray matter volume and diffusion tensor white matter integrity of the mOFC-rACC network in 26 healthy participants who also completed neuropsychological tests of intellectual abilities and executive function. Stochastic tractography, the most effective Diffusion Tensor Imaging method for examining white matter connections between adjacent gray matter regions, was employed to assess the integrity of mOFC-rACC pathways. Fractional anisotropy (FA), which reflects the integrity of white matter connections, was calculated. Results indicated that higher intelligence correlated with greater gray matter volumes for both mOFC and rACC, as well as with increased FA for left posterior mOFC-rACC connectivity. Hierarchical regression analyses revealed that DTI-derived FA of left posterior mOFC-rACC uniquely accounted for 29%–34% of the variance in IQ, in comparison to 11%–16% uniquely explained by gray matter volume of the left rACC. Together, left rACC gray matter volume and white matter connectivity between left posterior mOFC and rACC accounted for up to 50% of the variance in general intelligence. This study is to our knowledge the first to examine white matter connectivity between OFC and ACC, two gray matter regions of interests that are very close in physical proximity, and underscores the important independent contributions of variations in rACC gray matter volume and mOFC-rACC white matter connectivity to individual differences in general intelligence. PMID:25551572

  17. Endogenous androgens and carotid intimal-medial thickness in women.

    PubMed

    Bernini, G P; Sgro', M; Moretti, A; Argenio, G F; Barlascini, C O; Cristofani, R; Salvetti, A

    1999-06-01

    The influence of endogenous androgens on atherosclerotic disease in women is unknown. In this study involving 101 pre- and post-menopausal females, we evaluated the relationship between serum androgen levels and both carotid artery intimal-medial thickness (IMT) and major cardiovascular risk factors. In addition to evaluation of blood pressure, body mass index, and waist-to-hip ratio, serum dehydroepiandrosterone sulfate (DHEA-S), androstenedione (A), total testosterone (TTS), free testosterone (FTS), insulin, cholesterol (total and high density lipoproteins), triglycerides, and glucose were measured. All women underwent carotid ultrasonography. Spearman correlation coefficients showed that serum DHEA-S and A levels were negatively related (P < 0.03-0.0004) to several IMT measures. Higher tertiles of DHEA-S, A, and FTS corresponded to significantly lower measures of carotid thickness. DHEA-S, and all androgens were inversely related to age (P < 0.03 or less), showing no unfavorable association with major cardiovascular risk factors. In contrast, serum DHEA-S was negatively associated with WHR (P < 0.02), while A was negatively associated with body mass index (P < 0.02). Stepwise multiple regression analysis indicated that A and FTS showed an inverse association with IMT measures (P < 0.05-0.001). In conclusion, our data indicate that in women serum DHEA-S and androgens decline with age and that normal hormonal levels are not associated with major cardiovascular risk factors. They also show that higher DHEA-S and androgen concentrations are related to lower carotid wall thickness; for A this association is independent of cardiovascular risk factors. Our results suggest that, in the physiological range, DHEA-S and androgens in women are correlated with lower risk of carotid artery atherosclerosis.

  18. Tinnitus, Medial Olivocochlear System, and Music Exposure in Adolescents

    PubMed Central

    Hinalaf, María; Maggi, Ana L.; Hüg, Mercedes X.; Kogan, Pablo; Villalobo, Jorge Pérez; Biassoni, Ester C.

    2017-01-01

    Introduction: The most common cause of tinnitus is the exposure to noise; in the case of adolescents, music is the main sound source they are exposed to. Currently, one of the hypotheses about the genesis of tinnitus is related to the deterioration in the functioning of the medial olivocochlear system (MOCS). Aim: The aim of this study was to determine the presence or absence of tinnitus in adolescents with normal hearing and to relate it to: (a) the functioning of the MOCS, by the contralateral suppression of the transient evoked otoacoustic emissions (TEOAEs) and (b) the musical general exposure (MGE). Materials and Methods: A cross-sectional descriptive correlational study was conducted. The sample was composed by adolescents with ages between 14 and 15. Two questionnaires were administered, one in relation to the subjective report of tinnitus and the other in relation to recreational activities to know the MGE. Results: The results showed that the amplitude of frequencies (1000, 1500, 2000, and 3000 Hz) and global amplitude of TEOAEs, with and without acoustic contralateral stimulation, were higher in the group without tinnitus, with a statistically significant difference (P < 0.05). The suppressive effect was higher in the group without tinnitus; however, there was no statistically significant difference. Contrastingly, a significant association (P < 0.05) between exposure to music and tinnitus was observed; 72.41% of the adolescents with high exposure to music had tinnitus. Discussion and Conclusion: The results of the present investigation provide a contribution to the hypothesis of “the participation of the MOCS.” Furthermore, a high MGE can be considered a risk factor for the onset of tinnitus. PMID:29192619

  19. High-Frequency Resonance in the Gerbil Medial Superior Olive

    PubMed Central

    Mikiel-Hunter, Jason; Kotak, Vibhakar; Rinzel, John

    2016-01-01

    A high-frequency, subthreshold resonance in the guinea pig medial superior olive (MSO) was recently linked to the efficient extraction of spatial cues from the fine structure of acoustic stimuli. We report here that MSO neurons in gerbil also have resonant properties and, based on our whole-cell recordings and computational modeling, that a low-voltage-gated potassium current, IKLT, underlies the resonance. We show that resonance was lost following dynamic clamp replacement of IKLT with a leak conductance and in the model when voltage-gating of IKLT was suppressed. Resonance was characterized using small amplitude sinusoidal stimuli to generate impedance curves as typically done for linear systems analysis. Extending our study into the nonlinear, voltage-dependent regime, we increased stimulus amplitude and found, experimentally and in simulations, that the subthreshold resonant frequency (242Hz for weak stimuli) increased continuously to the resonant frequency for spiking (285Hz). The spike resonance of these phasic-firing (type III excitable) MSO neurons and of the model is of particular interest also because previous studies of resonance typically involved neurons/models (type II excitable, such as the standard Hodgkin-Huxley model) that can fire tonically for steady inputs. To probe more directly how these resonances relate to MSO neurons as slope-detectors, we presented periodic trains of brief, fast-rising excitatory post-synaptic potentials (EPSCs) to the model. While weak subthreshold EPSC trains were essentially low-pass filtered, resonance emerged as EPSC amplitude increased. Interestingly, for spike-evoking EPSC trains, the threshold amplitude at spike resonant frequency (317Hz) was lower than the single ESPC threshold. Our finding of a frequency-dependent threshold for repetitive brief EPSC stimuli and preferred frequency for spiking calls for further consideration of both subthreshold and suprathreshold resonance to fast and precise temporal processing

  20. Modeling Conflict and Error in the Medial Frontal Cortex

    PubMed Central

    Mayer, Andrew R.; Teshiba, Terri M.; Franco, Alexandre R.; Ling, Josef; Shane, Matthew S.; Stephen, Julia M.; Jung, Rex E.

    2014-01-01

    Despite intensive study, the role of the dorsal medial frontal cortex (dMFC) in error monitoring and conflict processing remains actively debated. The current experiment manipulated conflict type (stimulus conflict only or stimulus and response selection conflict) and utilized a novel modeling approach to isolate error and conflict variance during a multimodal numeric Stroop task. Specifically, hemodynamic response functions resulting from two statistical models that either included or isolated variance arising from relatively few error trials were directly contrasted. Twenty-four participants completed the task while undergoing event-related functional magnetic resonance imaging on a 1.5-Tesla scanner. Response times monotonically increased based on the presence of pure stimulus or stimulus and response selection conflict. Functional results indicated that dMFC activity was present during trials requiring response selection and inhibition of competing motor responses, but absent during trials involving pure stimulus conflict. A comparison of the different statistical models suggested that relatively few error trials contributed to a disproportionate amount of variance (i.e., activity) throughout the dMFC, but particularly within the rostral anterior cingulate gyrus (rACC). Finally, functional connectivity analyses indicated that an empirically derived seed in the dorsal ACC/pre-SMA exhibited strong connectivity (i.e., positive correlation) with prefrontal and inferior parietal cortex but was anticorrelated with the default-mode network. An empirically derived seed from the rACC exhibited the opposite pattern, suggesting that sub-regions of the dMFC exhibit different connectivity patterns with other large scale networks implicated in internal mentations such as daydreaming (default-mode) versus the execution of top-down attentional control (fronto-parietal). PMID:21976411

  1. Intraoperative assessment of medial rectus pulley location in strabismus.

    PubMed

    Thouvenin, Dominique; Norbert, Olivier

    2013-01-21

    Purpose. Extraocular muscle (EOM) pulleys are important in eye movement physiology and may play a role in the outcome of strabismus surgery. Few studies have evaluated "normal" position of EOM pulleys. We sought to assess intraoperatively medial rectus (MR) pulley location and variations in a prospective observational case series. Methods. A total of 194 consecutive patients with all types of strabismus aged 2 to 64 years had primary surgery on MR. We conducted 357 measures of the distance between scleral insertion of MR and anterior part of the pulley. We compared results to preoperative angle of deviation, age, refraction, and position of eyes under anesthesia. Results. Median location of the anterior part of the MR's pulley is 12.03 mm from scleral insertion, varying from 8 to 15 mm. There is a strong relation with refraction (p=0.005) and with preoperative angle of deviation (p=0.00002) and deviation under anesthesia (p=0.0001). The MR's pulley tends to be more anterior in hyperopic cases and esotropias, and posterior in myopias and exotropias. Conclusions. Our study shows physiologic variations of MR's pulley position with evidence of an adaptation to biometric parameters of the globe, represented by refraction state of the eyes in our study. Elsewhere, strabismus leads to an independent variation of MR's pulley location evaluated relatively to muscle's scleral insertion, but probably not if evaluated relatively to the orbit. We discuss consequences on ocular motility and surgery of these variations. They may explain some unexpected effects of strabismus surgery. Further studies are needed to ascertain their real impact.

  2. Visualization of the medial forebrain bundle using diffusion tensor imaging.

    PubMed

    Hana, Ardian; Hana, Anisa; Dooms, Georges; Boecher-Schwarz, Hans; Hertel, Frank

    2015-01-01

    Diffusion tensor imaging is a technique that enables physicians the portrayal of white matter tracts in vivo. We used this technique in order to depict the medial forebrain bundle (MFB) in 15 consecutive patients between 2012 and 2015. Men and women of all ages were included. There were six women and nine men. The mean age was 58.6 years (39-77). Nine patients were candidates for an eventual deep brain stimulation. Eight of them suffered from Parkinson's disease and one had multiple sclerosis. The remaining six patients suffered from different lesions which were situated in the frontal lobe. These were 2 metastasis, 2 meningiomas, 1 cerebral bleeding, and 1 glioblastoma. We used a 3DT1-sequence for the navigation. Furthermore T2- and DTI- sequences were performed. The FOV was 200 × 200 mm(2), slice thickness 2 mm, and an acquisition matrix of 96 × 96 yielding nearly isotropic voxels of 2 × 2 × 2 mm. 3-Tesla-MRI was carried out strictly axial using 32 gradient directions and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2. b-value was 800 s/mm(2). The maximal angle was 50°. Additional scanning time was < 9 min. We were able to visualize the MFB in 12 of our patients bilaterally and in the remaining three patients we depicted the MFB on one side. It was the contralateral side of the lesion. These were 2 meningiomas and one metastasis. Portrayal of the MFB is possible for everyday routine for neurosurgical interventions. As part of the reward circuitry it might be of substantial importance for neurosurgeons during deep brain stimulation in patients with psychiatric disorders. Surgery in this part of the brain should always take the preservation of this white matter tract into account.

  3. The remarkable migration of the medial collateral ligament

    PubMed Central

    Wang, Meina; Nasiri, Ali; VanHouten, Joshua N; Tommasini, Steven M; Broadus, Arthur E

    2014-01-01

    The developing cortical surfaces of long bones are sculpted and modeled by periosteal osteoclasts and osteoblasts. These surfaces also receive the insertions of tendons and ligaments, and these insertion sites too are modeled to form the root systems that anchor them into the cortical bone. The regulatory molecules that control modeling are poorly understood, but recent evidence suggests that parathyroid hormone-related protein (PTHrP) participates in this process. PTHrP functions principally as a paracrine regulatory molecule, and is known to be induced by mechanical loading in a number of sites. The most curious example of developmental modeling of the cortex is the migration of insertion sites such as that of the medial collateral ligament (MCL) along the bone surface during long-bone growth. We report here the mechanisms that mediate MCL migration using a combination of genetic, imaging and histological techniques. We describe a MCL migratory complex that comprises two components. The first is the MCL insertion site itself, which is a prototypical fibrous insertion site with coupled osteoclast and osteoblast activities, and its key feature is that it is anchored early in development, well before initiation of the long-bone growth spurt. Above the insertion site the periosteum is excavated by osteoclasts to form a migratory tract; this is mediated by wholly uncoupled osteoclastic bone resorption and remains as an unmineralized canal on the cortical surface in the adult. Load-induction of PTHrP appears to regulate the osteoclastic activity in both the insertion site and migratory tract. PMID:24266550

  4. A Large, Longitudinal Dune

    NASA Image and Video Library

    2015-02-11

    Taken in late southern spring and when Mars is near perihelion (closest distance to the Sun), this image shows the effects of dry ice sublimation on a longitudinal dune in the far Southern hemisphere. The bright patches on the dune are still covered in frost, and the dark regions are frost-free. Longitudinal dunes form when the wind switches between two common directions*. Based on the direction of this dune's long crest and the orientation of the smaller ripples, it appears the wind blows from the east and from the northwest. However, it would require taking multiple HiRISE images of this location over time and noticing movement before we could say this definitively. The broad base of this dune may indicate that dune sand has spilled out from areas once covered in ice. During the next Martian Southern hemisphere winter (about half a Mars year or one Earth year from when this image was taken), this dune will again be covered in frost and possibly solid carbon dioxide ice, unable to blow in the wind until the volatiles begin to sublimate in the spring. *These are ripples indicating a wind out of the north/northwest. The scene is 250 m across. http://photojournal.jpl.nasa.gov/catalog/PIA19293

  5. The "Double Medial Malleolus": A New Physical Finding in Talocalcaneal Coalition.

    PubMed

    Rocchi, Vanna; Huang, Ming-Tung; Bomar, James D; Mubarak, Scott

    2016-06-02

    It has been the observation of the senior author that there is a bony fullness or "double medial malleolus" over the middle facet as a consistent finding with most talocalcaneal coalitions (TCC). To document this observation, we reviewed records and radiographs in 3 patient groups. Part 1: retrospective chart review was completed for 111 feet to determine the clinical presence of a palpable "double medial malleolus." Part 2: computed tomography (CT) scans for evaluation of tarsal coalition or symptomatic flatfoot between January 2006 and December 2014 were retrospectively reviewed for the same cohort. Soft tissue thickness was measured as the shortest distance between bone and skin surface at both the medial malleolus and the middle facet/coalition. The volume of the middle facet or coalition was measured at their midpoint. These findings were compared among feet with TCC (n=53), calcaneonavicular coalition (CNC) (n=20), and flatfoot (n=38). Part 1-clinical: from medical records, 38 feet (34%) had documented record of a palpable medial prominence. Of the feet reviewed with a "double medial malleolus," all had TCC (no false positives or false negatives). Clinical and CT prominence demonstrated significant correlation (rs=0.519, P=0.001). Part 2-radiographic: CT observation of "double medial malleolus" is significantly associated with TCC (P<0.001). CT observation of double medial malleolus is 81% sensitive and 79% specific as a predictive test for TCC. The middle facet-to-skin distance was significantly closer in those with TCC versus controls (P<0.001). The ratio was larger in patients with TCC versus CNC (P=0.006) or flatfeet (P<0.001). Volume was nearly twice the size in patients with TCC versus the controls (P<0.001). TCCs have a bony prominence below the medial malleolus on clinical exam and CT scan not present in flatfeet or CNCs. This abnormal middle facet is almost twice the size of the normal middle facet. Obesity or severe valgus may mask this finding. If

  6. Safe Zone for Medial Open-Wedge Supramalleolar Osteotomy of the Ankle: A Cadaveric Study.

    PubMed

    Nha, Kyung Wook; Lee, Soon Hyuck; Rhyu, Im Joo; Kim, Hak Jun; Song, Jae Gwang; Han, Jae Hwi; Yeo, Eui Dong; Lee, Young Koo

    2016-01-01

    The purpose of this present study was to determine the incidence of lateral cortical fracture depending on the plane of osteotomy in medial open-wedge supramalleolar osteotomy (SMO) and to define a safe zone through which a medial open-wedge SMO could be performed with minimal risk of lateral cortical fracture. Matched pairs of fresh-frozen human cadaver lower leg specimens were obtained from 7 males and 3 females (average age = 63.9 [range 49-75] years). In group A, a safe zone-level medial open-wedge SMO (plane of osteotomy oriented to the proximal one-third of the intrasyndesmosis) was performed, and in group B, a higher-level medial open-wedge SMO (plane of osteotomy oriented to the suprasyndesmosis) was performed. In group A, 7 of the 10 limbs had no lateral cortical fracture, and 3 had lateral cortical fracture, but all of the fractured limbs were stable during the medial open-wedge SMO procedure. In group B, 2 of 10 limbs had no lateral cortical fracture and 8 had lateral cortical fracture. Three of the 8 fractured limbs were stable, but 5 were unstable during the medial open-wedge SMO procedure. The incidence of lateral cortical fracture in group B was significantly higher compared to group A (P = .04). According to the present findings, lateral cortical fracture was less likely to occur when open-wedge SMO was at the plane of the proximal one-third of the intrasyndesmosis, the so-called "safe zone," than at the plane of the suprasyndesmosis. A safe zone for medial open-wedge SMO to prevent lateral cortical fracture during the medial open-wedge SMO procedure was identified. © The Author(s) 2015.

  7. Sexual experience enhances cognitive flexibility and dendritic spine density in the medial prefrontal cortex.

    PubMed

    Glasper, Erica R; LaMarca, Elizabeth A; Bocarsly, Miriam E; Fasolino, Maria; Opendak, Maya; Gould, Elizabeth

    2015-11-01

    The medial prefrontal cortex is important for cognitive flexibility, a capability that is affected by environmental conditions and specific experiences. Aversive experience, such as chronic restraint stress, is known to impair performance on a task of cognitive flexibility, specifically attentional set-shifting, in rats. Concomitant with this performance decrement, chronic stress reduces the number of dendritic spines on pyramidal neurons in the medial prefrontal cortex. No previous studies have examined whether a rewarding experience, namely mating, affects cognitive flexibility and dendritic spines in the medial prefrontal cortex of male rats. To test this possibility, we exposed adult male rats to sexual receptive females once daily for one week, assessed attentional set-shifting performance, and then analyzed their brains for changes in dendritic spines. We found that sexual experience improved performance on extradimensional set-shifting, which is known to require the medial prefrontal cortex. Additionally, we observed increased dendritic spine density on apical and basal dendrites of pyramidal neurons in the medial prefrontal cortex, but not the orbitofrontal cortex, after sexual experience. We also found that sexual experience enhanced dendritic spine density on granule neurons of the dentate gyrus. The ventral hippocampus sends a direct projection to the medial prefrontal cortex, raising the possibility that experience-dependent changes in the hippocampus are necessary for alterations in medial prefrontal cortex structure and function. As a first attempt at investigating this, we inactivated the ventral hippocampus with the GABA agonist muscimol, after each daily bout of sexual experience to observe whether the beneficial effects on cognitive flexibility were abolished. Contrary to our hypothesis, blocking hippocampal activity after sexual experience had no impact on enhanced cognitive flexibility. Taken together, these findings indicate that sexual

  8. 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.

  9. Transcaruncular medial canthal tendon plication with lower eyelid suture sling in facial nerve palsy.

    PubMed

    Sira, Mano; Norris, Jonathan H; Nduka, Charles; Malhotra, Raman

    2014-06-01

    To report a technique for correcting lower eyelid punctal ectropion with an inferiorly displaced or retracted medial eyelid due to facial nerve palsy, by extending a suture sling along the pre-tarsal lower eyelid when performing transcaruncular medial canthal tendon plication. Single-centre retrospective, non-comparative review of patients with facial nerve palsy who underwent medial canthal tendon plication with lower eyelid suture sling (MCT suture sling). Outcome measures included: the presence of lower eyelid ectropion, medial eyelid height, punctal position, inferior marginal reflex distance (MRD) and inferior scleral show measured both pre-operatively and at the last follow-up visit. Thirty-three patients with facial nerve palsy with a mean age of 59, underwent MCT suture sling for lagophthalmos and/or ectropion. Then, 66% (21/32) of cases had punctal ectropion pre-operatively and 9% (3/32) had punctal ectropion at the last follow-up. Medial eyelid height was deemed to improve in 66% (21/32) of cases at the last follow up visit. Follow-up was mean 13.5 months. Six (18%) patients were deemed failures due to inferior MRD and inferior scleral showing worse than pre-operative measurements. We report a technique for incorporating a suture sling to transcaruncular-approach MCT plication when the medial canthus has retracted or descended thus requiring support and a posterior vector. It avoids rounding of the medial canthal angle that may occur with traditional medial canthoplasty. Transcaruncular MCT plication is well described. Incorporating a suture sling to potentially reduce single point-fixation cheese-wiring and early dehiscence is minimally invasive, non-excisional and repeatable.

  10. Medial and lateral osteoarthritis of the knee is related to variations of hip and pelvic anatomy.

    PubMed

    Weidow, J; Mars, I; Kärrholm, J

    2005-06-01

    We evaluated if increased risk of combined hip and lateral knee osteoarthritis (OA) could be attributed to anatomical reasons in the hip region resulting in increased abductor moment over the knee. We measured pelvic width, femoral offset, femoral neck length and angle in 29 women with lateral knee OA (13 unilateral, 16 bilateral) and 27 women with bilateral medial OA. Twenty-one of these patients with normal hips (lateral/medial OA of the knee=12/9) and 35 with associated hip OA (lateral/medial OA of the knee=17/18) were evaluated separately. Radiographic examinations in 14 women planned for hip prosthesis because of failures after hip fracture acted as controls. Patients with lateral OA of the knee had wider pelvis than controls (13.7 mm increased distance between the medial borders of the acetabulum, P=0.001). Patients with medial OA had 11.4mm longer distance from the centre of the femoral head to the centre of the proximal part of the femoral shaft (P=0.005), corresponding to a higher offset. The pelvic and hip anatomy also differed between patients with medial and lateral OA of the knee. In the groups without hip OA, presence of lateral knee OA was associated with a wider pelvis (P=0.009), shorter femoral neck (P=0.02) and Head-Shaft distance (P=0.04). In the groups with OA of the hip associated lateral OA of the knee also implied increased Neck Shaft angle (coxa valga, P=0.008), but there was no difference in pelvic width (P=0.15). We found a shorter lever arm over the hip in lateral knee OA compared to medial knee OA (P=0.02), but not when compared to controls. Our findings suggest that occurrence of medial or lateral OA has a biomechanical background originating from pelvis and hip anatomy.

  11. Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top

    DTIC Science & Technology

    2013-12-01

    1996;24:575–580. 24. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligaments in athletes . J Bone Joint Surg Am. 1986;68A:1158...fractures is unknown. The purpose of this study was to quantitatively compare the osseous and ligamentous exposure of the medial elbow using the flexor...medial collateral ligament (MCL), posterior bundle of the MCL, and radial head] was assessed. A calibrated digital image was taken from the surgeon’s

  12. Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

    PubMed

    Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

    2016-01-01

    Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright

  13. Diffusion Tensor Imaging Parameters in Mild Traumatic Brain Injury and Its Correlation with Early Neuropsychological Impairment: A Longitudinal Study

    PubMed Central

    Narayanan, Vairavan; Kuo, Tan Li; Delano-Wood, Lisa; Chinna, Karuthan; Bondi, Mark William; Waran, Vicknes; Ganesan, Dharmendra; Ramli, Norlisah

    2015-01-01

    Abstract We explored the prognostic value of diffusion tensor imaging (DTI) parameters of selected white matter (WM) tracts in predicting neuropsychological outcome, both at baseline and 6 months later, among well-characterized patients diagnosed with mild traumatic brain injury (mTBI). Sixty-one patients with mTBI (mean age=27.08; standard deviation [SD], 8.55) underwent scanning at an average of 10 h (SD, 4.26) post-trauma along with assessment of their neuropsychological performance at an average of 4.35 h (SD, 7.08) upon full Glasgow Coma Scale recovery. Results were then compared to 19 healthy control participants (mean age=29.05; SD, 5.84), both in the acute stage and 6 months post-trauma. DTI and neuropsychological measures between acute and chronic phases were compared, and significant differences emerged. Specifically, chronic-phase fractional anisotropy and radial diffusivity values showed significant group differences in the corona radiata, anterior limb of internal capsule, cingulum, superior longitudinal fasciculus, optic radiation, and genu of corpus callosum. Findings also demonstrated associations between DTI indices and neuropsychological outcome across two time points. Our results provide new evidence for the use of DTI as an imaging biomarker and indicator of WM damage occurring in the context of mTBI, and they underscore the dynamic nature of brain injury and possible biological basis of chronic neurocognitive alterations. PMID:25952562

  14. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    PubMed Central

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  15. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair.

    PubMed

    Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N

    2009-11-01

    There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in

  16. Effect of Transosseous Tunnels on Patella Fracture Risk After Medial Patellofemoral Ligament Reconstruction: A Cadaveric Study.

    PubMed

    Bonazza, Nicholas A; Lewis, Gregory S; Lukosius, Eric Z; Roush, Evan P; Black, Kevin P; Dhawan, Aman

    2018-02-01

    To determine whether (1) tunnels that breach the anterior cortex of the patella result in increased fracture risk and (2) transosseous tunnels drilled across the patella significantly reduce the tensile force needed to fracture the patella. Twenty-six fresh-frozen cadaveric human patellas were randomized to 1 of 3 groups: a control group with unmodified patellas, a group with 2 transverse tunnels (TT) that did not breach the anterior cortex, and a group with 2 TT that breached the anterior cortex of the patella (PA). Patellas were connected in series to a load cell via freeze clamp attachments to the quadriceps and patellar tendons. Pull was fixed at 45° with the patella set in the trochlear groove of a synthetic femur. Patellas were loaded cyclically, then to failure. Twenty-six patellas were tested (mean age = 71.4 years; range = 37-95, standard deviation [STD] = 11.5 years). PA patellas were more likely to fracture through the tunnel than TT patellas (100% vs 25%, P = .033). Control, TT, and PA groups failed at 1,915 N (STD = 508 N), 1,901 N (STD = 884 N), and 1,640 N (STD = 625 N), respectively. There was no statistically significant difference in overall load to failure between control and TT (P = .969), control and PA (P = .321), and TT and PA (P = .488) groups. Transosseous patellar tunnels for medial patellofemoral ligament reconstruction that breached the anterior cortex were more likely to fracture during longitudinal load than those that did not breach the anterior cortex. However, we found no statistically significant difference in the tensile load to failure between native patellas and patellas with either type of transosseous tunnel. The results of this study show that breaching the anterior cortex during transosseous drilling increases the risk of a patellar fracture occurring through the transosseous tunnel. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    PubMed

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  18. Object and spatial mnemonic interference differentially engage lateral and medial entorhinal cortex in humans.

    PubMed

    Reagh, Zachariah M; Yassa, Michael A

    2014-10-07

    Recent models of episodic memory propose a division of labor among medial temporal lobe cortices comprising the parahippocampal gyrus. Specifically, perirhinal and lateral entorhinal cortices are thought to comprise an object/item information pathway, whereas parahippocampal and medial entorhinal cortices are thought to comprise a spatial/contextual information pathway. Although several studies in human subjects have demonstrated a perirhinal/parahippocampal division, such a division among subregions of the human entorhinal cortex has been elusive. Other recent work has implicated pattern separation computations in the dentate gyrus and CA3 subregions of the hippocampus as a mechanism supporting the resolution of mnemonic interference. However, the nature of contributions of medial temporal lobe cortices to downstream hippocampal computations is largely unknown. We used high-resolution fMRI during a task selectively taxing mnemonic discrimination of object identity or spatial location, designed to differentially engage the two information pathways in the medial temporal lobes. Consistent with animal models, we demonstrate novel evidence for a domain-selective dissociation between lateral and medial entorhinal cortex in humans, and between perirhinal and parahippocampal cortex as a function of information content. Conversely, hippocampal dentate gyrus/CA3 demonstrated signals consistent with resolution of mnemonic interference across domains. These results provide insight into the information processing capacities and hierarchical interference resolution throughout the human medial temporal lobe.

  19. Object and spatial mnemonic interference differentially engage lateral and medial entorhinal cortex in humans

    PubMed Central

    Reagh, Zachariah M.; Yassa, Michael A.

    2014-01-01

    Recent models of episodic memory propose a division of labor among medial temporal lobe cortices comprising the parahippocampal gyrus. Specifically, perirhinal and lateral entorhinal cortices are thought to comprise an object/item information pathway, whereas parahippocampal and medial entorhinal cortices are thought to comprise a spatial/contextual information pathway. Although several studies in human subjects have demonstrated a perirhinal/parahippocampal division, such a division among subregions of the human entorhinal cortex has been elusive. Other recent work has implicated pattern separation computations in the dentate gyrus and CA3 subregions of the hippocampus as a mechanism supporting the resolution of mnemonic interference. However, the nature of contributions of medial temporal lobe cortices to downstream hippocampal computations is largely unknown. We used high-resolution fMRI during a task selectively taxing mnemonic discrimination of object identity or spatial location, designed to differentially engage the two information pathways in the medial temporal lobes. Consistent with animal models, we demonstrate novel evidence for a domain-selective dissociation between lateral and medial entorhinal cortex in humans, and between perirhinal and parahippocampal cortex as a function of information content. Conversely, hippocampal dentate gyrus/CA3 demonstrated signals consistent with resolution of mnemonic interference across domains. These results provide insight into the information processing capacities and hierarchical interference resolution throughout the human medial temporal lobe. PMID:25246569

  20. Injury to the Posterior Tibial Tendon After Open Reduction Internal Fixation of the Medial Malleolus.

    PubMed

    DeMill, Shyler L; Bussewitz, Bradly W; Philbin, Terrence M

    2015-10-01

    The management of ankle fractures with open reduction and internal fixation (ORIF) has been a proven method to help prevent deformity and posttraumatic arthritis. The incidence of continued ankle pain due to retained hardware after ORIF of ankle fractures has been documented. The goal of this study was to determine if the starting point for medial malleolus screw placement is associated with posterior tibial tendon (PTT) damage when performing ORIF of the medial malleolus. Patients that had ORIF of the medial malleolus and subsequent repair of the PTT with medial malleolar hardware removal were identified. Zones were established and labeled 1 through 3 as described in the literature. This template was used as an overlay on lateral ankle radiographs to analyze the position and assign zones to the medial malleolus screws. Fifteen patients met the inclusion criteria. Three screws were found in zone 1, 11 in zone 2, and 1 in zone 3. The middle and posterior zones (zones 2 and 3) contained 80% of the screws, which may potentially cause risk to the PTT. We conclude that there is an increased probability that medial malleolar hardware in zones 2 and 3 can compromise the PTT. Therapeutic, Level IV: Case series. © 2015 The Author(s).

  1. The JCR:LA-cp rat: a novel rodent model of cystic medial necrosis.

    PubMed

    Pung, Yuh Fen; Chilian, William M; Bennett, Martin R; Figg, Nichola; Kamarulzaman, Mohd Hamzah

    2017-03-01

    Although there are multiple rodent models of the metabolic syndrome, very few develop vascular complications. In contrast, the JCR:LA-cp rat develops both metabolic syndrome and early atherosclerosis in predisposed areas. However, the pathology of the normal vessel wall has not been described. We examined JCR:LA control (+/+) or cp/cp rats fed normal chow diet for 6 or 18 mo. JCR:LA-cp rats developed multiple features of advanced cystic medial necrosis including "cysts," increased collagen formation and proteoglycan deposition around cysts, apoptosis of vascular smooth muscle cells, and spotty medial calcification. These appearances began within 6 mo and were extensive by 18 mo. JCR:LA-cp rats had reduced medial cellularity, increased medial thickness, and vessel hypoxia that was most marked in the adventitia. In conclusion, the normal chow-fed JCR:LA-cp rat represents a novel rodent model of cystic medial necrosis, associated with multiple metabolic abnormalities, vascular smooth muscle cell apoptosis, and vessel hypoxia. NEW & NOTEWORTHY Triggers for cystic medial necrosis (CMN) have been difficult to study due to lack of animal models to recapitulate the pathologies seen in humans. Our study is the first description of CMN in the rat. Thus the JCR:LA-cp rat represents a useful model to investigate the underlying molecular changes leading to the development of CMN. Copyright © 2017 the American Physiological Society.

  2. Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers.

    PubMed

    Gras-Cabrerizo, Juan R; Martel-Martin, Maria; Garcia-Lorenzo, Jacinto; Rodríguez-Álvarez, Fernando; Montserrat-Gili, Joan R; Mirapeix-Lucas, Rosa; Massegur-Solench, Humbert

    2016-12-01

    Objective  The aim of our study is to present the anatomical landmarks to perform an endoscopic endonasal approach to the medial wall of the orbit (EEAMO). Material and Methods  We performed 14 complete nasal and orbital endoscopic dissections in 7 adult cadaveric heads. Results  The EEAMO provides a surgical corridor between the medial rectus muscle superiorly and the inferior rectus muscle inferiorly .The mean distance between the ethmoidal crest and medial rectus muscle was 1.5 cm (range, 1.3-1.9 cm). The width of the medial rectus muscle was 1.2 cm (range, 1-1.5 cm). The main vascular structure in this retrobulbar space was the ophthalmic artery that crosses over the optic nerve in 86% of the cases. In its intraorbital route, the anterior ethmoidal artery and the ethmoidal nerves were situated inferior to the superior oblique muscle in all cases. The posterior ethmoidal artery was found superior to it. We could identify the inferior division of the oculomotor nerve in this surgical approach. Conclusions  The EEAMO allows adequate exposure of the space between the medial rectus muscle and the inferior rectus muscle. The location of the ethmoidal crest of the palatine bone, and its relationship with the medial rectus muscle, is a useful anatomical landmark for this surgical approach.

  3. Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers

    PubMed Central

    Gras-Cabrerizo, Juan R.; Martel-Martin, Maria; Garcia-Lorenzo, Jacinto; Rodríguez-Álvarez, Fernando; Montserrat-Gili, Joan R.; Mirapeix-Lucas, Rosa; Massegur-Solench, Humbert

    2016-01-01

    Objective The aim of our study is to present the anatomical landmarks to perform an endoscopic endonasal approach to the medial wall of the orbit (EEAMO). Material and Methods We performed 14 complete nasal and orbital endoscopic dissections in 7 adult cadaveric heads. Results The EEAMO provides a surgical corridor between the medial rectus muscle superiorly and the inferior rectus muscle inferiorly .The mean distance between the ethmoidal crest and medial rectus muscle was 1.5 cm (range, 1.3–1.9 cm). The width of the medial rectus muscle was 1.2 cm (range, 1–1.5 cm). The main vascular structure in this retrobulbar space was the ophthalmic artery that crosses over the optic nerve in 86% of the cases. In its intraorbital route, the anterior ethmoidal artery and the ethmoidal nerves were situated inferior to the superior oblique muscle in all cases. The posterior ethmoidal artery was found superior to it. We could identify the inferior division of the oculomotor nerve in this surgical approach. Conclusions The EEAMO allows adequate exposure of the space between the medial rectus muscle and the inferior rectus muscle. The location of the ethmoidal crest of the palatine bone, and its relationship with the medial rectus muscle, is a useful anatomical landmark for this surgical approach. PMID:27857868

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

    PubMed Central

    2012-01-01

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

  5. Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA Study

    PubMed Central

    Hayashi, D; Felson, DT; Niu, J; Hunter, DJ; Roemer, FW; Aliabadi, P; Guermazi, A

    2013-01-01

    Objective To determine which subregions of the knee joint have a high prevalence of pre-radiographic osteoarthritic changes, i.e. cartilage damage and osteophytes that can only be detected by MRI, in radiographically normal knees. Methods Institutional review board approval and written informed consent from all participants was obtained. Data was collected from a community cohort in Framingham, MA, involving people aged 50–79. Participants underwent weight-bearing posteroanterior and lateral knee radiography with the fixed-flexion protocol, and 1.5T MRI. Knees without radiographic osteoarthritis (Kellgren Lawrence grade 0 for the tibiofemoral joint and absence of any osteophytes or joint space narrowing in the patellofemoral joint) were included. The knee joint was divided into 14 subregions for cartilage and 16 subregions for osteophytes, and prevalence and severity of cartilage damage (grade 0–6) and osteophytes (grade 0–7) were semiquantitatively assessed using the Whole Organ Magnetic Resonance Imaging Score. Results The mean age of 696 participants was 62.3±8.4 years, and the mean body mass index was 27.9±5.1 kg/m2. Women comprised 55.2% of the study sample (384/696). Prevalence of cartilage damage (grade ≥2) was 47.7% (332/696) in the medial patellar and 29.9% (208/696) in patellar lateral subregions, and 24.0% (167/696) in femoral medial anterior and 26.5% (184/696) in femoral medial central subregions. Prevalence of osteophytes (grade ≥2) was highest at 60.8% (423/696) in the medial femoral posterior subregion, followed by 34.0% (237/696) in patellar lateral and 24.6% (171/696) in patellar medial subregions. For all other subregions, prevalence of these lesions was lower than the aforementioned percentages. Conclusion MRI-detected cartilage damage and osteophytes are highly prevalent in the medial patellofemoral and medial posterior tibiofemoral joints in radiographically normal knees in persons aged 50–79. PMID:24185108

  6. Treatment of medial tibial stress syndrome: a systematic review.

    PubMed

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H; Backx, Frank J G; Bakker, Eric W P

    2013-12-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS. Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect. Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports. The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The 'levels of evidence', according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality. Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] -0.06; 95 % CI -0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI -0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT

  7. Distinct Regions within Medial Prefrontal Cortex Process Pain and Cognition.

    PubMed

    Jahn, Andrew; Nee, Derek Evan; Alexander, William H; Brown, Joshua W

    2016-12-07

    Neuroimaging studies of the medial prefrontal cortex (mPFC) suggest that the dorsal anterior cingulate cortex (dACC) region is responsive to a wide variety of stimuli and psychological states, such as pain, cognitive control, and prediction error (PE). In contrast, a recent meta-analysis argues that the dACC is selective for pain, whereas the supplementary motor area (SMA) and pre-SMA are specifically associated with higher-level cognitive processes (Lieberman and Eisenberger, 2015). To empirically test this claim, we manipulated effects of pain, conflict, and PE in a single experiment using human subjects. We observed a robust dorsal-ventral dissociation within the mPFC with cognitive effects of PE and conflict overlapping dorsally and pain localized more ventrally. Classification of subjects based on the presence or absence of a paracingulate sulcus showed that PE effects extended across the dorsal area of the dACC and into the pre-SMA. These results begin to resolve recent controversies by showing the following: (1) the mPFC includes dissociable regions for pain and cognitive processing; and (2) meta-analyses are correct in localizing cognitive effects to the dACC, although these effects extend to the pre-SMA as well. These results both provide evidence distinguishing between different theories of mPFC function and highlight the importance of taking individual anatomical variability into account when conducting empirical studies of the mPFC. Decades of neuroimaging research have shown the mPFC to represent a wide variety of stimulus processing and cognitive states. However, recently it has been argued whether distinct regions of the mPFC separately process pain and cognitive phenomena. To address this controversy, this study directly compared pain and cognitive processes within subjects. We found a double dissociation within the mPFC with pain localized ventral to the cingulate sulcus and cognitive effects localized more dorsally within the dACC and spreading

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

    PubMed

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

    2016-07-20

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

  9. How Tibiofemoral Alignment and Contact Locations Affect Predictions of Medial and Lateral Tibiofemoral Contact Forces

    PubMed Central

    Lerner, Zachary F.; DeMers, Matthew S.; Delp, Scott L.; Browning, Raymond C.

    2015-01-01

    Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We developed a full-body OpenSim musculoskeletal model with a knee joint that incorporates subject-specific tibiofemoral alignment (i.e. knee varus-valgus) and geometry (i.e. contact locations). We tested the accuracy of our model and determined the importance of these subject-specific parameters by comparing estimated to measured medial and lateral contact forces during walking in an individual with an instrumented knee replacement and post-operative genu valgum (6°). The errors in the predictions of the first peak medial and lateral contact force were 12.4% and 11.9%, respectively, for a model with subject-specific tibiofemoral alignment and contact locations determined via radiographic analysis, vs. 63.1% and 42.0%, respectively, for a model with generic parameters. We found that each degree of tibiofemoral alignment deviation altered the first peak medial compartment contact force by 51N (r2=0.99), while each millimeter of medial-lateral translation of the compartment contact point locations altered the first peak medial compartment contact force by 41N (r2=0.99). The model, available at www.simtk.org/home/med-lat-knee/, enables the specification of subject-specific joint alignment and compartment contact locations to more accurately estimate medial and lateral tibiofemoral contact forces in individuals with non-neutral alignment. PMID:25595425

  10. Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics.

    PubMed

    Shalhoub, Sami; Fitzwater, Fallon G; Cyr, Adam J; Maletsky, Lorin P

    2016-10-01

    A change in hamstring strength and activation is typically seen after injuries or invasive surgeries such as anterior cruciate reconstruction or total knee replacement. While many studies have investigated the influence of isometric increases in hamstring load on knee joint kinematics, few have quantified the change in kinematics due to a variation in medial to lateral hamstring force ratio. This study examined the changes in knee joint kinematics on eight cadaveric knees during an open-chain deep knee bend for six different loading configurations: five loaded hamstring configurations that varied the ratio of a total load of 175 N between the semimembranosus and biceps femoris and one with no loads on the hamstring. The anterior-posterior translation of the medial and lateral femoral condyles' lowest points along proximal-distal axis of the tibia, the axial rotation of the tibia, and the quadriceps load were measured at each flexion angle. Unloading the hamstring shifted the medial and lateral lowest points posteriorly and increased tibial internal rotation. The influence of unloading hamstrings on quadriceps load was small in early flexion and increased with knee flexion. The loading configuration with the highest lateral hamstrings force resulted in the most posterior translation of the medial lowest point, most anterior translation of the lateral lowest point, and the highest tibial external rotation of the five loading configurations. As the medial hamstring force ratio increased, the medial lowest point shifted anteriorly, the lateral lowest point shifted posteriorly, and the tibia rotated more internally. The results of this study, demonstrate that variation in medial-lateral hamstrings force and force ratio influence tibiofemoral transverse kinematics and quadriceps loads required to extend the knee. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1707-1715, 2016. © 2016 Orthopaedic Research Society. Published by

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

    PubMed

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

    2016-01-01

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

  12. Functional specialization of medial auditory belt cortex in the alert rhesus monkey.

    PubMed

    Kusmierek, Pawel; Rauschecker, Josef P

    2009-09-01

    Responses of neural units in two areas of the medial auditory belt (middle medial area [MM] and rostral medial area [RM]) were tested with tones, noise bursts, monkey calls (MC), and environmental sounds (ES) in microelectrode recordings from two alert rhesus monkeys. For comparison, recordings were also performed from two core areas (primary auditory area [A1] and rostral area [R]) of the auditory cortex. All four fields showed cochleotopic organization, with best (center) frequency [BF(c)] gradients running in opposite directions in A1 and MM than in R and RM. The medial belt was characterized by a stronger preference for band-pass noise than for pure tones found medially to the core areas. Response latencies were shorter for the two more posterior (middle) areas MM and A1 than for the two rostral areas R and RM, reaching values as low as 6 ms for high BF(c) in MM and A1, and strongly depended on BF(c). The medial belt areas exhibited a higher selectivity to all stimuli, in particular to noise bursts, than the core areas. An increased selectivity to tones and noise bursts was also found in the anterior fields; the opposite was true for highly temporally modulated ES. Analysis of the structure of neural responses revealed that neurons were driven by low-level acoustic features in all fields. Thus medial belt areas RM and MM have to be considered early stages of auditory cortical processing. The anteroposterior difference in temporal processing indices suggests that R and RM may belong to a different hierarchical level or a different computational network than A1 and MM.

  13. Dynamic study of the medial and lateral recti capsulopalpebral fasciae using cine mode magnetic resonance imaging.

    PubMed

    Kakizaki, Hirohiko; Selva, Dinesh; Leibovitch, Igal

    2010-02-01

    To assess the dynamic features of the medial rectus capsulopalpebral fascia (mrCPF) and the lateral rectus CPF (lrCPF) during horizontal eye movements using cine mode magnetic resonance imaging (MRI). Observational case series. Ten patients (9 males and 1 female; age range, 8-75 years; mean age, 41.1 years) diagnosed with a unilateral orbital blowout fracture (medial wall, floor, or both) and having a normal contralateral orbit. Cine mode MRI was used to examine the role of the mrCPF and the lrCPF in relation to the eyelid and horizontal recti muscles during horizontal eye movements. To assess the dynamic features of the mrCPF and the lrCPF. In medial gaze, the medial part of the eyelid moves posteromedially, in synchronicity with medial rectus muscle contraction, mediated by the mrCPF. The lateral part of the eyelid moves anteromedially, in synchronicity with lateral rectus muscle relaxation, mediated by the lrCPF. In lateral gaze, the lateral part of the eyelid moves posterolaterally, in synchronicity with the lateral rectus muscle contraction, mediated by the lrCPF. The medial part of the eyelid moves anterolaterally, in synchronicity with medial rectus muscle relaxation, mediated by the mrCPF. These findings were demonstrated in all 10 patients. Cine mode MRI was used to demonstrate the dynamic roles of the mrCPF and the lrCPF in mediating eyelid position with the corresponding horizontal recti muscles. This study may allow a better understanding of the importance of these anatomic structures and may reduce functional and cosmetic complications during common oculoplastic and strabismus surgeries. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  14. Postburn shoulder medial-adduction contracture: anatomy and treatment with trapeze-flap plasty.

    PubMed

    Grishkevich, Viktor M

    2013-03-01

    Shoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern. Anatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed. Eighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold. Medial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  15. Functional Specialization of Medial Auditory Belt Cortex in the Alert Rhesus Monkey

    PubMed Central

    Kuśmierek, Paweł; Rauschecker, Josef P.

    2009-01-01

    Responses of neural units in two areas of the medial auditory belt (middle medial area [MM] and rostral medial area [RM]) were tested with tones, noise bursts, monkey calls (MC), and environmental sounds (ES) in microelectrode recordings from two alert rhesus monkeys. For comparison, recordings were also performed from two core areas (primary auditory area [A1] and rostral area [R]) of the auditory cortex. All four fields showed cochleotopic organization, with best (center) frequency [BF(c)] gradients running in opposite directions in A1 and MM than in R and RM. The medial belt was characterized by a stronger preference for band-pass noise than for pure tones found medially to the core areas. Response latencies were shorter for the two more posterior (middle) areas MM and A1 than for the two rostral areas R and RM, reaching values as low as 6 ms for high BF(c) in MM and A1, and strongly depended on BF(c). The medial belt areas exhibited a higher selectivity to all stimuli, in particular to noise bursts, than the core areas. An increased selectivity to tones and noise bursts was also found in the anterior fields; the opposite was true for highly temporally modulated ES. Analysis of the structure of neural responses revealed that neurons were driven by low-level acoustic features in all fields. Thus medial belt areas RM and MM have to be considered early stages of auditory cortical processing. The anteroposterior difference in temporal processing indices suggests that R and RM may belong to a different hierarchical level or a different computational network than A1 and MM. PMID:19571201

  16. Knee adduction moment relates to medial femoral and tibial cartilage morphology in clinical knee osteoarthritis.

    PubMed

    Maly, Monica R; Acker, Stacey M; Totterman, Saara; Tamez-Peña, José; Stratford, Paul W; Callaghan, Jack P; Adachi, Jonathan D; Beattie, Karen A

    2015-09-18

    The objective was to determine the extent to which the external peak knee adduction moment (KAM) and cumulative knee adductor load explained variation in medial cartilage morphology of the tibia and femur in knee osteoarthritis (OA). Sixty-two adults with clinical knee OA participated (61.5 ± 6.2 years). To determine KAM, inverse dynamics was applied to motion and force data of walking. Cumulative knee adductor load reflected KAM impulse and loading frequency. Loading frequency was captured from an accelerometer. Magnetic resonance imaging scans were acquired with a coronal fat-saturated sequence using a 1.0 T peripheral scanner. Scans were segmented for medial cartilage volume, surface area of the bone-cartilage interface, and thickness. Forward linear regressions assessed the relationship of loading variables with cartilage morphology unadjusted, then adjusted for covariates. In the medial tibia, age and peak KAM explained 20.5% of variance in mean cartilage thickness (p<0.001). Peak KAM alone explained 12.3% of the 5th percentile of medial tibial cartilage thickness (i.e., thinnest cartilage region) (p=0.003). In the medial femur, sex, BMI, age, and peak KAM explained 44% of variance in mean cartilage thickness, with peak KAM contributing 7.9% (p<0.001). 20.7% of variance in the 5th percentile of medial femoral cartilage thickness was explained by BMI and peak KAM (p=0.001). In these models, older age, female sex, greater BMI, and greater peak KAM related with thinner cartilage. Models of KAM impulse produced similar results. In knee OA, KAM peak and impulse, but not loading frequency, were associated with cartilage thickness of the medial tibia and femur. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Medial and Lateral Heel Whips: Prevalence and Characteristics in Recreational Runners.

    PubMed

    Souza, Richard B; Hatamiya, Nicolas; Martin, Carly; Aramaki, Andrew; Martinelli, Brian; Wong, Jamie; Luke, Anthony

    2015-08-01

    To investigate the prevalence and characteristics of recreational runners with medial and lateral heel whips. Observational cohort study. Clinical research laboratory. A total of 256 recreationally active runners and joggers participated. High-definition video was acquired from a posterior view while runners ran at a self-selected pace on a treadmill. Heel whips, defined as the medial or lateral rotation of the foot in the transverse plane during initial swing, were measured with Dartfish software. Subjects were stratified by direction (medial and lateral) and severity (W_5-10 = 5-10 degrees; W_10+ = >10 degrees) of heel whip. Body mass index and gender comparisons, as well as measurement reliability, also were explored. Mean heel whip angle across runners was 0.4 degrees (medial) with a standard deviation of 9.2 degrees. Of the 512 feet analyzed, 274 (54%) demonstrated a 5 degree whip or greater. There was a similar number of medial and lateral heel whips observed (27% each). Female runners were twice as likely to demonstrate a lateral heel whip of greater than 8.9 degrees. Overweight runners had more medially directed whips when compared with normal and underweight runners. More than half of the recreational runners studied were observed to have a medial or lateral heel whip of greater than 5 degrees. These data reveal the age, body mass index, and gender distribution of recreational runners with and without heel whips. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  18. Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors.

    PubMed

    Tanaka, Makoto; Hayashida, Kenji; Kobayashi, Atsushi; Kakiuchi, Masaaki

    2015-11-01

    To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3 months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P < .0001) and the American Shoulder and Elbow Surgeons index improved from 55.1 to 87.7 (P < .0001). No complications were observed. The retear rates after DR-ARCR with absorbable sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series. Copyright © 2015

  19. Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?

    PubMed Central

    2013-01-01

    Background The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation. Methods Sixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer’s evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression. Results There were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer’s criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%). Conclusions In the treatment of unstable proximal

  20. Clinical Outcomes of Medial Meniscus Posterior Root Tears

    PubMed Central

    Krych, Aaron John; Reardon, Patrick J.; Pareek, Ayoosh; Peter, Logan; Dahm, Diane L.; Levy, Bruce A.; Stuart, Michael J.

    2016-01-01

    Objectives: Medial meniscus posterior root tears (MMPRTs) present a unique challenge for both patients and surgeons as these tears have shown to be biomechanically equivalent to complete meniscectomy. However, little is known about the natural history of these lesions. Therefore, the purpose of this study is to describe the clinical course of MMPRTs with respect to subsequent operative and non-operative treatments, and associated comorbidities. Methods: Over 2600 MRIs were identified by searching radiologist reads for the terms “root” or “root tear” from 2005-2013. Presence or absence of MMPRTs and other associated boney, meniscal, or ligamentous injuries were identified and recorded. Of these MRIs, 102 MRIs from 102 patients who had unrepaired MMPRTs with minimum 2-year follow-up and no prior ligamentous surgery were followed. These MRIs were evaluated to confirm the presence of a meniscal root tear and the presence or absence of associated meniscal or ligamentous injuries, as well as meniscal extrusion, subchondral edema, or insufficiency fractures. Chart review was performed to obtain the treatment summary after diagnosis. Radiographs from before and after the diagnosis of MMPRT were reviewed and Kellgren-Lawrence scores were determined. Finally, the association between concomitant boney, ligamentous, or meniscal injuries, patient factors, and rate of arthroplasty, as well as final Kellgren-Lawrence scores were evaluated. Chi-square analysis was used for categorical variables, and Wilcoxon Rank-Sums was used for continuous variables. Kaplan-Meier analysis was used to evaluate the effect of meniscal extrusion on the time-dependant rate of arthroplasty. Results: 104 patients (43 M:61F) were diagnosed with MMPRTs at a mean age of 54±13. These patients were followed for a mean of 66±26 months. 75 (74%) patients had associated meniscal extrusion, 64 (62%) had associated subchondral edema, and 14 (13%) had associated insufficiency fractures at the time of

  1. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome.

    PubMed

    Griebert, Maggie C; Needle, Alan R; McConnell, Jennifer; Kaminski, Thomas W

    2016-03-01

    Medial tibial stress syndrome (MTSS) is an overuse injury occurring among the physically active. Linked to increased strain on the medial tendons of the ankle, studies emphasize controlling medial foot loading in the management of this condition. Kinesio taping (KT) has gained popularity for treating musculoskeletal pathologies; however, its effect on MTSS remains uninvestigated. This study aimed to determine if healthy participants and patients with current or previous history of MTSS differ in the rate of loading, and if KT affects plantar pressures in these participants. Twenty healthy participants and 20 participants with current or previous history of MTSS were recruited and walked across a plantar pressure mat prior to KT application, immediately after application, and after 24-h of continued use. Time-to-peak force was measured in 6 foot areas and compared across groups and conditions. ANOVA revealed a significant interaction between group, condition, and foot area (F = 1.990, p = 0.033). MTSS participants presented with lower medial midfoot time-to-peak force before tape application (95%CI: 0.014-0.160%, p = 0.021) that significantly increased following tape application (p < 0.05). These results suggest that KT decreases the rate of medial loading in MTSS patients. Future research might assess mechanisms by which this effect is achieved. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.

    PubMed

    Tweed, Jo L; Campbell, Jackie A; Avil, Steven J

    2008-01-01

    We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation.

  3. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

    PubMed

    Craft, Jason A; Kurzweil, Peter R

    2015-06-01

    The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

  4. Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears.

    PubMed

    Park, Jong-Hoon; Jeong, Woong-Kyo; Lee, Jin-Hyuck; Cho, Jae-Jin; Lee, Dae-Hee

    2015-01-01

    To compare postural stability in patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with associated meniscal tears. Quadriceps and hamstring muscle strength and their ratio, as well as the relationships of these parameters with postural stability, were compared in 23 patients with isolated ACL tears and 27 with combined ACL and medial meniscus tears. Postural stability was determined from the anterior-posterior, medial-lateral, and overall stability indices using the Biodex Stability System. On both the involved and uninvolved sides, there were no differences in mean stability indices, including anterior-posterior, medial-lateral, and overall stability indices, in patients with isolated and combined ACL tears. In patients with isolated ACL tears, both overall (2.3 ± 1.2 vs. 1.8 ± 1.4, p = 0.033) and medial-lateral (1.2 ± 0.6 vs. 1.0 ± 0.5, p = 0.031) stability indices were significantly higher on the involved compared to the uninvolved side. These differences, however, were not observed in the combined ACL tear group. No significant differences in postural instability on the affected and unaffected sides were observed in patients with isolated ACL tears and those with combined ACL and medial meniscus tears. These findings indicate that there is no need to reduce the goal of restoring proprioception in patients with combined compared with isolated ACL tears. III.

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

    NASA Technical Reports Server (NTRS)

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

    2004-01-01

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

  6. Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after one year of wear

    PubMed Central

    Barrios, Joaquin A.; Butler, Robert J.; Crenshaw, Jeremy R.; Royer, Todd D.; Davis, Irene S.

    2014-01-01

    Purpose The use of lateral foot wedging in the management of medial knee osteoarthritis is under scrutiny. Interestingly, there have been minimal efforts to evaluate biomechanical effectiveness with long term use. Therefore, we aimed to evaluate dynamic knee loading (assessed using the knee adduction moment) and other secondary gait parameters in patients with medial knee osteoarthritis wearing lateral foot wedging at a baseline visit and after 1 year of wear. Methods 3-dimensional gait data were captured in an intervention group of 19 patients with symptomatic medial knee osteoarthritis wearing their prescribed laterally wedged foot orthoses at 0 and 12 months. Wedge amounts were prescribed based on symptom response to a step-down test. A control group of 19 patients wearing prescribed neutral orthoses were also captured at 0 and 12 months. The gait of the intervention group wearing neutral orthoses was additionally captured. Walking speed and shoes were controlled. Analyses of variance were conducted to examine for group-by-time (between the groups in their prescribed orthoses) and condition-by-time (within the intervention group) interactions, main effects, and simple effects. Results We observed increased knee adduction moments and frontal plane motion over time in the control group but not the intervention group. Further, within the intervention group, the mechanical effectiveness of the lateral wedging did not decrease. Conclusions In patients with medial knee osteoarthritis, the effects of lateral foot wedging on pathomechanics associated with medial knee osteoarthritis were favorable and sustained over time. PMID:23097326

  7. Aminoglycoside ototoxicity and the medial efferent system: II. Comparison of acute effects of different antibiotics.

    PubMed

    Lima da Costa, D; Erre, J P; Pehourq, F; Aran, J M

    1998-01-01

    Gentamicin (GM) has been shown to reversibly reduce the ability of contralateral noise to suppress ipsilateral cochlear activity, in a dose-dependent manner. However, during chronic administration of lower doses (60 mg/kg) the involvement of medial efferents could not be demonstrated. The purposes of the present study were to determine whether other aminoglycosides would display the same acute effects as GM and whether there was any correlation between their specificity and degree of cochlear and vestibular toxicity and their potency of blockade of the medial efferent system. Thus, we observed changes in ipsilateral ensemble background activity (EBA) of the VIIIth nerve without and with contralateral low level (55 dB SPL) broadband noise stimulation, in awake guinea pigs (GPs), before and after one single high-dose intramuscular injection of different aminoglycoside antibiotics (AAs) (gentamicin, amikacin, neomycin, netilmicin, streptomycin, tobramycin). For comparison, the effects of strychnine, a known antagonist of the efferent transmission and of cisplatin, an antineoplastic agent with cochleotoxic properties were also studied. Netilmicin displayed blocking properties similar to GM, although less pronounced, while amikacin and neomycin had no effect on medial efferent function. With tobramycin and streptomycin a decrease in suppression was usually associated with a reduction of the EBA measured without acoustic stimulation. However, with cisplatin, suppression was still effective when EBA was severely decreased. We could not observe specific effects of strychnine on medial efferent function. In conclusion, no correlation was found between specificity and degree of AA ototoxicity and their action on the medial efferent system.

  8. Retrograde amnesia in patients with hippocampal, medial temporal, temporal lobe, or frontal pathology

    PubMed Central

    Bright, Peter; Buckman, Joseph; Fradera, Alex; Yoshimasu, Haruo; Colchester, Alan C.F.; Kopelman, Michael D.

    2006-01-01

    There is considerable controversy concerning the theoretical basis of retrograde amnesia (R.A.). In the present paper, we compare medial temporal, medial plus lateral temporal, and frontal lesion patients on a new autobiographical memory task and measures of the more semantic aspects of memory (famous faces and news events). Only those patients with damage extending beyond the medial temporal cortex into the lateral temporal regions showed severe impairment on free recall remote memory tasks, and this held for both the autobiographical and the more semantic memory tests. However, on t-test analysis, the medial temporal group was impaired in retrieving recent autobiographical memories. Within the medial temporal group, those patients who had combined hippocampal and parahippocampal atrophy (H+) on quantified MRI performed somewhat worse on the semantic tasks than those with atrophy confined to the hippocampi (H−), but scores were very similar on autobiographical episodic recall. Correlational analyses with regional MRI volumes showed that lateral temporal volume was correlated significantly with performance on all three retrograde amnesia tests. The findings are discussed in terms of consolidation, reconsolidation, and multiple trace theory: We suggest that a widely distributed network of regions underlies the retrieval of past memories, and that the extent of lateral temporal damage appears to be critical to the emergence of a severe remote memory impairment. PMID:17015852

  9. Reconstruction of the Medial Canthus Using an Ipsilateral Paramedian Forehead Flap

    PubMed Central

    Kim, Jin Hyung; Kim, Jeong Min; Park, Jang Wan; Hwang, Jae Ha; Kim, Kwang Seog

    2013-01-01

    Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches. PMID:24286048

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

    NASA Technical Reports Server (NTRS)

    Rigby, David L.

    2004-01-01

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

  11. Medial prefrontal cortex supports source memory accuracy for self-referenced items

    PubMed Central

    Leshikar, Eric D.; Duarte, Audrey

    2013-01-01

    Previous behavioral work suggests that processing information in relation to the self enhances subsequent item recognition. Neuroimaging evidence further suggests that regions along the cortical midline, particularly those of the medial prefrontal cortex, underlie this benefit. There has been little work to date, however, on the effects of self-referential encoding on source memory accuracy or whether the medial prefrontal cortex might contribute to source memory for self-referenced materials. In the current study, we used fMRI to measure neural activity while participants studied and subsequently retrieved pictures of common objects superimposed on one of two background scenes (sources) under either self-reference or self-external encoding instructions. Both item recognition and source recognition were better for objects encoded self-referentially than self-externally. Neural activity predictive of source accuracy was observed in the medial prefrontal cortex (BA 10) at the time of study for self-referentially but not self-externally encoded objects. The results of this experiment suggest that processing information in relation to the self leads to a mnemonic benefit for source level features, and that activity in the medial prefrontal cortex contributes to this source memory benefit. This evidence expands the purported role that the medial prefrontal cortex plays in self-referencing. PMID:21936739

  12. The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review.

    PubMed

    Maleki, Maryam; Arazpour, Mokhtar; Joghtaei, Mahmoud; Hutchins, Stephen W; Aboutorabi, Atefeh; Pouyan, Ali

    2016-04-01

    Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented. The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients. Literature review According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria. The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee. Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis. Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2014.

  13. Acquired personality traits of autism following damage to the medial prefrontal cortex.

    PubMed

    Umeda, Satoshi; Mimura, Masaru; Kato, Motoichiro

    2010-01-01

    Recent neuroimaging studies on "theory of mind" have demonstrated that the medial prefrontal cortex (PFC) is involved when subjects are engaged in various kinds of mentalising tasks. Although a large number of neuroimaging studies have been published, a relatively small amount of neuropsychological evidence supports involvement of the medial PFC in theory of mind reasoning. We recruited two neurological cases with damage to the medial PFC and initially performed the standard neuropsychological assessments for intelligence, memory, and executive functions. To examine theory of mind performance in these two cases, four kinds of standard and advanced tests for theory of mind were used, including first- and second-order false belief tests, the strange stories test, and the faux pas recognition test. Both patients were also requested to complete the questionnaire for the autism-spectrum quotient. Neither case showed impairment on standard theory of mind tests and only mild impairments were seen on advanced theory of mind tests. This pattern of results is basically consistent with previous studies. The most interesting finding was that both cases showed personality changes after surgical operations, leading to characteristics of autism showing a lack of social interaction in everyday life. We discuss herein the possible roles of the medial PFC and emphasize the importance of using multiple approaches to understand the mechanisms of theory of mind and medial prefrontal functions.

  14. Medial auditory thalamic stimulation as a conditioned stimulus for eyeblink conditioning in rats

    PubMed Central

    Campolattaro, Matthew M.; Halverson, Hunter E.; Freeman, John H.

    2007-01-01

    The neural pathways that convey conditioned stimulus (CS) information to the cerebellum during eyeblink conditioning have not been fully delineated. It is well established that pontine mossy fiber inputs to the cerebellum convey CS-related stimulation for different sensory modalities (e.g., auditory, visual, tactile). Less is known about the sources of sensory input to the pons that are important for eyeblink conditioning. The first experiment of the current study was designed to determine whether electrical stimulation of the medial auditory thalamic nuclei is a sufficient CS for establishing eyeblink conditioning in rats. The second experiment used anterograde and retrograde tract tracing techniques to assess neuroanatomical connections between the medial auditory thalamus and pontine nuclei. Stimulation of the medial auditory thalamus was a very effective CS for eyeblink conditioning in rats, and the medial auditory thalamus has direct ipsilateral projections to the pontine nuclei. The results suggest that the medial auditory thalamic nuclei and their projections to the pontine nuclei are components of the auditory CS pathway in eyeblink conditioning. PMID:17351138

  15. Current Topics Regarding the Function of the Medial Temporal Lobe Memory System.

    PubMed

    Clark, Robert E

    2018-01-05

    The first clear insight that the medial temporal lobe of the human brain was in fact a system of anatomically connected structures that were organized into a memory system came in 1957 from the observations by Brenda Milner of the noted amnesic patient H.M. Subsequent work in humans, monkeys, and rodents has identified all of the components of the medial temporal lobe (MTL) that formed the memory system. Currently, work is ongoing to identify the specific contributions each structure in the medial temporal lobe makes towards the formation and storage of long-term declarative memory. The historical background of this work is described including what insights the study of noted neurologic patients H.M. and E.P. provided for understanding the function of the medial temporal lobe. The development of an animal model of medial temporal lobe function is described. Additionally, the insights that lead to the understanding that the brain contains multiple, anatomically discrete, memory systems are described. Finally, three current topics of debate are addressed: First, does the perirhinal cortex exclusively support memory, or does it support both memory and higher order visual perception? Second, is there an anatomical separation between recollection and familiarity ? Third, is the organization of spatial memory different between humans and rats, or perhaps the difference is between the working memory capacities of the two species?

  16. Contrasting medial moraine development at adjacent temperate, maritime glaciers: Fox and Franz Josef Glaciers, South Westland, New Zealand

    NASA Astrophysics Data System (ADS)

    Brook, Martin; Hagg, Wilfried; Winkler, Stefan

    2017-08-01

    Medial moraines form important pathways for sediment transportation in valley glaciers. Despite the existence of well-defined medial moraines on several glaciers in the New Zealand Southern Alps, medial moraines there have hitherto escaped attention. The evolving morphology and debris content of medial moraines on Franz Josef Glacier and Fox Glacier on the western flank of the Southern Alps is the focus of this study. These temperate maritime glaciers exhibit accumulation zones of multiple basins that feed narrow tongues flowing down steep valleys and terminate 400 m above sea level. The medial moraines at both glaciers become very prominent in the lower ablation zones, where the medial moraines widen, and develop steeper flanks coeval with an increase in relative relief. Medial moraine growth appears somewhat self-limiting in that relief and slope angle increase eventually lead to transport of debris away from the medial moraine by mass-movement-related processes. Despite similarities in overall morphologies, a key contrast in medial moraine formation exists between the two glaciers. At Fox Glacier, the medial moraine consists of angular rockfall-derived debris, folded to varying degrees along flow-parallel axes throughout the tongue. The debris originates above the ELA, coalesces at flow-unit boundaries, and takes a medium/high level transport pathway before subsequently emerging at point-sources aligned with gently dipping fold hinges near the snout. In contrast at Franz Josef Glacier, the medial moraine emerges farther down-glacier immediately below a prominent rock knob. Clasts show a mix of angular to rounded shapes representing high level transport and subglacially transported materials, the latter facies possibly also elevated by supraglacial routing of subglacial meltwater. Our observations confirm that a variety of different debris sources, transport pathways, and structural glaciological processes can interact to form medial moraines within New Zealand

  17. Longitudinal joint treatment : construction report.

    DOT National Transportation Integrated Search

    2000-05-01

    Maine highways have been showing signs of longitudinal joint failure for a number of : years. In an effort to reduce the amount of joint failures the Maine Department of : Transportation (MDOT) is currently evaluating two projects. One project is mon...

  18. Etiologic factors in the development of medial tibial stress syndrome: a review of the literature.

    PubMed

    Tweed, Jo L; Avil, Steven J; Campbell, Jackie A; Barnes, Mike R

    2008-01-01

    Medial tibial stress syndrome is a type of exercise-induced leg pain that is common in recreational and competitive athletes. Although various studies have attempted to find the exact pathogenesis of this common condition, it remains unknown. Various theories in literature from 1976 to 2006 were reviewed using key words. Until recently, inflammation of the periosteum due to excessive traction was thought to be the most likely cause of medial tibial stress syndrome. This periostitis has been hypothesized by some authors to be caused by the tearing away of the muscle fibers at the muscle-bone interface, although there are several suggestions as to which, if any, muscle is responsible. Recent studies have supported the view that medial tibial stress syndrome is not an inflammatory process of the periosteum but instead a stress reaction of bone that has become painful.

  19. Fornix and medial temporal lobe lesions lead to comparable deficits in complex visual perception.

    PubMed

    Lech, Robert K; Koch, Benno; Schwarz, Michael; Suchan, Boris

    2016-05-04

    Recent research dealing with the structures of the medial temporal lobe (MTL) has shifted away from exclusively investigating memory-related processes and has repeatedly incorporated the investigation of complex visual perception. Several studies have demonstrated that higher level visual tasks can recruit structures like the hippocampus and perirhinal cortex in order to successfully perform complex visual discriminations, leading to a perceptual-mnemonic or representational view of the medial temporal lobe. The current study employed a complex visual discrimination paradigm in two patients suffering from brain lesions with differing locations and origin. Both patients, one with extensive medial temporal lobe lesions (VG) and one with a small lesion of the anterior fornix (HJK), were impaired in complex discriminations while showing otherwise mostly intact cognitive functions. The current data confirmed previous results while also extending the perceptual-mnemonic theory of the MTL to the main output structure of the hippocampus, the fornix. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. White-eyed medial wall blowout fracture mimicking head injury due to persistent oculocardiac reflex.

    PubMed

    Jurdy, Lama; Malhotra, Raman

    2011-09-01

    White-eyed medial wall blowout fracture associated with muscle entrapment is rare. It may present with symptoms consistent with an intracranial injury, delaying the diagnosis and putting the patient at risk for permanent damage. A case of an isolated white-eyed medial wall fracture associated with persistent bradycardia on abduction secondary to oculocardiac reflex as well as limited abduction mimicking sixth-nerve weakness is presented. Patients with white-eyed medial wall blowout fracture with muscle entrapment can present with oculocardiac reflex symptoms, pain, diplopia, and strabismus in the absence of any signs on ocular examination except for abnormal motility. Computed tomography imaging of the orbit should be performed to confirm the diagnosis, followed by immediate surgical intervention to avoid ischemia and permanent injury.

  1. Medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis.

    PubMed

    Kim, Gang Deuk; Chae, Soo Uk; Cha, Myoung Soo

    2013-11-01

    Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we report a case with a medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis. This case shows that we should be aware of the possibility of encountering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.

  2. Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

    PubMed

    Goldstein, W M; Barmada, R

    1984-05-01

    The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

  3. Fear conditioned changes of heart rate in patients with medial cerebellar lesions.

    PubMed

    Maschke, M; Schugens, M; Kindsvater, K; Drepper, J; Kolb, F P; Diener, H-C; Daum, I; Timmann, D

    2002-01-01

    Fear conditioned changes of heart rate and skin conductance responses were investigated in patients with medial cerebellar lesions. A classical conditioning paradigm with a tone as the conditioned stimulus (CS) and an electrical shock as the unconditioned stimulus (US) was tested on five patients with medial cerebellar lesions due to surgery for astrocytoma and five controls. The CS preceded the US by 5900 ms and coterminated with the US. Changes in heart rate and skin conductance responses were obtained as measures for autonomic fear responses. Effects of conditioning were quantified by comparison of the habituation and extinction phases. Controls, but not cerebellar patients, showed a significant decrease of heart rate during fear conditioning. However, there were no significant fear conditioned changes in electrodermal responses in either group. In summary, the medial cerebellum seems to be involved in fear-conditioned bradycardia in humans.

  4. Medial Patella Femoral Ligament Reconstruction With Periosteal Tunnels and Suture Fixation.

    PubMed

    Brand, Jefferson; Hardy, Richard; Westerberg, Paul

    2017-10-01

    Lateral patellar dislocations can damage the medial patella femoral ligament. Nonoperative care is preferred but some tears may require a surgical intervention. Patella fractures are considered a risk factor after surgery. The technique described in this Technical Note avoids any bone tunnel drilling, which may eliminate the possibility of a patella fracture. The surgical procedure uses periosteal fibro-osseous tunnels to a double-limbed gracilis graft to reconstruct the upper and lower borders as conventionally used for medial patella femoral ligament reconstruction. Once the graft is tensioned, it is sutured to the periosteal fibro-osseous tunnel with 2 sutures on the medial side and at least 1 suture on the lateral side of each periosteal fibro-osseous sleeve. Each of the 2 periosteal fibro-osseous tunnels has 3 to 4 sutures securing the graft. After surgery, the patients complete 5 phases of rehabilitation to reduce swelling and to regain their strength and range of motion.

  5. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player.

    PubMed

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-07-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain.

  6. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player

    PubMed Central

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-01-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain. PMID:26311991

  7. Synovial fluid biomarker levels predict articular cartilage damage following complete medial meniscectomy in the canine knee.

    PubMed

    Carlson, Cathy S; Guilak, Farshid; Vail, Thomas P; Gardin, Jean F; Kraus, Virginia B

    2002-01-01

    The purposes of this study were to document the histological changes present in the tibial plateaus 12 weeks after complete medial meniscectomy in dogs and to determine if synovial lavage fluid biomarker levels are predictive of the severity of joint damage. Twelve adult dogs underwent complete unilateral medial meniscectomy and synovial lavage fluid biomarker levels, including cartilage oligomeric matrix protein (COMP), keratan sulfate (5D4). 3B3(-), and 3B3(+), were measured serially at 4-week intervals. The dogs were euthanized 12 weeks after surgery and each medial and lateral tibial plateau from the meniscectomized and contralateral knees was graded histologically. Histological data were analyzed using principal components analysis, which resulted in 4 factors that explained 70% of the variation in the data. Factor 2 (weighted most heavily by subchondral bone thickness) and Factor 3 (representative of articular cartilage damage) were significantly affected by compartmental site (P < 0.01 for both). Both of these factors were highest in the medial tibial plateau of the meniscectomized knee, and Factor 3 was significantly higher in this site than in the medial tibial plateau of the contralateral knee (P < 0.01). Peak levels of all 4 synovial lavage fluid biomarkers occurred at 4 weeks post-meniscectomy and 4-week minus baseline levels of all biomarkers were significantly correlated with the Factor 3 scores. This study demonstrates that significant articular cartilage damage occurs relatively quickly following complete medial meniscectomy in dogs and establishes the content and criterion validity for these synovial fluid lavage biomarkers in canine meniscectomy as surrogate measures of articular cartilage damage.

  8. Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer

    PubMed Central

    Roshdy, Sameh; Hussein, Osama; Khater, Ashraf; Zuhdy, Mohammad; El-Hadaad, Hend A; Farouk, Omar; Senbel, Ahmad; Fathi, Adel; Hamed, Emadeldeen; Denewer, Adel

    2015-01-01

    Background Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations. PMID:26185469

  9. [Anatomic study on perforating branch flap of medial vastus muscle and its clinical application].

    PubMed

    Guo, Yongqiang; Liang, Xiaoqin; Wang, Jianli; Wang, Chenqi; Guo, Deliang; Wang, Changde; Cui, Lei

    2012-09-01

    To investigate the anatomic features of the perforating branch flap of the medial vastus muscle, so as to provide a new perforating branch flap for repairing the soft tissue defect. Six fresh donated lower limb specimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation. The integument of the thigh was dissected to observe the origin, course, size, and location of the perforating branch of the medial vastus muscle by angiography and photography. Based on the anatomic study, the free perforating branch flaps of the medial vastus muscle (14 cm x 6 cm to 20 cm x 5 cm) were used to repair skin and soft tissue defects (8 cm x 6 cm to 12 cm x 8 cm) of the feet in 4 patients between June 2009 and August 2011. The artery of the medial vastus was sent out constantly from the femoral artery, and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateral femoral circumflex artery to form prepatellar vascular network. The artery of the medial vastus sent out 3-5 musculocutaneous perforating branches into the deep fascia and then extended superficially to the overlying skin. Four flaps survived after surgery; wounds at the donor site and recipient site healed by first intention. After follow-up of 6-12 months, the flaps had good appearance and texture. All ankles had normal movement range of plantarflexion and dorsiflexion. The free perforating branch flaps of the medial vastus muscle can be harvested easily, and have the advantage of good texture and abundant donor site.

  10. Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries.

    PubMed

    Vyas, Shail; van Eck, Carola F; Vyas, Nina; Fu, Freddie H; Otsuka, Norman Y

    2011-03-01

    Variations in bony morphology have been associated with anterior cruciate ligament (ACL) injury risk. The primary aim of this study was to compare the tibial slope in the teenage pediatric population with open physes, with and without ACL injury. The secondary aims were to compare the notch width index (NWI) and determine the influence of gender and age on tibial slope and NWI. Thirty-nine teenage pediatric subjects were included in this study, 16 with and 23 without ACL injury. Medial tibial slope and lateral tibial slope and NWI as measured on plain radiographs were compared between the groups using an independent t-test. Comparison of tibial slope and NWI was also performed between male and female subjects. Pearson correlation coefficient between age and tibial slope and NWI was calculated. The medial tibial slope averaged 10.2 (±3.9) degrees, the lateral tibial slope 11.5 (±3.9) degrees, and the NWI 0.26. There was a significant difference in medial tibial slope between the ACL-injured (12.1 degrees) subjects and the controls (8.9 degrees) (P = 0.009). There was no significant difference in lateral tibial slope or NWI between the groups. There was no significant difference in the medial tibial slope and lateral tibial slope and NWI between the male and female subjects. Subject age was not correlated with medial tibial slope and lateral tibial slope or NWI. There was an increased medial tibial slope in ACL-injured teenagers with open physes, when compared to a control group of teenager with open physes without ACL injury.

  11. Better quality of life after medial versus lateral unicondylar knee arthroplasty.

    PubMed

    Liebs, Thoralf R; Herzberg, Wolfgang

    2013-08-01

    The number of unicompartmental knee arthroplasties (UKAs) is growing worldwide. Because lateral UKAs are performed much less frequently than medial UKAs, the limited information leaves unclear whether UKAs have comparable survival and health-related quality of life (HRQoL) of the lateral UKA to medial UKAs. We therefore compared the (1) survivorship and (2) HRQoL after lateral versus medial cemented mobile-bearing UKAs and (3) determined whether there is an association of survival to modifications of surgical technique in one of three phases. We retrospectively reviewed 558 patients who underwent mobile-bearing UKAs from 2002 to 2009. From the records we determined revision of the joint for any reason and revision for aseptic loosening. Patients reported their physical function, pain, and stiffness as measured by the WOMAC, SF-36 physical-component summary (PCS), and Lequesne knee score. Information regarding implant survival was collected for 93% of the patients. We analyzed the patients separately by three phases based on surgical changes associated with each phase (1: initial technique; 2: improved cementing; 3: additional bone resection to ensure backward sliding of the inlay without impingement). The minimum followup was 2.1 years (mean, 6 years; range, 2.1-9.8 years). Implant survival was 88% at 9 years. We found similar implant survival rates for medial (90%) and lateral UKAs (83%). In all HRQoL measures, patients receiving a medial UKA had better mean scores compared with patients who had a lateral UKA: WOMAC physical function (23 versus 34, respectively) and pain (21 versus 34) and SF-36 PCS (41 versus 38). There were no survival differences by surgical phase. Our observations suggest a medial UKA is associated with superior HRQoL when compared with a lateral UKA, although implant survival is similar.

  12. A retrospective comparison of cost and efficiency of the medial double and dual incision triple arthrodeses.

    PubMed

    Galli, Melissa M; Scott, Ryan T; Bussewitz, Bradly W; Hyer, Christopher F

    2014-02-01

    While the medial double arthrodesis has gained significant popularity for hindfoot arthrodesis in recent years, much has been touted about the efficiency and cost savings of the procedure in comparison to its triple counterpart without any literature to reinforce this claim. The purpose of this retrospective study was to compare the hardware costs and operative time between the medial double and triple arthrodeses. A total of 276 patients (277 feet) were identified via CPT codes with 47 hindfoot cases (47 feet) meeting the inclusion criteria consisting of 21 medial double (6 males, 15 females) and 26 triple (8 males, 18 females) arthrodeses. No significant difference was noted in age, body mass index, gender, chronic steroid use, preoperative osteopenia/osteoporosis, tobacco abuse, surgical side, presence of diabetes, immune compromised state, kidney disease, rheumatoid arthritis, or liver disease. Mean medial double operative (OR) time 106 ± 31 minutes (range = 73-201 minutes) with a procedure time of 84 ± 29 minutes (range = 44-163 minutes) was identified versus an OR time of 127 ± 23 minutes (range = 91-200 minutes) and procedure time of 104 ± 23 minutes (range = 50-169 minutes) for the triple arthrodesis group. The mean fixation cost for the triple arthrodesis was found to be higher with the mean triple hardware cost $2932.75 ± $736.60 (range = $1434.00 to $3980.00) against the medial double's $1197.59 ± $635.57 (range = $463.20 to $2019.00). Both efficiency and cost were found to favor the medial double for hindfoot arthrodesis at a level of statistical significance level (P = .0028 for OR time, P = .0033 for procedure time, and P < .0001 for cost).

  13. Estrogens and their receptors in the medial amygdala rapidly facilitate social recognition in female mice.

    PubMed

    Lymer, Jennifer M; Sheppard, Paul A S; Kuun, Talya; Blackman, Andrea; Jani, Nilay; Mahbub, Sahnon; Choleris, Elena

    2017-12-28

    Estrogens have been shown to rapidly (within 1 h) affect learning and memory processes, including social recognition. Both systemic and hippocampal administration of 17β-estradiol facilitate social recognition in female mice within 40 min of administration. These effects were likely mediated by estrogen receptor (ER) α and the G-protein coupled estrogen receptor (GPER), as administration of the respective receptor agonists (PPT and G-1) also facilitated social recognition on a rapid time scale. The medial amygdala has been shown to be necessary for social recognition and long-term manipulations in rats have implicated medial amygdalar ERα. As such, our objective was to investigate whether estrogens and different ERs within the medial amygdala play a role in the rapid facilitation of social recognition in female mice. 17β-estradiol, G-1, PPT, or ERβ agonist DPN was infused directly into the medial amygdala of ovariectomized female mice. Mice were then tested in a social recognition paradigm, which was completed within 40 min, thus allowing the assessment of rapid effects of treatments. 17β-estradiol (10, 25, 50, 100 nM), PPT (300 nM), DPN (150 nM), and G-1 (50 nM) each rapidly facilitated social recognition. Therefore, estrogens in the medial amygdala rapidly facilitate social recognition in female mice, and the three main estrogen receptors: ERα, ERβ, and the GPER all are involved in these effects. This research adds to a network of brain regions, including the medial amygdala and the dorsal hippocampus, that are involved in mediating the rapid estrogenic facilitation of social recognition in female mice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Morphologic changes in the lumbar spine after lumbar medial branch radiofrequency neurotomy: a quantitative radiological study.

    PubMed

    Smuck, Mathew; Crisostomo, Ralph A; Demirjian, Ryan; Fitch, David S; Kennedy, David J; Geisser, Michael E

    2015-06-01

    Medial branch radiofrequency neurotomy (RFN) is a common treatment for zygapophyseal joint pain. The lumbar medial branch innervates these joints and adjacent structures. The impact of the intended neurotomy on these structures remains unclear. No studies have yet verified quantitatively the effect of medial branch RFN on intervertebral discs, facet joints, and multifidus cross-sectional area. The aim of this study was to determine, using objective radiographic measures, whether there is a quantitative difference in the lumbar multifidus muscle cross-sectional area, facet joint degeneration, or intervertebral disc degeneration after segmental medial branch RFN. This is a retrospective single-cohort study performed at a university spine center. The patient sample consisted of 27 patients treated with lumbar medial branch RFN, with pre- and posttreatment magnetic resonance images available for analysis. The primary study outcome measure was interval change in fat-subtracted multifidus cross-sectional area, and intervertebral disc and zygapophyseal joint degeneration grade. In this retrospective study, segmental levels unaffected by RFN treatment were used as controls to compare against levels affected by treatment. Levels affected by RFN demonstrated a significantly greater amount of disc degeneration compared with unaffected levels (14.9% vs. 4.6%; p=.0489). There was no statistical difference in the multifidus cross-sectional area or rates of deterioration in the zygapophyseal joints observed. The full impact of RFN on multifidus function, morphology, and segmental anatomy is unknown. This retrospective study indicates that measurable changes in segmental morphology may occur after lumbar medial branch RFN. These findings require validation in a prospective, controlled study. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Estimating medial gastrocnemius muscle volume in children with spastic cerebral palsy: a cross-sectional investigation.

    PubMed

    Schless, Simon-Henri; Hanssen, Britta; Cenni, Francesco; Bar-On, Lynn; Aertbeliën, Erwin; Molenaers, Guy; Desloovere, Kaat

    2018-01-01

    This cross-sectional investigation evaluates the reliability of estimating medial gastrocnemius anatomical cross-sectional area (aCSA) in typically developing and spastic cerebral palsy (SCP) cohorts. It verifies whether muscle volume estimations based on aCSA improve when aCSA is multiplied by muscle-tendon unit (MTU) or muscle length, and whether the resulting errors in volume estimations are smaller than changes after intervention. Fifteen typically developing children (mean age 8y 2mo [SD 1y 5mo], six males, nine females) and 30 children with SCP (mean age 9y 2mo [SD 2y 5mo], 22 males, eight females, Gross Motor Function Classification System [GMFCS] level I=15, II=15) participated in the investigation. The SCP cohort was divided according to GMFCS level. A three-dimensional freehand ultrasound technique was used to estimate medial gastrocnemius aCSA, muscle volume, MTU, and muscle length. Estimated muscle volume (aCSA×MTU or muscle length) was compared with the measured muscle volume. Anatomical cross-sectional area, muscle volume, and muscle length significantly differed between the typically developing and two SCP cohorts (p≤0.050). aCSA multiplied by either MTU or muscle length improved estimations of medial gastrocnemius volume. Leave-one-out cross-validation revealed an absolute difference with measured muscle volume of 3.77 ml (SD 2.90). This investigation revealed that medial gastrocnemius muscle volume can be reliably estimated in a clinically feasible manner in typically developing children and those with SCP. Medial gastrocnemius anatomical cross-sectional area (aCSA) can be reliably estimated in children with spastic cerebral palsy. The location of the anatomical cross-section should be taken with respect to muscle and not bone length. Medial gastrocnemius volume can be reliably estimated by multiplying aCSA and muscle length. The errors in volume estimations are smaller than reported differences after interventions. © 2017 Mac Keith Press.

  16. Representation of Behavioral Tactics and Tactics-Action Transformation in the Primate Medial Prefrontal Cortex.

    PubMed

    Matsuzaka, Yoshiya; Tanji, Jun; Mushiake, Hajime

    2016-06-01

    To expedite the selection of action under a structured behavioral context, we develop an expedient to promote its efficiency: tactics for action selection. Setting up a behavioral condition for subhuman primates (Macaca fuscata) that induced the development of a behavioral tactics, we explored neuronal representation of tactics in the medial frontal cortex. Here we show that neurons in the posterior medial prefrontal cortex, but not much in the medial premotor cortex, exhibit activity representing the behavioral tactics, in advance of action-selective activity. Such activity appeared during behavioral epochs of its retrieval from instruction cues, maintenance in short-term memory, and its implementation for the achievement of action selection. At a population level, posterior medial prefrontal cortex neurons take part in transforming the tactics information into the information representing action selection. The tactics representation revealed an aspect of neural mechanisms for an adaptive behavioral control, taking place in the medial prefrontal cortex. We studied behavioral significance of neuronal activity in the posterior medial prefrontal cortex (pmPFC) and found the representation of behavioral tactics defined as specific and efficient ways to achieve objectives of actions. Neuronal activity appeared during behavioral epochs of its retrieval from instruction cues, maintenance in short-term memory, and its use preceding the achievement of action selection. We found further that pmPFC neurons take part in transforming the tactics information into the information representing action selection. A majority of individual neurons was recruited during a limited period in each behavioral epoch, constituting, as a whole, a temporal cascade of activity. Such dynamics found in behavioral-tactics specific activity characterize the participation of pmPFC neurons in executive control of purposeful behavior. Copyright © 2016 the authors 0270-6474/16/365974-14$15.00/0.

  17. Mechanism of the Rapid Effect of 17β -Estradiol on Medial Amygdala Neurons

    NASA Astrophysics Data System (ADS)

    Nabekura, Junichi; Oomura, Yutaka; Minami, Taketsugu; Mizuno, Yuji; Fukuda, Atsuo

    1986-07-01

    The mechanism by which sex steroids rapidly modulate the excitability of neurons was investigated by intracellular recording of neurons in rat medial amygdala brain slices. Brief hyperpolarization and increased potassium conductance were produced by 17β - estradiol. This effect persisted after elimination of synaptic input and after suppression of protein synthesis. Thus, 17β -estradiol directly changes the ionic conductance of the postsynaptic membrane of medial amygdala neurons. In addition, a greater proportion of the neurons from females than from males responded to 17β -estradiol.

  18. Radiosurgery for Medial Temporal Lobe Epilepsy Resulting from Mesial Temporal Sclerosis.

    PubMed

    Gianaris, Thomas; Witt, Thomas; Barbaro, Nicholas M

    2016-01-01

    Medial temporal lobe epilepsy associated with mesial temporal sclerosis (MTS) is perhaps the most well-defined epilepsy syndrome that is responsive to structural interventions such as surgery. Several minimally invasive techniques have arisen that provide additional options for the treatment of MTS while potentially avoiding many of open surgery's associated risks. By evading these risks, they also open up treatment options to patients who otherwise are poor surgical candidates. Radiosurgery is one of the most intensively studied of these alternatives and has found a growing role in the treatment of medial temporal lobe epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Editorial Commentary: Is Medial-Side Repair Indicated in the Treatment of Multiligament Knee Injuries?

    PubMed

    Marx, Robert G

    2016-09-01

    Multiligament knee injuries are heterogenous and demand individualized treatment. In addition to the complexity of the injury, factors such as the timing and type of surgery are also crucial to patient outcomes. In a case series, patients who underwent medial-side repair had inferior patient-reported outcomes compared with those who had medial reconstruction or lateral surgery. Interestingly, patients with common peroneal nerve injury did not have inferior outcomes, probably because of the lack of sensitivity of rating scales to measure nerve-related disability. In view of the complexity and heterogeneity of these injuries, the above-mentioned findings may not be generalizable to all patients. Published by Elsevier Inc.

  20. Resting-State Functional Connectivity Within Medial Prefrontal Cortex Mediates Age Differences in Risk Taking.

    PubMed

    Yu, Jing; Li, Rui; Guo, Yuhua; Fang, Fang; Duan, Suhuan; Lei, Xu

    2017-01-01

    To investigate the association between age-related changes in risk taking and resting-state functional activity, we recorded resting-state scans from both young (n = 26) and older adults (n = 27). In addition, all participants completed two decision-making tasks: the Cambridge Gambling Task and the Balloon Analogue Risk Task. We found that older adults showed decreased functional connectivity within the medial prefrontal cortex, particularly between the ventromedial prefrontal cortex and the dorsal medial prefrontal cortex. Moreover, these changes in resting-state functional connectivity were associated with the individuals' risk-taking behavior, and mediated the influence of age on risk taking.

  1. The Rotterdam Foot Classification: A Classification System for Medial Polydactyly of the Foot.

    PubMed

    Burger, Elise B; Hovius, Steven E R; Burger, Bart J; van Nieuwenhoven, Christianne A

    2016-08-03

    Polydactyly at the medial side of the foot ("medial polydactyly" of the foot) is a rare and diverse congenital anomaly. In order to plan and evaluate surgical treatment, the classification of medial polydactyly is useful. The aim of our study was to develop a reliable and valid classification system for medial polydactyly of the foot that is more useful than previous systems for preoperative evaluation and surgical planning. A review of the literature and the clinical experience of a single experienced surgeon were used to determine classification categories. We identified all patients with medial polydactyly who had preoperative radiographs and clinical photographs and were treated at our hospital between 1993 and 2014. All affected feet were assessed according to our proposed classification system, the Rotterdam foot classification. The intrarater and interrater reliability among 5 observers who evaluated 30 feet were assessed with use of the Cohen kappa (κ) statistic. We developed a classification system that describes duplication type, syndactyly, the presence of a hypoplastic ray, and deviation of the hallux. Seventy-three feet were classified according to the system. Seven duplication types were distinguished. Complete metatarsal duplication was most frequently seen (in 29%). Twelve feet showed a broad hallux without external expression of duplication. Syndactyly between medial and lateral (duplicate) halluces was present in 30 feet; between the lateral hallux and second toe, in 13 feet; and between both duplicated halluces and the lateral hallux and second toe, in 21 feet. A hypoplastic ray was seen in 75% of the feet. Intrarater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.79, 0.75, 0.59, and 0.78. Interrater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.72, 0.54, 0.48, and 0.64. The proposed classification system contains 4 categories of anatomic

  2. The impact of television viewing on brain structures: cross-sectional and longitudinal analyses.

    PubMed

    Takeuchi, Hikaru; Taki, Yasuyuki; Hashizume, Hiroshi; Asano, Kohei; Asano, Michiko; Sassa, Yuko; Yokota, Susumu; Kotozaki, Yuka; Nouchi, Rui; Kawashima, Ryuta

    2015-05-01

    Television (TV) viewing is known to affect children's verbal abilities and other physical, cognitive, and emotional development in psychological studies. However, the brain structural development associated with TV viewing has never been investigated. Here we examined cross-sectional correlations between the duration of TV viewing and regional gray/white matter volume (rGMV/rWMV) among 133 boys and 143 girls as well as correlations between the duration of TV viewing and longitudinal changes that occurred a few years later among 111 boys and 105 girls. After correcting for confounding factors, we found positive effects of TV viewing on rGMV of the frontopolar and medial prefrontal areas in cross-sectional and longitudinal analyses, positive effects of TV viewing on rGMV/rWMV of areas of the visual cortex in cross-sectional analyses, and positive effects of TV viewing on rGMV of the hypothalamus/septum and sensorimotor areas in longitudinal analyses. We also confirmed negative effects of TV viewing on verbal intelligence quotient (IQ) in cross-sectional and longitudinal analyses. These anatomical correlates may be linked to previously known effects of TV viewing on verbal competence, aggression, and physical activity. In particular, the present results showed effects of TV viewing on the frontopolar area of the brain, which has been associated with intellectual abilities. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Longitudinal white matter change in frontotemporal dementia subtypes and sporadic late onset Alzheimer's disease.

    PubMed

    Elahi, Fanny M; Marx, Gabe; Cobigo, Yann; Staffaroni, Adam M; Kornak, John; Tosun, Duygu; Boxer, Adam L; Kramer, Joel H; Miller, Bruce L; Rosen, Howard J

    2017-01-01

    Degradation of white matter microstructure has been demonstrated in frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). In preparation for clinical trials, ongoing studies are investigating the utility of longitudinal brain imaging for quantification of disease progression. To date only one study has examined sample size calculations based on longitudinal changes in white matter integrity in FTLD. To quantify longitudinal changes in white matter microstructural integrity in the three canonical subtypes of frontotemporal dementia (FTD) and AD using diffusion tensor imaging (DTI). 60 patients with clinical diagnoses of FTD, including 27 with behavioral variant frontotemporal dementia (bvFTD), 14 with non-fluent variant primary progressive aphasia (nfvPPA), and 19 with semantic variant PPA (svPPA), as well as 19 patients with AD and 69 healthy controls were studied. We used a voxel-wise approach to calculate annual rate of change in fractional anisotropy (FA) and mean diffusivity (MD) in each group using two time points approximately one year apart. Mean rates of change in FA and MD in 48 atlas-based regions-of-interest, as well as global measures of cognitive function were used to calculate sample sizes for clinical trials (80% power, alpha of 5%). All FTD groups showed statistically significant baseline and longitudinal white matter degeneration, with predominant involvement of frontal tracts in the bvFTD group, frontal and temporal tracts in the PPA groups and posterior tracts in the AD group. Longitudinal change in MD yielded a larger number of regions with sample sizes below 100 participants per therapeutic arm in comparison with FA. SvPPA had the smallest sample size based on change in MD in the fornix (n = 41 participants per study arm to detect a 40% effect of drug), and nfvPPA and AD had their smallest sample sizes based on rate of change in MD within the left superior longitudinal fasciculus (n = 49 for nfvPPA, and n = 23 for AD). Bv

  4. Tissue elasticity of in vivo skeletal muscles measured in the transverse and longitudinal planes using shear wave elastography.

    PubMed

    Chino, Kentaro; Kawakami, Yasuo; Takahashi, Hideyuki

    2017-07-01

    The aim of the present study was to measure in vivo skeletal muscle elasticity in the transverse and longitudinal planes using shear wave elastography and then to compare the image stability, measurement values and measurement repeatability between these imaging planes. Thirty-one healthy males participated in this study. Tissue elasticity (shear wave velocity) of the medial gastrocnemius, rectus femoris, biceps brachii and rectus abdominis was measured in both the transverse and longitudinal planes using shear wave elastography. Image stability was evaluated by the standard deviation of the colour distribution in the shear wave elastography image. Measurement repeatability was assessed by the coefficient of variance obtained from three measurement values. Image stability of all tested muscles was significantly higher in the longitudinal plane (P<0·001), but measurement repeatability did not differ significantly between the imaging planes (P>0·05), except in the biceps brachii (P = 0·001). Measurement values of the medial gastrocnemius, rectus femoris and biceps brachii were significantly different between the imaging planes (P<0·001). Image stability and measurement values of shear wave elastography images varied with imaging plane, which indicates that imaging plane should be considered when measuring skeletal muscle tissue elasticity by shear wave elastography. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  5. First sacral nerve and anterior longitudinal ligament anatomy: clinical applications during sacrocolpopexy.

    PubMed

    Florian-Rodriguez, Maria E; Hamner, Jennifer J; Corton, Marlene M

    2017-11-01

    The recommended location of graft attachment during sacrocolpopexy is at or below the sacral promontory on the anterior surface of the first sacral vertebra. Graft fixation below the sacral promontory may potentially involve the first sacral nerve. The objectives of this study were to examine the anatomy of the right first sacral nerve relative to the midpoint of the sacral promontory and to evaluate the thickness and ultrastructural composition of the anterior longitudinal ligament at the sacral promontory level. Anatomic relationships were examined in 18 female cadavers (8 unembalmed and 10 embalmed). The midpoint of the sacral promontory was used as reference for all measurements. The most medial and superior point on the ventral surface of the first sacral foramen was used as a marker for the closest point at which the first sacral nerve could emerge. Distances from midpoint of sacral promontory and the midsacrum to the most medial and superior point of the first sacral foramen were recorded. The right first sacral nerve was dissected and its relationship to the presacral space was noted. The anterior longitudinal ligament thickness was examined at the sacral promontory level in the midsagittal plane. The ultrastructural composition of the ligament was evaluated using transmission electron microscopy. Height of fifth lumbar to first sacral disc was also recorded. Descriptive statistics were used for data analyses. Median age of specimens was 78 years and median body mass index was 20.1 kg/m 2 . Median vertical distance from midpoint of sacral promontory to the level of the most medial and superior point of the first sacral foramen was 26 (range 22-37) mm. Median horizontal distance from the midsacrum to the first sacral foramen was 19 (range 13-23) mm. In all specimens, the first sacral nerve was located just behind the layer of parietal fascia covering the piriformis muscle, and thus, outside the presacral space. Median anterior longitudinal ligament thickness

  6. Clinical and surgical implications regarding morphometric variations of the medial wall of the orbit in relation to age and gender.

    PubMed

    Morales-Avalos, Rodolfo; Santos-Martínez, Arlette Gabriela; Ávalos-Fernández, Cesia Gisela; Mohamed-Noriega, Karim; Sánchez-Mejorada, Gabriela; Montemayor-Alatorre, Adolfo; Martínez-Fernández, David A; Espinosa-Uribe, Abraham G; Mohamed-Noriega, Jibran; Cuervo-Lozano, Edgar E; Mohamed-Hamsho, Jesús; Quiroga-García, Oscar; Lugo-Guillen, Roberto A; Guzmán-López, Santos; Elizondo-Omaña, Rodrigo E

    2016-09-01

    The ethmoidal foramens are located on the medial wall of the orbit and are key reference points for intraoperative orientation. Detailed knowledge of the anatomy, bony landmarks and morphometric characteristics of the medial wall of the orbit is essential for various surgical procedures. The aim of this study was to determine the morphometric variations in the medial wall of the orbit and establish significant variations regarding age and gender. A total of 110 orbits were analyzed and subdivided by age (over or under 40 years) and gender. The distances of the medial wall of the orbit between the anterior lacrimal crest, the ethmoidal foramen, the optic canal and the interforamina were determined. Safe surgical areas were sought. Statistical tests were used to determine the differences between groups. In men, there is a safe surgical area proximal to the anterior and posterior ethmoidal foramen. In women, this area is in the posterior third of the medial wall of the orbit between the posterior ethmoidal foramen and the optic canal. Regarding variation according to age, the results of this study suggested that the anteroposterior diameter of the medial wall increases with age. This study showed that the anteroposterior total length of the medial orbit wall is similar between genders of similar age, increases with age, and has significant variations in the distances between the various structures that make up the medial orbit wall with regard to gender and age.

  7. [Primary recurrent medial subdislocation of both patellae. Long-term review of an exceptional case of miserably malalignment syndrome].

    PubMed

    García-Mata, S; Hidalgo-Ovejero, A

    2007-01-01

    We present a long-term review of a girl aged 11 years and 4 months with medial primary recurrent subluxation of both patellae of several months evolution associated with miserably malalignment syndrome. Not one case of medial recurrent dislocation of the patellae has been described previously. Three years previously following a jump she had suffered a right patellar luxation - self-reduced and not immobilised - followed by 10 subsequent episodes of subluxation and three more medial luxations. She could hardly walk autonomously due to persistent or habitual subluxation and patellofemoral pain, mainly in the right knee. Physical examination revealed habitual medial subluxation of both patellae, with clear medial patellar displacement, quadriceps amyotrophy and medial instability. The medial subluxation suppression test was positive. She showed excessive femoral anteversion of the hips (IR: 90 degrees, ER: 30 degrees), genu varum, neutral tibial torsion, patella alta, dysplastic trochlear grooves with medial condyle hipoplasia and both patellae were dysplastic (Wiberg type III). We performed a derotation subtrochanteric femoral osteotomy and bilateral proximal patellar realignment. Following surgery, bilateral stability of both sides permitted normal walking and running, as well as apprehension and the Smillie test (-), with a hip mobility of 65 degrees ER and 50 degrees IR. Fifteen years after the surgery the patient complains of antero-external knee pain in the right knee during prolonged walking, in getting up and down stairs and when in a prolonged sitting position, diagnosed as excessive lateral pressure syndrome.

  8. Neuropsychiatric effects of neurodegeneration of the medial vs. lateral ventral prefrontal cortex in humans

    PubMed Central

    Huey, Edward D.; Lee, Seonjoo; Brickman, Adam M.; Manoochehri, Masood; Griffith, Erica; Devanand, D.P.; Stern, Yaakov; Grafman, Jordan

    2015-01-01

    Animal evidence suggests that a brain network involving the medial and rostral ventral prefrontal cortex (PFC) is central for threat response and arousal and a network involving the lateral and caudal PFC plays an important role in reward learning and behavioral control. In this study, we contrasted the neuropsychiatric effects of degeneration of the medial versus lateral PFC in 43 patients with Frontotemporal dementia and 11 patients with Corticobasal Syndrome using MRI, the Neuropsychiatric Inventory (NPI), and the Sorting, Tower, Twenty Questions, and Fluency tests of the Delis-Kaplan Executive Function System (D-KEFS). Deviations in MRI grey matter volume from 86 age-matched healthy control subjects were determined for the patients using FreeSurfer. Multivariate regression was used to determine which brain areas were associated with specific neuropsychiatric and cognitive symptoms. Decreased grey matter volume of the right medial ventral PFC was associated with increased anxiety and apathy, decreased volume of the right lateral ventral PFC with apathy and inappropriate repetitive behaviors, and of the left lateral ventral PFC with poor performance on the sorting and Twenty Questions task in patients with FTD and CBS. Similar to in animal studies, damage to the medial OFC appears to be associated with a disruption of arousal, and damage to the lateral OFC appears to be associated with deficits in trial-and-error learning and behavioral dysregulation. Studies of brain dysfunction in humans are valuable to bridge animal and human neuropsychiatric research. PMID:26343341

  9. Neuropsychiatric effects of neurodegeneration of the medial versus lateral ventral prefrontal cortex in humans.

    PubMed

    Huey, Edward D; Lee, Seonjoo; Brickman, Adam M; Manoochehri, Masood; Griffith, Erica; Devanand, D P; Stern, Yaakov; Grafman, Jordan

    2015-12-01

    Animal evidence suggests that a brain network involving the medial and rostral ventral prefrontal cortex (PFC) is central for threat response and arousal and a network involving the lateral and caudal PFC plays an important role in reward learning and behavioral control. In this study, we contrasted the neuropsychiatric effects of degeneration of the medial versus lateral PFC in 43 patients with Frontotemporal dementia (FTD) and 11 patients with Corticobasal Syndrome (CBS) using MRI, the Neuropsychiatric Inventory (NPI), and the Sorting, Tower, Twenty Questions, and Fluency tests of the Delis-Kaplan Executive Function System (D-KEFS). Deviations in MRI grey matter volume from 86 age-matched healthy control subjects were determined for the patients using FreeSurfer. Multivariate regression was used to determine which brain areas were associated with specific neuropsychiatric and cognitive symptoms. Decreased grey matter volume of the right medial ventral PFC was associated with increased anxiety and apathy, decreased volume of the right lateral ventral PFC with apathy and inappropriate repetitive behaviors, and of the left lateral ventral PFC with poor performance on the sorting and Twenty Questions task in patients with FTD and CBS. Similar to in animal studies, damage to the medial OFC appears to be associated with a disruption of arousal, and damage to the lateral OFC appears to be associated with deficits in trial-and-error learning and behavioral dysregulation. Studies of brain dysfunction in humans are valuable to bridge animal and human neuropsychiatric research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Adaptation to Cognitive Context and Item Information in the Medial Temporal Lobes

    ERIC Educational Resources Information Center

    Diana, Rachel A.; Yonelinas, Andrew P.; Ranganath, Charan

    2012-01-01

    The medial temporal lobes (MTL) play an essential role in episodic memory, and accumulating evidence indicates that two MTL subregions--the perirhinal (PRc) and parahippocampal (PHc) cortices--might have different functions. According to the binding of item and context theory ( [16] and [21]), PRc is involved in processing item information, the…

  11. Medial Temporal Lobe Activity during Source Retrieval Reflects Information Type, Not Memory Strength

    ERIC Educational Resources Information Center

    Diana, Rachel A.; Yonelinas, Andrew P.; Ranganath, Charan

    2010-01-01

    The medial temporal lobes (MTLs) are critical for episodic memory but the functions of MTL subregions are controversial. According to memory strength theory, MTL subregions collectively support declarative memory in a graded manner. In contrast, other theories assert that MTL subregions support functionally distinct processes. For instance, one…

  12. The medial frontal cortex contributes to but does not organize rat exploratory behavior.

    PubMed

    Blankenship, Philip A; Stuebing, Sarah L; Winter, Shawn S; Cheatwood, Joseph L; Benson, James D; Whishaw, Ian Q; Wallace, Douglas G

    2016-11-12

    Animals use multiple strategies to maintain spatial orientation. Dead reckoning is a form of spatial navigation that depends on self-movement cue processing. During dead reckoning, the generation of self-movement cues from a starting position to an animal's current position allow for the estimation of direction and distance to the position movement originated. A network of brain structures has been implicated in dead reckoning. Recent work has provided evidence that the medial frontal cortex may contribute to dead reckoning in this network of brain structures. The current study investigated the organization of rat exploratory behavior subsequent to medial frontal cortex aspiration lesions under light and dark conditions. Disruptions in exploratory behavior associated with medial frontal lesions were consistent with impaired motor coordination, response inhibition, or egocentric reference frame. These processes are necessary for spatial orientation; however, they are not sufficient for self-movement cue processing. Therefore it is possible that the medial frontal cortex provides processing resources that support dead reckoning in other brain structures but does not of itself compute the kinematic details of dead reckoning. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

  13. Anterior Medial Temporal Lobe Activation during Encoding of Words: FMRI Methods to Optimize Sensitivity

    ERIC Educational Resources Information Center

    Parsons, Michael W.; Haut, Marc W.; Lemieux, Susan K.; Moran, Maria T.; Leach, Sharon G.

    2006-01-01

    The existence of a rostrocaudal gradient of medial temporal lobe (MTL) activation during memory encoding has historically received support from positron emission tomography studies, but less so from functional MRI (FMRI) studies. More recently, FMRI studies have demonstrated that characteristics of the stimuli can affect the location of activation…

  14. Cognitive Functioning after Medial Frontal Lobe Damage Including the Anterior Cingulate Cortex: A Preliminary Investigation

    ERIC Educational Resources Information Center

    Baird, Amee; Dewar, Bonnie-Kate; Critchley, Hugo; Gilbert, Sam J.; Dolan, Raymond J.; Cipolotti, Lisa

    2006-01-01

    Two patients with medial frontal lobe damage involving the anterior cingulate cortex (ACC) performed a range of cognitive tasks, including tests of executive function and anterior attention. Both patients lesions extended beyond the ACC, therefore caution needs to be exerted in ascribing observed deficits to the ACC alone. Patient performance was…

  15. Anatomic analysis specific for the endoscopic approach to the inferior, medial and lateral orbit.

    PubMed

    Van Rompaey, Jason; Bush, Carrie; Solares, C Arturo

    2014-04-01

    The endoscopic approaches to the medial and inferior orbital walls have continued to grow in popularity. The ability to provide a safe approach to the orbit through this technique has been described in a handful of studies. Even though metric analyses have been conducted on orbital anatomy, few have outlined the anatomical relations pertinent to endoscopic surgery. The goal is to provide improved understanding of the complex anatomy encountered through anatomical dissections and metric analysis of the orbit. This information could assist in approach selection during preoperative planning. Anatomical dissections via transantral and endonasal approaches were used to define the limits with current endoscopic sinus surgery instrumentation. The surface area was then calculated of the floor and medial wall to assess access created by the approaches. The path of the infraorbital canal was conducted to assess its placement within the orbital floor. The transantral and endonasal approaches to the orbit provided an adequate surgical window inferiorly and medially. This was confirmed by the surface area calculations. Access laterally was also possible, however, it became limited as dissection advanced superior to the lateral rectus muscle. The infraorbital canal was located consistently at midline on the orbital floor. Endoscopic access to the medial and inferior parts of the orbit is feasible and creates adequate access with current instrumentation. Knowing the surgical boundaries and the amount of exposure created can assist the surgeon in deciding a minimally invasive approach.

  16. Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study.

    PubMed

    Saenthaveesuk, P; Zhang, S-E; Zheng, G-S; Liang, Y-J; Su, Y-X; Liao, G-Q

    2018-01-20

    The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. Sensory-motor functions of the upper arm donor site were recorded before and after surgery. Four flaps were successfully transferred. One flap was abandoned during surgery because of a lack of perforators, and a forearm flap was used instead. All patients survived without loco-regional recurrence or distant metastasis. Functional outcomes, especially swallowing and speech, were satisfactory. The donor site scar was well hidden, with no functional impairment. This initial experience shows that the medial upper arm free flap represents an alternative perforator flap for oral cavity microsurgical reconstruction. The well-hidden scar and better texture match compared with other flaps make it suitable for oral cavity reconstruction. Copyright © 2017. Published by Elsevier Ltd.

  17. Correlation of bone scintigraphy and histological findings in medial tibial syndrome

    PubMed Central

    Bhatt, R; Lauder, I; Finlay, D; Allen, M; Belton, I

    2000-01-01

    Objective—To correlate bone scintigraphy and histopathological findings in patients with medial tibial syndrome. Methods—Twenty patients (32 limbs) with a clinical diagnosis of medial tibial syndrome had surgery. Bone scintigraphy before the operation was compared with the histological appearance of bone and periosteal specimens obtained at surgery. Results—Delayed bone scintigraphy showed normal appearance in 11 limbs, characteristic diffuse tubular pattern uptake in 16 limbs, and focal uptake in five. Periosteal histology disclosed fibrous thickening as the most common finding associated with increased vascularity, occasionally with chronic inflammatory cell infiltration, haemosiderin, and acid mucopolysaccharide deposition. Loss of osteocytes was the main finding of bone histology associated with some enlargement of lacunae and lamellar structure disruption. A grading system was used to score normal and abnormal histological appearance. For analysis the findings were regrouped to provide tables using Fisher's exact test. There was no correlation between bone scintigraphy and the histology of bone and periosteum, but two interesting observations were noted. Those cases with periosteal thickening had mostly normal bone scan appearance (p = 0.0028). Those cases with low levels of osteocyte loss had mostly abnormal bone scintigraphy. Conclusion—Abnormal histological appearance of bone and periosteum is a feature of medial tibial syndrome. These histological findings show poor correlation with bone scintigraphy. The exact pathogenesis of this syndrome remains unclear. Key Words: medial tibial syndrome; bone; periosteum; scintigraphy; histology PMID:10690451

  18. Exercise-induced stress resistance is independent of exercise controllability and the medial prefrontal cortex

    PubMed Central

    Greenwood, Benjamin N.; Spence, Katie G.; Crevling, Danielle M.; Clark, Peter J.; Craig, Wendy C.; Fleshner, Monika

    2014-01-01

    Exercise increases resistance against stress-related disorders such as anxiety and depression. Similarly, the perception of control is a powerful predictor of neurochemical and behavioral responses to stress, but whether the experience of choosing to exercise, and exerting control over that exercise, is a critical factor in producing exercise-induced stress resistance is unknown. The current studies investigated whether the protective effects of exercise against the anxiety- and depression-like consequences of stress are dependent on exercise controllability and a brain region implicated in the protective effects of controllable experiences, the medial prefrontal cortex. Adult male Fischer 344 rats remained sedentary, were forced to run on treadmills or motorised running wheels, or had voluntary access to wheels for 6 weeks. Three weeks after exercise onset, rats received sham surgery or excitotoxic lesions of the medial prefrontal cortex. Rats were exposed to home cage or uncontrollable tail shock treatment three weeks later. Shock-elicited fear conditioning and shuttle box escape testing occurred the next day. Both forced and voluntary wheel running, but not treadmill training, prevented the exaggerated fear conditioning and interference with escape learning produced by uncontrollable stress. Lesions of the medial prefrontal cortex failed to eliminate the protective effects of forced or voluntary wheel running. These data suggest that exercise controllability and the medial prefrontal cortex are not critical factors in conferring the protective effects of exercise against the affective consequences of stressor exposure, and imply that exercise perceived as forced may still benefit affect and mental health. PMID:23121339

  19. Eyelid avulsion repair with bi-canalicular silicone stenting without medial canthal tendon reconstruction.

    PubMed

    Tint, Naing L; Alexander, Philip; Cook, Anne E; Leatherbarrow, Brian

    2011-10-01

    To evaluate the functional and cosmetic success rate of combined canalicular laceration and eyelid avulsion repairs using the bi-canalicular Crawford stent, without the concomitant placement of a medial traction suture to repair medial canthal tendon (posterior limb) avulsion. Retrospective, non-comparative consecutive case series of 40 consecutive patients with traumatic eyelid avulsion injuries associated with canalicular laceration from 1997 to 2003 who underwent surgical repair using the bi-canalicular Crawford stent were included. All patients underwent surgical repair of the canalicular laceration under general anaesthesia using the bi-canalicular stent. Meticulous anastomosis of the torn canaliculus was undertaken. No attempt was made to suture the avulsed medial canthal tendon (posterior limb) to the periosteum of the posterior lacrimal crest. Blunt trauma was the most common mechanism of injury and the inferior canaliculus was most commonly involved. Of the 37 patients who attended postoperative follow-up, 24 patients had no subjective symptoms of epiphora. Minimal, mild and moderate epiphora was present in seven, five and one patient respectively. Thirty-three patients had excellent cosmetic repositioning of the lid; two developed medial ectropia and a further two patients had lid margin notching but good lid position. Eight patients had premature stent loss. Bi-canalicular stenting achieved excellent cosmetic results in eyelid avulsion injuries, by facilitating adequate tissue realignment without the need for a posterior lacrimal crest fixation suture. Good functional results were achieved and were comparable with previous studies.

  20. SF-1 in the ventral medial hypothalamic nucleus: A key regulator of homeostasis

    USDA-ARS?s Scientific Manuscript database

    The ventral medial hypothalamic nucleus (VMH) regulates food intake and body weight homeostasis. The nuclear receptor NR5A1 (steroidogenic factor 1; SF-1) is a transcription factor whose expression is highly restricted in the VMH and is required for the development of the nucleus. Neurons expressing...

  1. Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment.

    PubMed

    Shelbourne, K Donald; Carr, Donald R

    2003-01-01

    A detailed history, thorough examination, and a high index of suspicion for associated injuries together are the cornerstone for diagnosing and treating a knee with multiple ligament injuries. Acute surgery in patients with combined ligament injuries of the knee can lead to stiffness, primarily with medial-side injuries. Knee dislocations with lateral-side injuries require acute repair to achieve a good long-term result. All knee dislocations should not be grouped together because of the difference in healing potential between medial- and lateral-side injuries. Patients likely prefer a knee that is mildly lax but functional with full range of motion as opposed to a stiff, painful, stable knee. Treatment is based on the individual healing potential of the injured structures and the natural history of these injuries, along with the following principles: (1) medial-side injuries can heal with proper nonsurgical treatment; (2) posterior cruciate ligament (PCL) tears with grade II laxity or less can heal with similar long-term results as PCL tears with grade I laxity; therefore, surgery may not be indicated. As surgical techniques are developed and improved upon, a more aggressive approach to PCL reconstruction may be warranted; (3) PCL laxity greater than grade II and a soft end point should be considered for semiacute reconstruction; and (4) anterior cruciate ligament injuries in combination with medial collateral ligament and/or PCL injury can initially be treated nonsurgically and reconstructed later as dictated by patient symptoms and activity level.

  2. Medial unicompartmental knee arthroplasty improves congruence and restores joint space width of the lateral compartment.

    PubMed

    Khamaisy, Saker; Zuiderbaan, Hendrik A; van der List, Jelle P; Nam, Denis; Pearle, Andrew D

    2016-06-01

    Osteoarthritic progression of the lateral compartment remains a leading indication for medial unicompartmental knee arthroplasty (UKA) revision. Therefore, the purpose of this study was to evaluate the alterations of the lateral compartment congruence and joint space width (JSW) following medial UKA. Retrospectively, lateral compartment congruence and JSW were evaluated in 174 knees (74 females, 85 males, mean age 65.5years; SD±10.1) preoperatively and six weeks postoperatively, and compared to 41 healthy knees (26 men, 15 women, mean age 33.7years; SD±6.4). Congruence (CI) was calculated using validated software that evaluates the geometric relationship between surfaces and calculates a congruence index (CI). JSW was measured on three sides (inner, middle, outer) by subdividing the lateral compartment into four quarters. The CI of the control group was 0.98 (SD±0.01). The preoperative CI was 0.88 (SD±0.01), which improved significantly to 0.93 (SD±0.03) postoperatively (p<0.001). In 82% of knees, CI improved after surgery, while in 18% it decreased. The preoperative significant JSW differences of the inner (p<0.001) and outer JSW (p<0.001) were absent postoperatively. Our data suggests that a well-conducted medial UKA not only resurfaces the medial compartment but also improves congruence and restores the JSW of the lateral compartment. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Dissociated Roles for the Lateral and Medial Septum in Elemental and Contextual Fear Conditioning

    ERIC Educational Resources Information Center

    Calandreau, Ludovic; Jaffard, Robert; Desmedt, Aline

    2007-01-01

    Extensive evidence indicates that the septum plays a predominant role in fear learning, yet the direction of this control is still a matter of debate. Increasing data suggest that the medial (MS) and lateral septum (LS) would be differentially required in fear conditioning depending on whether a discrete conditional stimulus (CS) predicts, or not,…

  4. Distinct Roles for Medial Temporal Lobe Structures in Memory for Objects and Their Locations

    ERIC Educational Resources Information Center

    Buffalo, Elizabeth A.; Bellgowan, Patrick S. F.; Martin, Alex

    2006-01-01

    The ability to learn and retain novel information depends on a system of structures in the medial temporal lobe (MTL) including the hippocampus and the surrounding entorhinal, perirhinal, and parahippocampal cortices. Damage to these structures produces profound memory deficits; however, the unique contribution to memory of each of these…

  5. Biomechanical Effects of Different Varus and Valgus Alignments in Medial Unicompartmental Knee Arthroplasty.

    PubMed

    Innocenti, Bernardo; Pianigiani, Silvia; Ramundo, Gaetano; Thienpont, Emmanuel

    2016-12-01

    Medial unicompartmental tibial components are not always positioned following neutral mechanical alignment and a tibial varus alignment of 3° has been suggested based on several clinical follow-up studies. However, no biomechanical justification is currently available to confirm the suitability of different alignment positions. This study aims at quantifying the effects on bone stresses, load distribution, ligament strains, and polyethylene insert stress distribution induced by a possible varus/valgus alignment in medial unicompartmental knee arthroplasty, ranging from 6° of varus to 6° of valgus, developing and using a validated patient-specific finite element model. Results demonstrate that both neutral mechanical and 3° of varus alignment induce lower stress distributions than valgus or a higher varus alignment for which higher values, up to 40%, are achieved for the polyethylene stress. When a unicompartmental knee arthroplasty is implanted, a mismatch in the stiffness of the joint is introduced, changing the load distribution from medial to lateral for all configurations with respect to the native configuration. However, slight differences are noticeable among the different configurations with a maximum of 190 N and 90 N for the lateral and the medial side, respectively. Neutral mechanical or 3° of varus alignment present similar biomechanical outputs in the bone, collateral ligament strain, and on the polyethylene insert. A 6° varus alignment or changes in valgus alignment were always associated with more detrimental effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Estrogen receptor-a in medial amygdala neurons regulates body weight

    USDA-ARS?s Scientific Manuscript database

    Estrogen receptor–a (ERa) activity in the brain prevents obesity in both males and females. However, the ERa-expressing neural populations that regulate body weight remain to be fully elucidated. Here we showed that single-minded–1 (SIM1) neurons in the medial amygdala (MeA) express abundant levels ...

  7. Auditory/visual Duration Bisection in Patients with Left or Right Medial-Temporal Lobe Resection

    ERIC Educational Resources Information Center

    Melgire, Manuela; Ragot, Richard; Samson, Severine; Penney, Trevor B.; Meck, Warren H.; Pouthas, Viviane

    2005-01-01

    Patients with unilateral (left or right) medial temporal lobe lesions and normal control (NC) volunteers participated in two experiments, both using a duration bisection procedure. Experiment 1 assessed discrimination of auditory and visual signal durations ranging from 2 to 8 s, in the same test session. Patients and NC participants judged…

  8. Material-Specific Lateralization of Working Memory in the Medial Temporal Lobe

    ERIC Educational Resources Information Center

    Wagner, Dylan D.; Sziklas, Viviane; Garver, Krista E.; Jones-Gotman, Marilyn

    2009-01-01

    Mnemonic deficits in patients with medial temporal lobe (MTL) damage arising from temporal lobe epilepsy (TLE) are traditionally constrained to long-term episodic memory, sparing short-term and working memory (WM). This view of WM as being independent of MTL structures has recently been challenged by a small number of patient and neuroimaging…

  9. Vascularized periosteal transfer from the medial femoral condyle: is it compulsory to include the cortical bone?

    PubMed

    Vegas, Manuel R; Delgado, Pedro; Roger, Ignacio; Carosini, Ramon

    2012-04-01

    The corticoperiosteal flap from the medial femoral condyle has become the workhorse in the management of recalcitrant nonunions with vascularized periosteum. Inclusion of the outer condylar cortex has been advocated to avoid damaging the osteogenic capacity of the periosteum and is at present an ordinary technical step in the procedure. A clinical prospective study was undertaken to evaluate the effectiveness of periosteal-only microvascular transfers from the medial femoral condyle associated with bone grafts in the treatment of recalcitrant nonunions. A group of 8 patients with periosteal-only flaps (study group) is compared with a corticoperiosteal control group (13 patients). A statistical analysis is made of the results. We had 100% union rate in both the study and control groups. Evaluation of early signs of bone healing by two independent evaluators did not found differences between the groups (4.5 months in the study and 4.9 months in the control group). Although not statistically significant because of the small sample size, our study might support the idea that both periosteal and corticoperiosteal flaps from the medial femoral condyle are effective, when associated with a bone graft, in the treatment of recalcitrant nonunions with small gaps. A further analysis of the results suggests, albeit no statistical significant, that structural and nonstructural bone grafts are both effective when associated with a vascularized periosteal or corticoperiosteal transfer from the medial femoral condyle.

  10. Distinct medial temporal networks encode surprise during motivation by reward versus punishment.

    PubMed

    Murty, Vishnu P; LaBar, Kevin S; Adcock, R Alison

    2016-10-01

    Adaptive motivated behavior requires predictive internal representations of the environment, and surprising events are indications for encoding new representations of the environment. The medial temporal lobe memory system, including the hippocampus and surrounding cortex, encodes surprising events and is influenced by motivational state. Because behavior reflects the goals of an individual, we investigated whether motivational valence (i.e., pursuing rewards versus avoiding punishments) also impacts neural and mnemonic encoding of surprising events. During functional magnetic resonance imaging (fMRI), participants encountered perceptually unexpected events either during the pursuit of rewards or avoidance of punishments. Despite similar levels of motivation across groups, reward and punishment facilitated the processing of surprising events in different medial temporal lobe regions. Whereas during reward motivation, perceptual surprises enhanced activation in the hippocampus, during punishment motivation surprises instead enhanced activation in parahippocampal cortex. Further, we found that reward motivation facilitated hippocampal coupling with ventromedial PFC, whereas punishment motivation facilitated parahippocampal cortical coupling with orbitofrontal cortex. Behaviorally, post-scan testing revealed that reward, but not punishment, motivation resulted in greater memory selectivity for surprising events encountered during goal pursuit. Together these findings demonstrate that neuromodulatory systems engaged by anticipation of reward and punishment target separate components of the medial temporal lobe, modulating medial temporal lobe sensitivity and connectivity. Thus, reward and punishment motivation yield distinct neural contexts for learning, with distinct consequences for how surprises are incorporated into predictive mnemonic models of the environment. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Medial forefoot fillet flap for primary closure of transmetatarsal amputation: A series of four cases.

    PubMed

    Sidon, Eliezer; Shemesh, Shai; Rosenthal, Yoav; Heller, Snir; Velkes, Steven; Burg, Alon

    2017-12-01

    Amputation of the forefoot is a salvage procedure for several forefoot acute or chronic infection. A good, sensate and durable skin cover is important for quicker and better rehabilitation. The use of filleted flaps (or "spare parts technique") has been published in the past as a creative technique. The purpose of this article is to introduce a reproducible, pre-planned, technique that requires less creativity for the use of the "spare parts". The authors describe a case series of 4 patients with deep infection and osteomyelitis of the forefoot, without involvement of the medial skin that underwent two staged procedure for transmetatarsal amputation with medial forefoot fillet flap. The first procedure was amputation of the 4 lesser metatarsal and the wound was left open. After a few days the second operation was done with amputation of the first metatarsal bone and using the filleted medial skin and subcutaneous tissue for closure of the wound. In conclusion the medial fillet flap is an effective method of covering large wounds after partial, lateral forefoot amputation. This method shortens the healing time of the patient, and in hospital stay. The authors recommend using the staged method when dealing with diabetic patients with partial, central and lateral forefoot deep infection and/or necrosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Stability of the Medial Olivocochlear Reflex as Measured by Distortion Product Otoacoustic Emissions

    ERIC Educational Resources Information Center

    Mishra, Srikanta K.; Abdala, Carolina

    2015-01-01

    Purpose: The purpose of this study was to assess the repeatability of a fine-resolution, distortion product otoacoustic emission (DPOAE)-based assay of the medial olivocochlear (MOC) reflex in normal-hearing adults. Method: Data were collected during 36 test sessions from 4 normal-hearing adults to assess short-term stability and 5 normal-hearing…

  13. In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall.

    PubMed

    Uemura, Tetsuji; Yanai, Tetsu; Yasuta, Masato; Harada, Yoshimi; Morikawa, Aya; Watanabe, Hidetaka; Kurokawa, Masato

    2017-06-01

    In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20-70 mm), the mean width of these was 14.9 mm (range, 8-20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

  14. Does increasing step width alter knee biomechanics in medial compartment knee osteoarthritis patients during stair descent?

    PubMed

    Paquette, Max R; Zhang, Songning; Milner, Clare E; Klipple, Gary

    2014-06-01

    Research shows that one of the first complaints from knee osteoarthritis (OA) patients is difficulty in stair ambulation due to knee pain. Increased step width (SW) has been shown to reduce first and second peak internal knee abduction moments, a surrogate variable for medial compartment knee joint loading, during stair descent in healthy older adults. This study investigates the effects of increased step width (SW) on knee biomechanics and knee pain in medial compartment knee OA patients during stair descent. Thirteen medial compartment knee OA patients were recruited for the study. A motion analysis system was used to obtain three-dimensional joint kinematics. An instrumented staircase was used to collect ground reaction forces (GRF). Participants performed stair descent trials at their self-selected speed using preferred, wide, and wider SW. Participants rated their knee pain levels after each SW condition. Increased SW had no effect on peak knee abduction moments and knee pain. Patients reported low levels of knee pain during all stair descent trials. The 2nd peak knee adduction angle and frontal plane GRF at time of 2nd peak abduction moment were reduced with increasing SW. The findings suggest that increases in SW may not influence knee loads in medial compartment knee OA patients afflicted with low levels of knee pain during stair descent. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Auditory illusions caused by a small lesion in the right medial geniculate body.

    PubMed

    Fukutake, T; Hattori, T

    1998-11-01

    Although the medial geniculate body (MGB) is a well-known integration center for the central auditory pathways, auditory symptoms caused by MGB damage have not been described. We report the appearance of the auditory illusions of hyperacusis and palinacousis in a 49-year-old man without previous psychiatric or epileptic illness after a small hemorrhagic infarction located mainly in the right MGB.

  16. Disruption of the Perineuronal Net in the Hippocampus or Medial Prefrontal Cortex Impairs Fear Conditioning

    ERIC Educational Resources Information Center

    Hylin, Michael J.; Orsi, Sara A.; Moore, Anthony N.; Dash, Pramod K.

    2013-01-01

    The perineuronal net (PNN) surrounds neurons in the central nervous system and is thought to regulate developmental plasticity. A few studies have shown an involvement of the PNN in hippocampal plasticity and memory storage in adult animals. In addition to the hippocampus, plasticity in the medial prefrontal cortex (mPFC) has been demonstrated to…

  17. Hippocampus and Medial Prefrontal Cortex Contributions to Trace and Contextual Fear Memory Expression over Time

    ERIC Educational Resources Information Center

    Beeman, Christopher L.; Bauer, Philip S.; Pierson, Jamie L.; Quinn, Jennifer J.

    2013-01-01

    Previous work has shown that damage to the dorsal hippocampus (DH) occurring at recent, but not remote, timepoints following acquisition produces a deficit in trace conditioned fear memory expression. The opposite pattern has been observed with lesions to the medial prefrontal cortex (mPFC). The present studies address: (1) whether these lesion…

  18. Detection of defects in formed sheet metal using medial axis transformation

    NASA Astrophysics Data System (ADS)

    Murmu, Naresh C.; Velgan, Roman

    2003-05-01

    In the metal forming processes, the sheet metals are often prone to various defects such as thinning, dents, wrinkles etc. In the present manufacturing environments with ever increasing demand of higher quality, detecting the defects of formed sheet metal using an effective and objective inspection system is the foremost norm to remain competitive in market. The defect detection using optical techniques aspire to satisfy its needs to be non-contact and fast. However, the main difficulties to achieve this goal remain essentially on the development of efficient evaluation technique and accurate interpretation of extracted data. The defect like thinning is detected by evaluating the deviations of the thickness in the formed sheet metal against its nominal value. The present evaluation procedure for determination of thickness applied on the measurements data is not without deficiency. To improve this procedure, a new evaluation approach based on medial axis transformation is proposed here. The formed sheet metals are digitized using fringe projection systems in different orientations, and afterwards registered into one coordinate frame. The medial axis transformation (MAT) is applied on the point clouds, generating the point clouds of MAT. This data is further processed and medial surface is determined. The thinning defect is detected by evaluating local wall thickness and other defects like wrinkles are determined using the shape recognition on the medial surface. The applied algorithm is simple, fast and robust.

  19. Network Alterations Supporting Word Retrieval in Patients with Medial Temporal Lobe Epilepsy

    ERIC Educational Resources Information Center

    Protzner, Andrea B.; McAndrews, Mary Pat

    2011-01-01

    Although the hippocampus is not considered a key structure in semantic memory, patients with medial-temporal lobe epilepsy (mTLE) have deficits in semantic access on some word retrieval tasks. We hypothesized that these deficits reflect the negative impact of focal epilepsy on remote cerebral structures. Thus, we expected that the networks that…

  20. Sonographic evaluation of the distal biceps tendon using a medial approach: the pronator window.

    PubMed

    Smith, Jay; Finnoff, Jonathan T; O'Driscoll, Shawn W; Lai, Jim K

    2010-05-01

    The purpose of this report is to describe and demonstrate the potential advantages of a technique to image the distal biceps tendon using a medial approach: the pronator window. Distal biceps tendon imaging via the medial approach was shown using real-time sonography on an asymptomatic volunteer as well as cadaveric anatomic dissection. The medial approach images the biceps tendon with minimal anisotropy while providing several potential advantages, including (1) complete visualization of the ulnarly facing radial tuberosity and the tapered distal biceps insertion, (2) increased contrast and reduced beam attenuation at the interface between the biceps tendon and overlying brachial artery, and (3) avoidance of the beam-attenuating effects of the supinator encountered when imaging the tendon from a lateral approach. The medial approach to image the distal biceps tendon complements previously described techniques and should be considered in the evaluation of patients presenting with distal biceps tendon disorders. Future clinical studies may elucidate the relative advantages and disadvantages of sonographic distal biceps imaging techniques in specific patient populations.

  1. Arthroscopic medial meniscus trimming or repair under nerve blocks: Which nerves should be blocked?

    PubMed Central

    Taha, AM; Abd-Elmaksoud, AM

    2016-01-01

    Background: This study aimed to determine the role of the sciatic and obturator nerve blocks (in addition to femoral block) in providing painless arthroscopic medial meniscus trimming/repair. Materials and Methods: One hundred and twenty patients with medial meniscus tear, who had been scheduled to knee arthroscopy, were planned to be included in this controlled prospective double-blind study. The patients were randomly allocated into three equal groups; FSO, FS, and FO. The femoral, sciatic, and obturator nerves were blocked in FSO groups. The femoral and sciatic nerves were blocked in FS group, while the femoral and obturator nerves were blocked in FO group. Intraoperative pain and its causative surgical maneuver were recorded. Results: All the patients (n = 7, 100%) in FO group had intraoperative pain. The research was terminated in this group but completed in FS and FSO groups (40 patients each). During valgus positioning of the knee for surgical management of the medial meniscus tear, the patients in FS group experienced pain more frequently than those in FSO group (P = 0.005). Conclusion: Adding a sciatic nerve block to the femoral nerve block is important for painless knee arthroscopy. Further adding of an obturator nerve block may be needed when a valgus knee position is required to manage the medial meniscus tear. PMID:27375382

  2. Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers.

    PubMed

    Petersen, Wolf; Forkel, Philipp; Achtnich, Andrea; Metzlaff, Sebastian; Zantop, Thore

    2013-06-01

    The purpose of this article was to demonstrate an anterior cruciate ligament (ACL) reconstruction technique using oval tunnels. Aim of this single bundle technique is to fit the footprint anatomy of the ACL as closely as possible. TECHNIQUE AND PATIENTS: The presented technique is a single bundle technique using a semitendinosus graft. For femoral tunnel placement, a specific medial portal aimer (Karl Storz, Tuttlingen, Germany) is used. Aiming and drilling of the femoral tunnel are performed via the medial portal. Oval tunnels are created by stepwise dilatation with ovally shaped dilatators. The position of the femoral tunnel is visualized and controlled with the arthroscope via the medial portal. For the tibial tunnel placement, a specific aimer was used as well. With this technique, 24 patients were operated and all intra- and postoperative complications were analyzed prospectively. The tunnel position was documented postoperatively by CT scan. There were no significant intra- and postoperative complications associated with the oval tunnel technique. The postoperative 3D CT scan revealed that all femoral and tibial tunnels were located within the area of the anatomical ACL insertions. This article presents an ACL reconstruction technique using oval dilatators and medial portal aimers to create oval tunnels. These oval tunnels match the insertion site anatomy much closer than round tunnels do. Level IV, case series.

  3. Working Memory, Long-Term Memory, and Medial Temporal Lobe Function

    ERIC Educational Resources Information Center

    Jeneson, Annette; Squire, Larry R.

    2012-01-01

    Early studies of memory-impaired patients with medial temporal lobe (MTL) damage led to the view that the hippocampus and related MTL structures are involved in the formation of long-term memory and that immediate memory and working memory are independent of these structures. This traditional idea has recently been revisited. Impaired performance…

  4. Biomechanical effects of plate area and locking screw on medial open tibial osteotomy.

    PubMed

    Luo, Chu-An; Lin, Shang-Chih; Hwa, Su-Yang; Chen, Chun-Ming; Tseng, Ching-Shiow

    2015-01-01

    Medial open high tibial osteotomy (HTO) has been used to treat osteoarthritis of the medial compartment of the knee. However, weaker plate strength, unstable plate/screw junction and improper surgery technique are highly related to the HTO outcomes. Two π-shape plates were designed and eight variations (two supporting area × four locking stiffness) were compared by finite-element method. The computed tomography-based tibia was reconstructed and both wedge micromotion and implant stresses were chosen as the comparison indices. The construct was subjected to surgical and physiological loads. The medial-posterior region is the most loaded region and the load through the posterior leg is about four times that through the anterior leg. This indicates that the two-leg design can form a force-couple mechanism to effectively reduce the implant stresses. The use of locking screws significantly decrease the screw and hole stresses. However, the extending plate reduces the stresses of screws and holes above the wedge but makes the distal screws and holes much stressed. Wedge micromotion is affected by extending plate rather than locking screw. Three factors contribute to effective stabilisation of unstable HTO wedge: (1) intimate tibia-plate contact at medial-posterior regions, (2) sufficient rigidity at plate-screw junctions and (3) effective moment-balancing design at distal tibia-plate interfaces.

  5. Role of Medial Prefrontal Cortex Narp in the Extinction of Morphine Conditioned Place Preference

    ERIC Educational Resources Information Center

    Blouin, Ashley M.; Han, Sungho; Pearce, Anne M.; Cheng, KaiLun; Lee, JongAh J.; Johnson, Alexander W.; Wang, Chuansong; During, Matthew J.; Holland, Peter C.; Shaham, Yavin; Baraban, Jay M.; Reti, Irving M.

    2013-01-01

    Narp knockout (KO) mice demonstrate an impaired extinction of morphine conditioned place preference (CPP). Because the medial prefrontal cortex (mPFC) has been implicated in extinction learning, we tested whether Narp cells in this region play a role in the extinction of morphine CPP. We found that intracranial injections of adenoassociated virus…

  6. Attention, Emotion, and Deactivation of Default Activity in Inferior Medial Prefrontal Cortex

    ERIC Educational Resources Information Center

    Geday, Jacob; Gjedde, Albert

    2009-01-01

    Attention deactivates the inferior medial prefrontal cortex (IMPC), but it is uncertain if emotions can attenuate this deactivation. To test the extent to which common emotions interfere with attention, we measured changes of a blood flow index of brain activity in key areas of the IMPC with positron emission tomography (PET) of labeled water…

  7. Medial Prefrontal Cortex Is Selectively Involved in Response Selection Using Visual Context in the Background

    ERIC Educational Resources Information Center

    Lee, Inah; Shin, Ji Yun

    2012-01-01

    The exact roles of the medial prefrontal cortex (mPFC) in conditional choice behavior are unknown and a visual contextual response selection task was used for examining the issue. Inactivation of the mPFC severely disrupted performance in the task. mPFC inactivations, however, did not disrupt the capability of perceptual discrimination for visual…

  8. Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players.

    PubMed

    Nawabi, Danyal H; Cro, Suzie; Hamid, Imran P; Williams, Andy

    2014-09-01

    Meniscectomy is frequently performed in elite soccer athletes to allow return to a high level of performance as early as possible. Although lateral meniscectomy is known to have more serious long-term sequelae than medial meniscectomy, little is known about the effect of lateral meniscectomy on the time to return to play during the early recovery phase in professional soccer players. Lateral meniscectomy results in longer times to return to preinjury level of competition and a higher incidence of adverse outcomes compared with medial meniscectomy in elite professional soccer players. Cohort study; Level of evidence, 3. A single-surgeon database containing the injury history and operative details of elite soccer athletes from 2005 to 2009 was used to identify players who had undergone an isolated partial lateral or medial meniscectomy. The time to return to preinjury level of competition, the incidence of adverse events during early recovery, and the need for further arthroscopy were recorded. Time to return to play was analyzed by using the Kaplan-Meier method. A multivariate analysis was used to control for age, location of meniscectomy, percentage of meniscus excised, and type of tear. Ninety soccer players were identified, of which 42 had a lateral meniscectomy and 48 had a medial meniscectomy. The median time to return to play, to the nearest week, was longer in the lateral group than the medial group (7 vs 5; P < .001). At all time points after surgery, the cumulative probability of returning to play was 5.99 times greater (95% confidence interval, 3.34-10.74; P < .001) after medial meniscectomy. More lateral meniscectomy cases experienced adverse events related to pain/swelling-29 (69%) vs 4 (8%) (P < .001)-and required a second arthroscopy: 3 (7%) vs 0 (P = .098). The time to return to preinjury level of competition is significantly longer after lateral than medial meniscectomy in elite professional soccer athletes. Lateral meniscectomy has a higher

  9. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears.

    PubMed

    Marchetti, Daniel Cole; Phelps, Brian M; Dahl, Kimi D; Slette, Erik L; Mikula, Jacob D; Dornan, Grant J; Bucci, Gabriella; Turnbull, Travis Lee; Singleton, Steven B

    2017-10-01

    To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged

  10. Gait retraining and incidence of medial tibial stress syndrome in army recruits.

    PubMed

    Sharma, Jagannath; Weston, Matthew; Batterham, Alan M; Spears, Iain R

    2014-09-01

    Gait retraining, comprising biofeedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait-retraining program on medial tibial stress syndrome incidence during a 26-wk basic military training regimen. A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation. The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR per 2 SD increment of 5.2 (1.6 to 53.6). The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample.

  11. [Athletes with exercise-related pain at the medial side of the lower leg].

    PubMed

    Hartgens, F; Hoogeveen, A R; Brink, P R G

    2008-08-16

    Two patients were diagnosed with exercise-related pain at the medial side of the lower leg. The first patient, an 18-year-old woman who had expanded her athletic activities extensively, had developed pain at the inner side of the distal third portion of the left lower leg. She showed over-pronation of the ankle during running. A 3-phase bone scintigram revealed diffuse uptake of the tracer covering a large portion of the medial tibia margin. Based on this evidence, a diagnosis of periostalgia was made. She recovered after a period of relative calf massages and used insoles. The second patient was a 28-year-old male endurance runner who developed pain at the medial shin after intensifying his training regimen. The periods without pain during running became increasingly shorter, and the medial side of the lower leg became sore and tense. Intracompartmental pressure measurements indicated exercise-related posterior deep compartment syndrome of the calf. The patient recovered after fasciotomy. In athletes, exercise-related symptoms of the medial side of the lower leg can be usually attributed to the tibial periosteum or tendons of the deep calfmusculature, tibial stress reaction or fracture, or a compartment syndrome of the deep calf. Surgery is indicated for chronic compartment syndrome, but conservative therapy provides favourable outcomes in the other types of disorders. The optimal conservative therapeutic approach is unknown, but it is advisable to temporary reduce symptom-provoking athletic activity and modify any risk factors present. Ankle over-pronation during running is considered a very relevant intrinsic risk factor.

  12. Medial temporal lobe atrophy and depressive symptoms in elderly patients with and without Alzheimer disease.

    PubMed

    Enache, Daniela; Cavallin, Lena; Lindberg, Olof; Farahmand, Bahman; Kramberger, Milica Gregoric; Westman, Eric; Jelic, Vesna; Eriksdotter, Maria; Ballard, Clive; Winblad, Bengt; Wahlund, Lars-Olof; Aarsland, Dag

    2015-03-01

    To determine whether depressive symptoms are associated with medial temporal lobe atrophy in older people with and without Alzheimer disease (AD). A total of 368 memory clinic patients with AD, mild cognitive impairment, and subjective cognitive impairment (SCI) were included. Depressive symptoms were defined as a score of 8 or higher on Cornell Scale for Depression in Dementia or use of antidepressant medications. Magnetic resonance imaging and computer tomography scans were rated for medial temporal lobe atrophy (MTA), using the Scheltens scale. For a subsample (n = 57 patients), hippocampal volume was manually traced. Based on visual assessment, AD patients with depressive symptoms had less atrophy of the right medial temporal lobe (odds ratio [OR] for having MTA: 0.39; 95% confidence interval [CI] 0.16-0.99) and decreased scores on Scheltens scale for the left medial temporal lobe (OR: 0.43, 95% CI 0.19-0.96) in comparison to AD patients without depressive symptoms. In the subgroup where manual tracing was used to measure hippocampal volume, people with SCI experiencing depressive symptoms had smaller right (mean difference: 0.28 cm(3); P = .005) and left (mean difference 0.32 cm(3); P = .002) hippocampal volumes compared to people with SCI who did not have depressive symptoms. Hippocampal atrophy was more pronounced among patients having SCI with depressive symptoms, while the medial temporal lobe was less atrophic in patients having AD with depressive symptoms than those without depressive symptoms. These findings suggest that different mechanisms underlie depression in older people with and without AD and may explain some of the inconsistent observations in previous studies. © The Author(s) 2014.

  13. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial

    PubMed Central

    Bowles, Kelly-Ann; Payne, Craig; Cicuttini, Flavia; Williamson, Elizabeth; Forbes, Andrew; Hanna, Fahad; Davies-Tuck, Miranda; Harris, Anthony; Hinman, Rana S

    2011-01-01

    Objective To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis. Design Randomised controlled trial. Setting Community in Melbourne, Australia. Participants 200 people aged 50 or more with clinical and radiographic diagnosis of mild to moderately severe medial knee osteoarthritis. Interventions Full length 5 degree lateral wedged insoles or flat control insoles worn inside the shoes daily for 12 months. Main outcome measures Primary symptomatic outcome was change in overall knee pain (past week) measured on an 11 point numerical rating scale. Primary structural outcome was change in volume of medial tibial cartilage from magnetic resonance imaging scans. Secondary clinical outcomes included changes in measures of pain, function, stiffness, and health related quality of life. Secondary structural outcomes included progression of medial cartilage defects and bone marrow lesions. Results Between group differences did not differ significantly for the primary outcomes of change in overall pain (−0.3 points, 95% confidence intervals −1.0 to 0.3) and change in medial tibial cartilage volume (−0.4 mm3, 95% confidence interval −15.4 to 14.6), and confidence intervals did not include minimal clinically important differences. None of the changes in secondary outcomes showed differences between groups. Conclusion Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefits compared with flat control insoles. Trial registration Australian New Zealand Clinical Trials Registry ACTR12605000503628 and ClinicalTrials.gov NCT00415259. PMID:21593096

  14. Combination of transorbital and endoscopic transnasal approaches to repair orbital medial wall and floor fractures.

    PubMed

    Shi, Wodong; Jia, Renbing; Li, Zhengkang; He, Dongmei; Fan, Xianqun

    2012-01-01

    This study aimed to illustrate the effectiveness of the combination of the transorbital and the endoscopic transnasal approach in the repair of medial wall and floor orbital fractures in Chinese patients. A retrospective study was carried out on 25 Chinese patients (18 men and 7 women) with orbital medial wall and floor fractures. All patients had enophthalmos more than 2 mm, 23 had diplopia, and 11 had eye movement restriction. Bone defect involving both medial and inferior walls was found with computed tomographic scans in all patients. In all 25 patients, surgery was done by 1 surgeon group using the transorbital and the endoscope-assisted transnasal approach. The endoscope was used to give a clear view of the posterior edge of the fracture. Titanium meshes were used to repair fractures of the orbital floor and the medial wall. Porous polyethylene sheet implants were used to recover the orbital volume. All patients were followed up 12 months after surgery. Enophthalmos was corrected in all 25 patients immediately, diplopia disappeared or improved in 21 of 23 cases, and eye movement restriction was released or improved in all 11 patients. No significant complications occurred. The titanium mesh was completely covered by nasal mucosa at 1 month after surgery by an endoscopic check. The endoscope-assisted transnasal approach allows for excellent visualization of the extent of the fracture, particularly in areas that are difficult to visualize by conventional methods. The combination of the transorbital and the endoscope-assisted transnasal approach is a good way to reconstruct a large orbital wall fracture involving the floor and the medial wall.

  15. Clinical and radiologic evaluation of medial epicondylar osteotomy for varus total knee arthroplasty.

    PubMed

    Sim, Jae Ang; Na, Young Gon; Go, Jae Yun; Lee, Beom Koo

    2018-01-09

    In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site. The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5±9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at <2mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union). The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus-valgus angle on the stress radiographs between the bony union and fibrous union group (1.6±1.2° vs. 1.6±0.8°, P<0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups. Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site. Copyright © 2017. Published by Elsevier B.V.

  16. The influence of pulleys on the quantitative characteristics of medial rectus muscle recessions: the torque vector model.

    PubMed

    Miller, Aaron M; Mims, James L

    2006-08-01

    To develop a new pulley-based torque vector mathematical model for medial rectus muscle recessions and compare it based on known clinical characteristics, to the currently accepted nonpulley length-tension model. The following quantitative characteristics of the results of bilateral medial rectus muscle recessions were chosen for study to see whether the new torque vector model or the classic length-tension model would better predict these characteristics: (1) larger bilateral medial rectus muscle recessions produce more effect per millimeter, with the dose-response curve approximating an exponential shape; (2) the exact location of the preplaced medial rectus muscle suture prior to muscle disinsertion in recessions has minimal effect on the postoperative ocular alignment; and (3) medial rectus muscle recessions of more than eight mm are likely to produce an early consecutive exotropia. Based on the documented location of the medial rectus muscle pulley, the change in the torque vector per millimeter of medial rectus muscle recession was calculated and shown to have an exponential shape. For all three of the quantitative characteristics chosen, the torque vector model appears to better predict the results of medial rectus muscle recessions when compared with the length-tension model. Many quantitative characteristics of medial rectus muscle recessions are better explained by the torque vector model, instead of the classical length-tension model, and support the presence, location, and function of the medial rectus muscle pulley. This new understanding of ocular motility mechanics may influence surgical technique and introduce new surgical considerations for correction of ocular motility disorders.

  17. Medial tilting of the joint line in posterior stabilized total knee arthroplasty increases contact force and stress.

    PubMed

    Tanaka, Yoshihisa; Nakamura, Shinichiro; Kuriyama, Shinichi; Nishitani, Kohei; Ito, Hiromu; Furu, Moritoshi; Watanabe, Mutsumi; Matsuda, Shuichi

    2018-02-09

    Kinematically aligned total knee arthroplasty is based on the concept to represent the premorbid joint alignment with cruciate-retaining implants, characterized by medial tilt and internal rotation. However, kinematic and kinetic effects of kinematically aligned total knee arthroplasty with posterior-stabilized implants is unknown. The purpose of this study was to examine the effect of medial tilting of the joint line with posterior-stabilized implants. A mechanical alignment model, and medial tilt 3° and 5° models were constructed. Knee kinematics and contact forces were simulated using a musculoskeletal computer simulation model. Contact stresses on the tibiofemoral joint and the post area were then calculated using finite element analysis. From 0° to 120° of knee flexion, greater external rotation of the femoral component was observed in medial tilt models (-0.6°, 1.8° and 4.2° in mechanical alignment, medial tilt 3° and medial tilt 5° models, respectively). The peak contact stresses on the tibiofemoral joint and the post area at 120° of knee flexion were higher in medial tilt models. The peak contact stresses on the post area in medial tilt 3° and 5° models were 2.2 and 3.8 times greater than that in mechanical alignment model, respectively. Medial tilting of the joint line causes greater axial rotation even with posterior-stabilized implants, which can represent near-normal kinematics. However, medial tilting of the joint line in total knee arthroplasty with posterior-stabilized implants may have a higher risk for polyethylene wear at the tibiofemoral joint and post area, leading to subsequent component loosening. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. Longitudinal dynamics in storage rings

    SciTech Connect

    Colton, E.P.

    1986-01-01

    The single-particle equations of motion are derived for charged particles in a storage ring. Longitudinal space charge is included in the potential assuming an infinitely conducting circular beam pipe with a distributed inductance. The framework uses Hamilton's equations with the canonical variables phi and W. The Twiss parameters for longitudinal motion are also defined for the small amplitude synchrotron oscillations. The space-charge Hamiltonian is calculated for both parabolic bunches and ''matched'' bunches. A brief analysis including second-harmonic rf contributions is also given. The final sections supply calculations of dynamical quantities and particle simulations with the space-charge effects neglected.

  19. Longitudinally-vibrating surgical microelectrode

    NASA Technical Reports Server (NTRS)

    Feldstein, C.; Crawford, D.; Kawabus, E. W.

    1977-01-01

    Microelectrode attached to cone of loudspeaker imparting longitudinal vibrations, penetrates relatively tough tissue of arterial walls easier and with more precise depth control because dimpling is eliminated. Vibrating microelectrode has been successfully used to make accurate oxygen-content measurements in arterial walls.

  20. Longitudinal Studies of Spelling Development.

    ERIC Educational Resources Information Center

    Ellis, Nick

    Noting that proposed models of literacy development suggest that reading and writing mutually influence and grow from each other, this paper summarizes aspects of stage theories of literacy development and an integrative model, and considers how the model fared in empirical longitudinal tests. The paper begins with a summary of the modal aspects…

  1. Students dance longitudinal standing waves

    NASA Astrophysics Data System (ADS)

    Ruiz, Michael J.

    2017-05-01

    A demonstration is presented that involves students dancing longitudinal standing waves. The resulting kinaesthetic experience and visualization both contribute towards an understanding of the natural modes of vibrations in open and closed pipes. A video of this fun classroom activity is provided (http://mjtruiz.com/ped/dance/).

  2. Congenital third nerve palsy with synergistic depression on attempted adduction and trigemino-oculomotor synkinesis: Underpinnings of a spectral dysinnervation disorder

    PubMed Central

    Pandey, Pramod Kumar; Bhambhwani, Vishaal; Ranjith, P C; Kadav, Mandar; Aparnaa, C

    2016-01-01

    The authors describe a case of congenital partial pupil-sparing third cranial nerve palsy with absent adduction, synergistic depression of globe and widening of palpebral fissure on attempted adduction and synergistic elevation and adduction on mouth opening and sideways thrusting of jaw. The case illustrates trigemino-oculomotor synkinesis associated with congenital third nerve palsy. The possible mechanism of miswiring involving the medial longitudinal fasciculus and trigeminal nuclei is discussed. At least some cases of congenital third cranial nerve palsy may fall in the realm of congenital cranial dysinnervation disorders (CCDDs) sharing a much wider spectrum of presentation. PMID:27380983

  3. Congenital third nerve palsy with synergistic depression on attempted adduction and trigemino-oculomotor synkinesis: Underpinnings of a spectral dysinnervation disorder.

    PubMed

    Pandey, Pramod Kumar; Bhambhwani, Vishaal; Ranjith, P C; Kadav, Mandar; Aparnaa, C

    2016-05-01

    The authors describe a case of congenital partial pupil-sparing third cranial nerve palsy with absent adduction, synergistic depression of globe and widening of palpebral fissure on attempted adduction and synergistic elevation and adduction on mouth opening and sideways thrusting of jaw. The case illustrates trigemino-oculomotor synkinesis associated with congenital third nerve palsy. The possible mechanism of miswiring involving the medial longitudinal fasciculus and trigeminal nuclei is discussed. At least some cases of congenital third cranial nerve palsy may fall in the realm of congenital cranial dysinnervation disorders (CCDDs) sharing a much wider spectrum of presentation.

  4. Spontaneously hypertensive rats have more orexin neurons in their medial hypothalamus than normotensive rats.

    PubMed

    Clifford, Liam; Dampney, Bruno W; Carrive, Pascal

    2015-04-01

    What is the central question of this study? Blockade of orexin receptors reduces blood pressure in spontaneously hypertensive rats (SHRs) but not in normotensive Wistar-Kyoto (WKY) rats, suggesting that upregulation of orexin signalling underlies the hypertensive phenotype of the SHR. However, it is not known what causes this upregulation. What is the main finding and its importance? Using orexin immunolabelling, we show that SHRs have 20% more orexin neurons than normotensive WKY and Wistar rats in the medial hypothalamus, which is a good match to their blood pressure phenotype. In contrast, there is no such match for the orexin neurons of the lateral hypothalamus. Essential hypertension may be linked to an increase in orexin neurons in the medial hypothalamus. The neuropeptide orexin contributes to the regulation of blood pressure as part of its role in the control of arousal during wakefulness and motivated behaviour (including responses to psychological stress). Recent work shows that pharmacological blockade of orexin receptors reduces blood pressure in spontaneously hypertensive rats (SHRs) but not in normotensive Wistar-Kyoto (WKY) rats. It is not clear why orexin signalling is upregulated in the SHR, but one possibility is that these animals have more orexin neurons than their normotensive WKY and Wistar relatives. To test this possibility, SHRs, WKY and Wistar male rats (6-16 weeks old) were killed, perfused and their brains sectioned and immunolabelled for orexin A. Labelled neurons were plotted and counted in the six best labelled hemisections (120 μm apart) of each brain. There were significantly more orexin neurons (+20%) in the medial hypothalamus (medial to fornix) of SHRs compared with WKY and Wistar rats (126 ± 4 versus 106 ± 5 and 104 ± 5 per hemisection, respectively, P < 0.05), which matches well the blood pressure phenotypes. In contrast, counts in the lateral hypothalamus did not match the blood pressure phenotypes (69 ± 2 versus 50 ± 3

  5. [Aortic aneurysm in Erdheim's idiopathic cystic medial necrosis in autopsy and forensic medical practice].