Microinfusion of nefazodone into the basolateral nucleus of the amygdala enhances defensive behavior induced by NMDA stimulation of the inferior colliculus.

PubMed

Maisonnette, S; Villela, C; Carotti, A P; Landeira-Fernandez, J

2000-01-01

The inferior colliculus is notably associated with defensive behavior. Electrical or pharmacological stimulation of the inferior colliculus induces aversive reactions such as running and jumping. Lesion of the basolateral nucleus of the amygdala decreases the threshold of aversive reactions induced by electrical stimulation of the inferior colliculus. The present work examined the influence of microinjections of nefazodone, a serotonin (5-HT(2)) antagonist, into the basolateral nucleus of amygdala on aversive reactions induced by N-methyl-D-aspartate (NMDA) microinjected into the inferior colliculus. Rats implanted with cannulae in the inferior colliculus and in the basolateral nucleus of the amygdala were submitted to the open-field test where defensive behaviors were observed. Results indicated that microinjection of nefazodone into the basolateral nucleus of the amygdala increases aversive responses induced by NMDA injections into the inferior colliculus. This result suggests that the inferior colliculus and the basolateral nucleus of the amygdala have a functional relationship on the neural circuitry of defensive behavior. Moreover, 5-HT(2) receptors located at the basolateral nucleus of the amygdala seem to play an inhibitory role on defensive behaviors induced by inferior colliculus stimulation.

Dynamic Analysis of Gene Expression in Rice Superior and Inferior Grains by RNA-Seq

PubMed Central

Sun, Hongzheng; Peng, Ting; Zhao, Yafan; Du, Yanxiu; Zhang, Jing; Li, Junzhou; Xin, Zeyu; Zhao, Quanzhi

2015-01-01

Poor grain filling of inferior grains located on lower secondary panicle branch causes great drop in rice yield and quality. Dynamic gene expression patterns between superior and inferior grains were examined from the view of the whole transcriptome by using RNA-Seq method. In total, 19,442 genes were detected during rice grain development. Genes involved in starch synthesis, grain storage and grain development were interrogated in particular in superior and inferior grains. Of the genes involved in sucrose to starch transformation process, most were expressed at lower level in inferior grains at early filling stage compared to that of superior grains. But at late filling stage, the expression of those genes was higher in inferior grains and lower in superior grains. The same trends were observed in the expression of grain storage protein genes. While, evidence that genes involved in cell cycle showed higher expression in inferior grains during whole period of grain filling indicated that cell proliferation was active till the late filling stage. In conclusion, delayed expression of most starch synthesis genes in inferior grains and low capacity of sink organ might be two important factors causing low filling rate of inferior grain at early filling stage, and shortage of carbohydrate supply was a limiting factor at late filling stage. PMID:26355995

Endovascular management of inferior vena cava filter thrombotic occlusion.

PubMed

Branco, Bernardino C; Montero-Baker, Miguel F; Espinoza, Eduardo; Gamero, Maria; Zea-Vera, Rodrigo; Labropoulos, Nicos; Leon, Luis R

2018-01-01

Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified. Demographics, clinical data, procedures, and outcomes were extracted. Patients were followed to the last clinic visit or until they died. Results One-hundred eighty filters were placed by our group practice during the study period. Of those, a total of 10 patients were identified. Overall, there were 7 males; the mean age was 57.1 years (25-78 years). The median time between inferior vena cava filter placement and filter occlusion was 105 days (range 5-4745 days). All patients were clinically symptomatic at the time of their presentation. Nine out of 10 patients were successfully managed endovascularly. Trellis™-8 thrombectomy was the most common endovascular strategy performed ( n = 9). Four patients had balloon angioplasty, two of those with stent placement for chronically occluded inferior vena cava/iliac veins. No thromboembolic complications developed during a median follow-up period of 233 days (range 4-1083 days). Conclusions Endovascular management of inferior vena cava occlusion is feasible, safe, and effective in decreasing thrombus burden in the presence of an inferior vena cava filter. Further studies evaluating long-term inferior vena cava patency and optimal surveillance regimen after endovascular management of filter-related inferior vena cava occlusion are warranted.

Prehospital Nitroglycerin Safety in Inferior ST Elevation Myocardial Infarction.

PubMed

Robichaud, Laurie; Ross, Dave; Proulx, Marie-Hélène; Légaré, Sébastien; Vacon, Charlene; Xue, Xiaoqing; Segal, Eli

2016-01-01

Patients with inferior ST elevation myocardial infarction (STEMI), associated with right ventricular infarction, are thought to be at higher risk of developing hypotension when administered nitroglycerin (NTG). However, current basic life support (BLS) protocols do not differentiate location of STEMI prior to NTG administration. We sought to determine if NTG administration is more likely to be associated with hypotension (systolic blood pressure < 90 mmHg) in inferior STEMI compared to non-inferior STEMI. We conducted a retrospective chart review of prehospital patients with chest pain of suspected cardiac origin and computer-interpreted prehospital ECGs indicating "ACUTE MI." We included all local STEMI cases identified as part of our STEMI registry. Univariate analysis was used to compare differences in proportions of hypotension and drop in systolic blood pressure ≥ 30 mmHg after nitroglycerin administration between patients with inferior wall STEMI and those with STEMI in another region (non-inferior). Multiple variable logistic regression analysis was also used to assess the study outcomes while controlling for various factors. Over a 29-month period, we identified 1,466 STEMI cases. Of those, 821 (56.0%) received NTG. We excluded 16 cases because of missing data. Hypotension occurred post NTG in 38/466 inferior STEMIs and 30/339 non-inferior STEMIs, 8.2% vs. 8.9%, p = 0.73. A drop in systolic blood pressure ≥ 30 mmHg post NTG occurred in 23.4% of inferior STEMIs and 23.9% of non-inferior STEMIs, p = 0.87. Interrater agreement for chart review of the primary outcome was excellent (κ = 0.94). NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories. Computer interpretation of inferior STEMI cannot be used as the sole predictor for patients who may be at higher risk for hypotension following NTG administration.

[Analysis of factors predicting early unplanned readmissions].

PubMed

Di Domenico, Gabriella; Tersigni, Ivan; Federico, Bruno; Leuter, Cinzia

2016-01-01

OBIETTIVI: determinare i fattori associati ai ricoveri ripetuti per identificare i pazienti a rischio di riospedalizzazione entro i 30 giorni dalla dimissione. DISEGNO: analisi retrospettiva delle dimissioni nell'anno 2013 attraverso le schede di dimissione ospedaliera (SDO). 3.900 pazienti ricoverati presso il presidio ospedaliero "Fabrizio Spaziani" di Frosinone. PRINCIPALI MISURE DI OUTCOME: analisi bivariata per l'analisi dell'associazione tra variabili. La regressione logistica è stata utilizzata per identificare i fattori di rischio associati al ricovero ripetuto. RISULTATI: tra i 3.900 pazienti considerati, il 12,8% ha avuto una riammissione non programmata entro un mese dalla dimissione precedente per le stesse categorie diagnostiche principali (MCD). Sono state rilevate differenze statisticamente significative tra i pazienti con e senza ricovero ripetuto per età, durata della degenza, titolo di studio, condizione occupazionale e diagnosi. I fattori che aumentano la probabilità di una riospedalizzazione sono il vivere da solo, la condizione di pensionato o casalinga, una degenza più lunga e alcune diagnosi, fra cui malattie dell'apparato respiratorio, del sistema nervoso e dell'apparato urinario. CONCLUSIONE: alcune caratteristiche sociodemografiche e la diagnosi dei pazienti ospedalizzati sono associate al rischio di riospedalizzazione entro 30 giorni dalla dimissione. I dati disponibili nell'archivio delle SDO possono essere utilizzati per un'identificazione dei pazienti a rischio sui quali definire specifici piani di dimissione.

Clinical and sociodemographic variables associated with diabetes-related distress in patients with type 2 diabetes mellitus.

PubMed

Zanchetta, Flávia Cristina; Trevisan, Danilo Donizetti; Apolinario, Priscila Peruzzo; Silva, Juliana Bastoni da; Lima, Maria Helena de Melo

2016-01-01

To evaluate the relation between diabetes-related distress and the clinical and sociodemographic characteristics of type 2 diabetes mellitus patients. A cross-sectional study based on a secondary analysis of data collected at a specialized care outpatient center in Brazil. Participants completed a questionnaire on sociodemographic and clinical characteristics and the Brazilian version of the Diabetes Distress Scale (B-DDS). About 31% of the 130 eligible patients reported diabetes distress, and the mean B-DDS score was 2.6. Multiple regression analysis showed the B-DDS score was positively correlated with marital status (p=0.0230), use of diet and physical activities for diabetes management (p=0.0180), and use of insulin therapy (p=0.0030). The "emotional burden", "regimen-related distress", and "interpersonal distress" domains from B-DDS were associated with the use of insulin therapy (p=0.0010), marital status (p=0.0110), and the presence of three or more comorbidities (p=0.0175). These findings suggest the clinical and sociodemographic variables are relatively weak predictors of diabetes-related distress. The highest scores in the B-DDS were observed in the emotional burden domain, indicating the presence of diabetes distress among the participants of the study. Avaliar a relação entre o estresse relacionado ao diabetes e as características clínicas e sociodemográficas de pacientes com diabetes mellitus do tipo 2. Estudo transversal com base na análise secundária de dados coletados em um ambulatório de atendimento terciário no Brasil. Os participantes preencheram um questionário sobre as características sociodemográficas e clínicas, e a versão brasileira da Diabetes Distress Scale (B-DDS). Aproximadamente 31% dos 130 pacientes elegíveis relataram estresse relacionado ao diabetes, e a média do escore da B-DDS foi de 2,6. O modelo de regressão múltipla mostrou que a pontuação B-DDS foi positivamente correlacionada com o estado civil (p=0,0230), realização de dieta e atividades físicas (p=0,0180), e uso de insulina (p=0,0030). Os domínios da B-DDS "carga emocional", "estresse relacionado ao regime terapêutico" e "estresse nas relações interpessoais" foram associados a uso de insulina (p=0,0010), estado civil (p=0,0110) e presença de três ou mais comorbidades (p=0,0175). Estes resultados sugerem que as variáveis clínicas e sociodemográficas são preditores relativamente fracos para o estresse relacionado ao diabetes. No domínio "carga emocional", foi observada a maior pontuação da B-DDS, indicando a presença do estresse relacionado ao diabetes entre os pacientes deste estudo.

Inferior tilt fixation of the glenoid component in reverse total shoulder arthroplasty: A biomechanical study.

PubMed

Chae, S W; Lee, J; Han, S H; Kim, S-Y

2015-06-01

Glenoid component fixation with an inferior tilt has been suggested to decrease scapular notching, but this remains controversial. We aimed here to evaluate the effect of glenoid component inferior tilt in reverse total shoulder arthroplasty (RSA) on micromotion and loss of fixation of the glenoid component by biomechanical testing. Increased inferior reaming of the glenoid for inferiorly tilted implantation of the glenoid component will decrease glenoid bone stock and compromise the fixation of RSA. The micromotions of the glenoid components attached to 14 scapulae from fresh frozen cadavers were measured and compared between neutral and 10° inferior tilts in 0.7- and 1-body weight cyclic loading tests using digital-image analysis. The incidence of bone breakage or loss of fixation was assessed in the 1-body weight fatigue-loading test. Micromotion was higher with a 10° inferior tilt than with a neutral tilt during both the 0.7-body weight (36 ± 11 μm vs. 22 ± 5 μm; P = 0.028) and 1-body weight (44 ± 16 μm vs. 28 ± 9 μm; P = 0.045) cyclic loading. The incidence of bone breakage or loss of fixation was 17% and 60% with a neutral and 10° inferior tilt, respectively. Glenoid component inferior tilt fixation in RSA may reduce primary stability and increase mechanical failure of the glenoid component, thereby reducing longevity of the prosthesis. Accordingly, we recommend careful placement of the glenoid component when an inferior tilt is used. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Origin of a common trunk for the inferior phrenic arteries from the right renal artery: a new anatomic vascular variant with clinical implications.

PubMed

Topaz, On; Topaz, Allyne; Polkampally, Pritam R; Damiano, Thomas; King, Christopher A

2010-01-01

The inferior phrenic arteries constitute a pair of important vessels, supplying multiple organs including the diaphragm, adrenal glands, esophagus, stomach, liver, inferior vena cava, and retroperitoneum. The vast majority (80-90%) of inferior phrenic arteries originate as separate vessels with near equal frequency from either the abdominal aorta or the celiac trunk. Infrequently, the right and left inferior phrenic arteries can arise in the form of a common trunk from the aorta or from the celiac trunk. We herein present three patients with a new anatomic vascular variant: a common trunk of the inferior phrenic arteries arising from the right renal artery. In one case, the left inferior phrenic branch of the common trunk provided collaterals connecting with a supra-diaphragmatic branch of the left internal mammary artery and in another with the lateral wall of the pericardium. Angiographic identification of a common trunk for the inferior phrenic arteries arising from the right renal artery is important for proper diagnosis and clinical management. The presence of this unique vascular variant can impact revascularization of the renal arteries. Published by Elsevier Inc.

Endobronchial Forceps-Assisted and Excimer Laser-Assisted Inferior Vena Cava Filter Removal: The Data, Where We Are, and How It Is Done.

PubMed

Chen, James X; Montgomery, Jennifer; McLennan, Gordon; Stavropoulos, S William

2018-06-01

The recognition of inferior vena cava filter related complications has motivated increased attentiveness in clinical follow-up of patients with inferior vena cava filters and has led to development of multiple approaches for retrieving filters that are challenging or impossible to remove using conventional techniques. Endobronchial forceps and excimer lasers are tools for designed to aid in complex inferior vena cava filter removals. This article discusses endobronchial forceps-assisted and excimer laser-assisted inferior vena cava filter retrievals. Copyright © 2018 Elsevier Inc. All rights reserved.

Superior versus inferior Ahmed glaucoma valve implantation.

PubMed

Pakravan, Mohammad; Yazdani, Shahin; Shahabi, Camelia; Yaseri, Mehdi

2009-02-01

To compare the efficacy and safety of Ahmed glaucoma valve (AGV) (New World Medical Inc., Rancho Cucamonga, CA) implantation in the superior versus inferior quadrants. Prospective parallel cohort study. A total of 106 eyes of 106 patients with refractory glaucoma. Consecutive patients with refractory glaucoma underwent AGV implantation in the superior or inferior quadrants. Main outcome measures included intraocular pressure (IOP) and rate of complications. Other outcome measures included best corrected visual acuity (BCVA), number of glaucoma medications, and success rate (defined as at least 30% IOP reduction and 50.122). After 1 year, statistically significant but comparable IOP reduction from baseline (P<0.001) was achieved in both groups (47.0%+/-27.2% and 43.0%+/-24.5% reduction for superior and inferior groups, respectively, P = 0.725). The mean number of glaucoma medications was comparable after 1 year (1.3+/-1.2 vs. 1.9+/-0.8 for superior and inferior implants, respectively, P = 0.256). Success rates were also similar at 1 year: 27 eyes (81.8%) versus 20 eyes (95.2%) for superior and inferior implants, respectively (P = 0.227). However, the overall rate of complications, such as implant exposure necessitating removal, cosmetically unappealing appearance, and endophthalmitis, was higher in the inferior group: 12 eyes (25%) versus 3 eyes (5.2%) for superior and inferior groups, respectively, (P = 0.004). Superior and inferior AGV implants have similar intermediate efficacy in terms of IOP reduction, decrease in number of glaucoma medications, and preservation of vision. However, the inferior quadrants entail significantly more complications. It may be prudent to avoid AGV implantation in the inferior quadrants if the superior quadrants have no contraindications to surgery. Proprietary or commercial disclosure may be found after the references.

Complications of inferior vena cava filters.

PubMed

Sella, David M; Oldenburg, W Andrew

2013-03-01

With the introduction of retrievable inferior vena cava filters, the number being placed for protection from pulmonary embolism is steadily increasing. Despite this increased usage, the true incidence of complications associated with inferior vena cava filters is unknown. This article reviews the known complications associated with these filters and suggests recommendations and techniques for inferior vena cava filter removal. Copyright © 2013. Published by Elsevier Inc.

Detecting and accounting for violations of the constancy assumption in non-inferiority clinical trials.

PubMed

Koopmeiners, Joseph S; Hobbs, Brian P

2018-05-01

Randomized, placebo-controlled clinical trials are the gold standard for evaluating a novel therapeutic agent. In some instances, it may not be considered ethical or desirable to complete a placebo-controlled clinical trial and, instead, the placebo is replaced by an active comparator with the objective of showing either superiority or non-inferiority to the active comparator. In a non-inferiority trial, the experimental treatment is considered non-inferior if it retains a pre-specified proportion of the effect of the active comparator as represented by the non-inferiority margin. A key assumption required for valid inference in the non-inferiority setting is the constancy assumption, which requires that the effect of the active comparator in the non-inferiority trial is consistent with the effect that was observed in previous trials. It has been shown that violations of the constancy assumption can result in a dramatic increase in the rate of incorrectly concluding non-inferiority in the presence of ineffective or even harmful treatment. In this paper, we illustrate how Bayesian hierarchical modeling can be used to facilitate multi-source smoothing of the data from the current trial with the data from historical studies, enabling direct probabilistic evaluation of the constancy assumption. We then show how this result can be used to adapt the non-inferiority margin when the constancy assumption is violated and present simulation results illustrating that our method controls the type-I error rate when the constancy assumption is violated, while retaining the power of the standard approach when the constancy assumption holds. We illustrate our adaptive procedure using a non-inferiority trial of raltegravir, an antiretroviral drug for the treatment of HIV.

Detecting and Accounting for Violations of the Constancy Assumption in Non-Inferiority Clinical Trials

PubMed Central

Koopmeiners, Joseph S.; Hobbs, Brian P.

2016-01-01

Randomized, placebo-controlled clinical trials are the gold standard for evaluating a novel therapeutic agent. In some instances, it may not be considered ethical or desirable to complete a placebo-controlled clinical trial and, instead, the placebo is replaced by an active comparator (AC) with the objective of showing either superiority or non-inferiority to the AC. In a non-inferiority trial, the experimental treatment is considered non-inferior if it retains a pre-specified proportion of the effect of the AC as represented by the non-inferiority margin. A key assumption required for valid inference in the non-inferiority setting is the constancy assumption, which requires that the effect of the AC in the non-inferiority trial is consistent with the effect that was observed in previous trials. It has been shown that violations of the constancy assumption can result in a dramatic increase in the rate of incorrectly concluding non-inferiority in the presence of ineffective or even harmful treatment. In this paper, we illustrate how Bayesian hierarchical modeling can be used to facilitate multi-source smoothing of the data from the current trial with the data from historical studies, enabling direct probabilistic evaluation of the constancy assumption. We then show how this result can be used to adapt the non-inferiority margin when the constancy assumption is violated and present simulation results illustrating that our method controls the type-I error rate when the constancy assumption is violated, while retaining the power of the standard approach when the constancy assumption holds. We illustrate our adaptive procedure using a non-inferiority trial of raltegravir, an antiretroviral drug for the treatment of HIV. PMID:27587591

A Case of Blunt Trauma of the Eyeball Associated With an Inferior Oblique Muscle and an Inferior Rectus Muscle Rupture.

PubMed

Nitta, Keisuke; Kashima, Tomoyuki; Miura, Fumihide; Hiroe, Takashi; Akiyama, Hideo; Kishi, Shoji

2016-01-01

Rupture of the extraocular muscle in the absence of significant injury to the eyeball and adnexa is uncommon. The authors report a case of blunt trauma of the eyeball associated with an inferior oblique muscle and an inferior rectus muscle rupture. A 55-year-old man slipped and fell down hitting his eye on an extended windshield wiper blade. Although he had treatment in the emergency room, he complained of diplopia in the primary position 1 day postoperatively. After noticing ruptures of the inferior oblique muscle and an inferior rectus muscle during exploratory surgery, the authors carefully repaired it. Diplopia in the primary position had disappeared within 1 month after the operation and by 6 months postoperatively. The movement of the eye had almost completely recovered.

Selective activation of the latissimus dorsi and the inferior fibers of trapezius at various shoulder angles during isometric pull-down exertion.

PubMed

Park, Se-yeon; Yoo, Won-gyu

2013-12-01

The aim of this study was to determine the effect of isometric pull down exercise on muscle activity with shoulder elevation angles of 60°, 90°, and 120° and sagittal, scapular, and frontal movement planes, by electromyography (EMG) of the latissimus dorsi, inferior fibers of trapezius, and latissimus dorsi/inferior fibers of trapezius activity ratio. Fourteen men performed nine conditions of isometric pull down exercise (three conditions of shoulder elevation × three conditions of movement planes). Surface EMG was used to collect data from the latissimus dorsi and inferior fibers of trapezius during exercise. Two-way repeated analysis of variance with two within-subject factors (shoulder elevation angles and planes of movement) was used to determine the significance of the latissimus dorsi and inferior fibers of trapezius activity and latissimus dorsi/inferior fibers of trapezius activity ratio. The latissimus dorsi activity and ratio between the latissimus dorsi and the inferior fibers of trapezius were significantly decreased as shoulder elevation angle increased from 60° to 120°. The inferior fibers of trapezius activity was significantly increased with shoulder elevation angle. The EMG activity and the ratios were not affected by changes in movement planes. This study suggests that selective activation of the latissimus dorsi is accomplished with a low shoulder elevation angle, while the inferior fibers of the trapezius are activated with high shoulder elevation angles. Copyright © 2013 Elsevier Ltd. All rights reserved.

Graded versus ungraded inferior oblique anterior transposition in patients with asymmetric dissociated vertical deviation.

PubMed

Rajavi, Zhale; Feizi, Mohadeseh; Naderi, Ali; Sabbaghi, Hamideh; Behradfar, Narges; Yaseri, Mehdi; Faghihi, Mohammad

2017-12-01

To report the surgical outcomes of graded versus ungraded inferior oblique anterior transposition (IOAT) in treatment of patients with asymmetric dissociated vertical deviation (DVD) and bilateral inferior oblique overaction (IOOA). A total of 74 eyes of 37 patients with asymmetric DVD (interocular difference of ≥5 Δ ) and bilateral IOOA of > +1 were included in this randomized clinical trial. In the ungraded group (n = 18), both inferior oblique muscles were sutured at the inferior rectus level; in the graded group (n = 19), the inferior oblique muscles of eyes with more DVD were sutured at the level of the inferior rectus and inferior oblique muscles of eyes with less DVD were sutured 2 mm posterior to the level of the inferior rectus muscle. DVD was significantly reduced in each group (P < 0.001 for both). Although the postoperative mean difference of asymmetry of DVD was less in the ungraded group compared to the graded group (1.2 ± 1.9 vs 3.2 ± 1.2 [P = 0.001]), the absolute amounts of reduction of DVD asymmetry were similar (4.3 ± 2.3 vs 4.4 ± 3.1 [P = 0.78]). IOOA and V patterns were also reduced postoperatively. Each method of IOAT was effective in reducing DVD, asymmetry, IOOA, and V patterns. Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis.

PubMed

Gayer, G; Luboshitz, J; Hertz, M; Zissin, R; Thaler, M; Lubetsky, A; Bass, A; Korat, A; Apter, S

2003-03-01

We describe a possible relationship between inferior vena cava anomalies and extensive thrombosis of the inferior vena cava and the iliac and femoral veins. An anomaly of the inferior vena cava should be considered in young patients who present with deep vein thrombosis of the femoral and iliac veins. Coagulation abnormalities, frequently found in these patients, may be a contributory factor.

Characterization and Utilization of Opiate-Like Hibernation Factors.

DTIC Science & Technology

1993-12-08

duodenum, and both kidneys were dissected free, along with the abdominal aorta and the inferior vena cava . The chest was then opened, and the heart, and...lungs along with the aorta and the superior and inferior vena cava (IVC), were dissected free. The trachea was transected and an endotracheal tube was...pericardial incision was extended inferiorly, exposing the anterior aspect of the left atrium and the left -Page 36 - inferior pulmonary vein. The

Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture.

PubMed

Michelin, Paul; Delarue, Yohann; Duparc, Fabrice; Dacher, Jean Nicolas

2013-10-01

The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side. Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann-Whitney test. The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P < 0.0001). Twenty per cent of patients with capsular contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff. The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US. • Ultrasound is increasingly used to diagnose shoulder problems. • The thickness of the inferior glenohumeral ligament is measurable in the axilla. • The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. • Capsular contracture ultrasound features can be associated with other rotator cuff problems.

Inferior alveolar nerve block: Alternative technique

PubMed Central

Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

2012-01-01

Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

Inferior alveolar nerve block: Alternative technique.

PubMed

Thangavelu, K; Kannan, R; Kumar, N Senthil

2012-01-01

Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages.

Active integration of glutamatergic input to the inferior olive generates bidirectional postsynaptic potentials

PubMed Central

Garden, Derek L. F.; Rinaldi, Arianna

2016-01-01

Key points We establish experimental preparations for optogenetic investigation of glutamatergic input to the inferior olive.Neurones in the principal olivary nucleus receive monosynaptic extra‐somatic glutamatergic input from the neocortex.Glutamatergic inputs to neurones in the inferior olive generate bidirectional postsynaptic potentials (PSPs), with a fast excitatory component followed by a slower inhibitory component.Small conductance calcium‐activated potassium (SK) channels are required for the slow inhibitory component of glutamatergic PSPs and oppose temporal summation of inputs at intervals ≤ 20 ms.Active integration of synaptic input within the inferior olive may play a central role in control of olivo‐cerebellar climbing fibre signals. Abstract The inferior olive plays a critical role in motor coordination and learning by integrating diverse afferent signals to generate climbing fibre inputs to the cerebellar cortex. While it is well established that climbing fibre signals are important for motor coordination, the mechanisms by which neurones in the inferior olive integrate synaptic inputs and the roles of particular ion channels are unclear. Here, we test the hypothesis that neurones in the inferior olive actively integrate glutamatergic synaptic inputs. We demonstrate that optogenetically activated long‐range synaptic inputs to the inferior olive, including projections from the motor cortex, generate rapid excitatory potentials followed by slower inhibitory potentials. Synaptic projections from the motor cortex preferentially target the principal olivary nucleus. We show that inhibitory and excitatory components of the bidirectional synaptic potentials are dependent upon AMPA (GluA) receptors, are GABAA independent, and originate from the same presynaptic axons. Consistent with models that predict active integration of synaptic inputs by inferior olive neurones, we find that the inhibitory component is reduced by blocking large conductance calcium‐activated potassium channels with iberiotoxin, and is abolished by blocking small conductance calcium‐activated potassium channels with apamin. Summation of excitatory components of synaptic responses to inputs at intervals ≤ 20 ms is increased by apamin, suggesting a role for the inhibitory component of glutamatergic responses in temporal integration. Our results indicate that neurones in the inferior olive implement novel rules for synaptic integration and suggest new principles for the contribution of inferior olive neurones to coordinated motor behaviours. PMID:27767209

[Anatomy of fractures of the inferior scapular angle].

PubMed

Bartoníček, J; Tuček, M; Malík, J

2018-01-01

The aim of this study is to describe the anatomy of fractures of the inferior angle and the adjacent part of the scapular body, based on 3D CT reconstructions. In a series of 375 scapular fractures, we identified a total of 20 fractures of the inferior angle of the scapular body (13 men, 7 women), with a mean patient age of 50 years (range 3373). In all fractures, 3D CT reconstructions were obtained, allowing an objective evaluation of the fracture pattern with a focus on the size and shape of the inferior angle fragment, propagation of the fracture line to the lateral and medial borders of the infraspinous part of the scapular body, fragment displacement and any additional fracture of the ipsilateral scapula and the shoulder girdle. We identified a total of 5 types of fracture involving the distal half of the infraspinous part of the scapular body. The first type, recorded in 5 cases, affected only the apex of the inferior angle, with a small part of the adjacent medial border. The second type, occurring in 4 cases, involved fractures separating the entire inferior angle. The third type, represented by 4 cases, was characterized by a fracture line starting medially close above the inferior angle and passing proximolaterally. The separated fragment had a shape of a big drop, carrying also the distal half of the lateral pillar in addition to the inferior angle. In the fourth type identified in 5 fractures, the separated fragment was formed both by the inferior angle and a variable part of the medial border. The fifth type, being by its nature a transition to the fracture of the infraspinous part of the body, was recorded in 2 cases, with the same V-shaped fragment. Fractures of the inferior angle and the adjacent part of the scapular body are groups of fractures differing from other infraspinous fractures of the scapular body. Although these fractures are highly variable in terms of shape, they have the same course of fracture line and the manner of displacement.Key words: scapula scapula fractures scapular body fractures inferior angle classification of scapular body fractures.

Urologic Oncologic SurveyRobotic level III inferior vena cava tumor thrombectomy: Initial series. Gill IS, Metcalfe C, Abreu A, Duddalwar V, Chopra S, Cunningham M, Thangathurai D, Ukimura O, Satkunasivam R, Hung A, Papalia R, Aron M, Desai M, Gallucci M. J Urol. 2015 Oct;194(4):929-938. [Epub 2015 Apr 6]. doi: 10.1016/j.juro.2015.03.119.

PubMed

Meng, Max

2017-05-01

Level III inferior vena cava tumor thrombectomy for renal cancer is one of the most challenging open urologic surgeries. We present the initial series of completely intracorporeal robotic level III inferior vena cava tumor thrombectomy. Nine patients underwent robotic level III inferior vena cava thrombectomy and 7 patients underwent level II thrombectomy. The entire operation (high intrahepatic inferior vena cava control, caval exclusion, tumor thrombectomy, inferior vena cava repair, radical nephrectomy, and retroperitoneal lymphadenectomy) was performed exclusively robotically. To minimize the chances of intraoperative inferior vena cava thrombus embolization, an "inferior vena cava-first, kidney-last" robotic technique was developed. Data were accrued prospectively. All 16 robotic procedures were successful, without open conversion or mortality. For level III cases (9), median primary kidney (right 6, left 3) cancer size was 8.5cm (range: 5.3-10.8) and inferior vena cava thrombus length was 5.7cm (range: 4-7). Median operative time was 4.9 hours (range: 4.5-6.3), estimated blood loss was 375ml (range: 200-7,000), and hospital stay was 4.5 days. All surgical margins were negative. There were no intraoperative complications and 1 postoperative complication (Clavien 3b). At a median 7 months of follow-up (range: 1-18) all patients are alive. Compared to level II thrombi the level III cohort trended toward greater inferior vena cava thrombus length (3.3 vs 5.7cm), operative time (4.5 vs 4.9h) and blood loss (290 vs 375ml). With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level III inferior vena cava thrombectomy is feasible and can be performed efficiently. Larger experience, longer follow-up and comparison with open surgery are needed to confirm these initial outcomes. Copyright © 2017. Published by Elsevier Inc.

Significance of localization of mandibular foramen in an inferior alveolar nerve block.

PubMed

Thangavelu, K; Kannan, R; Kumar, N Senthil; Rethish, E; Sabitha, S; Sayeeganesh, N

2012-07-01

The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation.

Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty.

PubMed

DiStefano, James Guido; Park, Andrew Y; Nguyen, Thuc-Quyen D; Diederichs, Gerd; Buckley, Jenni M; Montgomery, William H

2011-04-01

Scapular cortical thickness has not been fully characterized from the perspective of determining optimal screw placement for securing the glenoid base plate in reverse shoulder arthroplasty. Twelve fresh frozen cadaveric scapulae underwent high resolution CT scans with 3-dimensional reconstructions and wall thickness analysis. Digital base plates were positioned and virtual screws were placed according to 2 scenarios: A - intraosseous through the entire course and exits a "safe region" with no known neurovascular structures; B - may leave and re-enter the bone and penetrates the thickest cortical region accessible regardless of adjacent structures. For scenario A, the optimal screw configurations were: (superior screw) length = 35 mm, 9° superior, 2° posterior; (inferior screw-A) length = 34 mm, 16° inferior, 5° anterior; (inferior screw-B) length = 31 mm, 31 inferior, 4 posterior; (posterior screw) length 19 mm, 29° inferior, 3° anterior. For scenario B: (superior screw) length = 36 mm, 28° superior, 10° anterior; (inferior screw) length = 35 mm, 19° inferior, 4° anterior; (posterior screw) length 37 mm, 23° superior, 3° anterior. The anterior screw was consistent between scenarios A and B, averaged 29 mm in length and was directed 16° inferior and 14° posterior. Thicker cortical regions were present in the lateral aspect of the suprascapular notch, scapular spine base, anterior/superior aspect of inferior pillar and junction of glenoid neck and scapular spine. Regions with high cortical thickness were accessible for both scenarios except for the posterior screw in scenario A. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

What is the predictive value of ST segment depression in inferior leads in first acute anterior myocardial infarction?

PubMed

Hayıroğlu, Mert İlker; Keskin, Muhammed; Uzun, Ahmet Okan; Türkkan, Ceyhan; Tekkeşin, Ahmet İlker; Kozan, Ömer

Electrical phenomenon and remote myocardial ischemia are the main factors of ST segment depression in inferior leads in acute anterior myocardial infarction (AAMI). We investigated the prognostic value of the sum of ST segment depression amplitudes in inferior leads in patients with first AAMI treated with primary percutaneous coronary intervention. (PPCI). In this prospective analysis, we evaluated the in-hospital prognostic impact of the sum of ST segment depression in inferior leads on 206 patients with first AAMI. Patients were stratified by tertiles of the sum of admission ST segment depression in inferior leads. Clinical outcomes were compared between those tertiles. Univariate analysis revealed higher rate of in-hospital death for patients with ST segment depression in inferior leads in tertile 3, as compared to patients in tertile 1 (OR 9.8, 95% CI 1.5-78.2, p<0.001). After adjustment for baseline variables, ST segment depression in inferior leads in tertile 3 was associated with 5.7-fold hazard of in-hospital death (OR: 5.7, 95% CI 1.2-35.1, p<0.001). Spearman rank correlation test revealed correlation between the sum of ST segment depression amplitude in inferior leads and the sum of ST segment elevation amplitude in V1-6, L1 and aVL. Multivessel disease and additional RCA stenosis were also detected more often in tertile 3. The sum of ST segment depression amplitude in inferior leads of admission ECG in patients with first AAMI treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggest the sum of ST segment depression amplitude to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with first AAMI. Copyright © 2017 Elsevier Inc. All rights reserved.

Anatomy of the inferior petro-occipital vein and its relation to the base of the skull: application to surgical and endovascular procedures of the skull base.

PubMed

Tubbs, R Shane; Watanabe, Koichi; Loukas, Marios; Cohen-Gadol, Aaron A

2014-07-01

Although the inferior petro-occipital vein has been recently used for vascular access to the cavernous sinus, few detailed descriptions of its anatomy are in the literature. We aimed to investigate the morphology and relationships of this vessel. Twelve latex-injected cadaveric heads (24 sides) were dissected to identify the inferior petro-occipital vein and anatomic details documented. The petro-occipital vein was identified on 83.3% of sides. Generally this vein united the internal carotid venous plexus to the superior jugular bulb. However, on 10% of sides, the anterior part of this vein communicated directly with the cavernous sinus, and on 15%, the posterior vein drained into the inferior petrosal sinus at its termination into the superior jugular bulb. The petro-occipital vein was separated from the overlying inferior petrosal sinus by a thin plate of bone. On 40% of sides, small venous connections were found between these two venous structures. The vein was usually larger if a nondominant transverse sinus was present. The overlying inferior petrosal sinus was smaller in diameter when an underlying inferior petro-occipital vein was present. On 20% of sides, the posterior aspect of the vein communicated with the hypoglossal canal veins. On three sides, diploic veins from the clivus drained into the inferior petro-occipital vein. The inferior petro-occipital vein is present in most humans. This primarily extracranial vessel communicates with intracranial venous sinuses and should be considered an emissary vein. Knowledge of this vessel's exact anatomy may be useful to cranial base surgeons and endovascular specialists. Copyright © 2013 Wiley Periodicals, Inc.

Testing non-inferiority of a new treatment in three-arm clinical trials with binary endpoints.

PubMed

Tang, Nian-Sheng; Yu, Bin; Tang, Man-Lai

2014-12-18

A two-arm non-inferiority trial without a placebo is usually adopted to demonstrate that an experimental treatment is not worse than a reference treatment by a small pre-specified non-inferiority margin due to ethical concerns. Selection of the non-inferiority margin and establishment of assay sensitivity are two major issues in the design, analysis and interpretation for two-arm non-inferiority trials. Alternatively, a three-arm non-inferiority clinical trial including a placebo is usually conducted to assess the assay sensitivity and internal validity of a trial. Recently, some large-sample approaches have been developed to assess the non-inferiority of a new treatment based on the three-arm trial design. However, these methods behave badly with small sample sizes in the three arms. This manuscript aims to develop some reliable small-sample methods to test three-arm non-inferiority. Saddlepoint approximation, exact and approximate unconditional, and bootstrap-resampling methods are developed to calculate p-values of the Wald-type, score and likelihood ratio tests. Simulation studies are conducted to evaluate their performance in terms of type I error rate and power. Our empirical results show that the saddlepoint approximation method generally behaves better than the asymptotic method based on the Wald-type test statistic. For small sample sizes, approximate unconditional and bootstrap-resampling methods based on the score test statistic perform better in the sense that their corresponding type I error rates are generally closer to the prespecified nominal level than those of other test procedures. Both approximate unconditional and bootstrap-resampling test procedures based on the score test statistic are generally recommended for three-arm non-inferiority trials with binary outcomes.

Cross-sectional echocardiographic diagnosis of azygos continuation of the inferior vena cava.

PubMed

Huhta, J C; Smallhorn, J F; Macartney, F J

1984-01-01

Azygos continuation of the inferior vena cava has importance for both the invasive diagnosis of congenital heart disease by catheterization and for surgical treatment. Cross-sectional echocardiography was used to examine 1,000 patients (1 day to 16 years, mean 3.3 years) who also had angiographic or surgical confirmation. Twenty-eight patients (3%) had azygos continuation (left 13, right 14, bilateral 1) and, in 26 patients, the hepatic portion of the inferior vena cava was absent. Azygos continuation was prospectively detected in all and was directly visualized in subcostal scans as a venous structure posterior to the aorta coursing behind the heart and not entering the inferior aspect of either atrium in 26/28 (93%). Azygos connection to the ipsilateral superior vena cava or atrium was correctly predicted in all. The inferior vena cava was visualized in all patients without azygos continuation, except one neonate with omphalocele. We conclude that cross-sectional echocardiography can accurately detect azygos continuation of the inferior vena cava and predict its side and connection.

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Unilateral occurrence of five different thyroid arteries-a need of terminological systematization: a case report.

PubMed

Lovasova, Kvetuse; Kachlik, David; Santa, Marian; Kluchova, Darina

2017-08-01

This article highlights an unusual and unilateral variation in the blood supply to the inferior portion of the thyroid gland observed on the right lobe during anatomy dissection course. The rare variation of the occurrence of two anomalous arteries: the middle thyroid artery and the aberrant accessory inferior thyroid artery, and one uncommon variant, the thyroid ima artery, was detected in an adult female cadaver. The two generally constant arteries, the superior thyroid artery and the inferior thyroid artery, have been found in their usual anatomical location. Both the middle thyroid artery and aberrant accessory inferior thyroid artery arose from the right common carotid artery. The middle thyroid artery coursed as a very short branch ventromedially to enter the inferior lateral portion of the right lobe of the thyroid gland. It was at the same level, in which the inferior thyroid artery reached the lateral border of the thyroid gland. The aberrant accessory inferior thyroid artery originated similarly, from the ventromedial surface of the right common carotid artery and passed to supply the inferior pole of the right lobe. The thyroid ima artery was found to arise from the brachiocephalic trunk, entering the isthmus of the thyroid gland. Information about the embryological background might be helpful to clarify why such a type of variation occurs. It is necessary to understand the possible existence of this anomaly, to carry out successful radical neck dissection and to minimize the risk of postoperative complications in patients.

Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.

PubMed

Mostafa, Attiat M; Kassem, Rehab R

2018-05-01

To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction. Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis. A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient. The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Inferior vena caval masses identified by echocardiography

NASA Technical Reports Server (NTRS)

Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

1999-01-01

The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery.

PubMed

Ochi, Kentaro; Ohashi, Toru; Watanabe, Shoji

2003-02-01

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

Significance of localization of mandibular foramen in an inferior alveolar nerve block

PubMed Central

Thangavelu, K.; Kannan, R.; Kumar, N. Senthil; Rethish, E.; Sabitha, S.; SayeeGanesh, N.

2012-01-01

Background: The mandibular foramen (MF) is an opening on the internal surface of the ramus for divisions of the mandibular vessels and nerve to pass. The aim of this study is to determine the position of the MF from various anatomical landmarks in several dry adult mandibles. Materials and Methods: A total of 102 human dry mandibles were examined, of which 93 were of dentulous and 9 were of edentulous. The measurements were taken from the anterior border of the ramus (coronoid notch) to the midportion of the MF and then from the midportion of the MF to the other landmarks such as internal oblique ridge, inferior border, sigmoid notch, and condyle were measured and recorded. Results: The data were compared using Student's t-test. The MF is positioned at a mean distance of 19 mm (with SD 2.34) from coronoid notch of the anterior border of the ramus. Superio-inferiorly from the condyle to the inferior border MF is situated 5 mm inferior to the midpoint of condyle to the inferior border distance (ramus height). Conclusion: We conclude that failures in the anesthesia of the inferior alveolar nerve are due to the operator error and not due to the anatomical variation. PMID:23225978

Diagnostic Value of Ganglion Cell-Inner Plexiform Layer Thickness in Glaucoma With Superior or Inferior Visual Hemifield Defects.

PubMed

Kim, Ho Soong; Yang, Heon; Lee, Tae Heon; Lee, Kyung Heon

2016-06-01

To determine the diagnostic value of the ganglion cell-inner plexiform layer (GCIPL) thickness in glaucomatous eyes with superior or inferior visual hemifield defects. Eighty-five patients with glaucoma (42 isolated superior hemifield defects and 43 isolated inferior hemifield defects) and 46 normal subjects were enrolled. All patients underwent Cirrus high-definition optical coherence tomography and standard automated perimetry. The area under the receiver operating characteristic curve (AUC) was calculated to determine the diagnostic ability of the GCIPL and peripapillary retinal nerve fiber layer (pRNFL). In the superior hemifield defect glaucoma group, the best parameters for discriminating normal eyes from glaucomatous eyes were the inferotemporal GCIPL thickness (0.942), inferior quadrant RNFL thickness (0.974), and 7 o'clock sector RNFL thickness (0.999). For diagnosing inferior hemifield defect glaucoma, the AUCs of all GCIPL parameters (0.331 to 0.702) were significantly lower than that of the superior quadrant RNFL thickness (0.866, P<0.05). The diagnostic ability of GCIPL parameters was similar to that of the pRNFL parameters in superior hemifield defect glaucoma. However, the diagnostic performance of the GCIPL parameters was significantly inferior to those of the pRNFL parameters in eyes with inferior hemifield defect glaucoma.

Non-inferiority cancer clinical trials: scope and purposes underlying their design.

PubMed

Riechelmann, R P; Alex, A; Cruz, L; Bariani, G M; Hoff, P M

2013-07-01

Non-inferiority clinical trials (NIFCTs) aim to demonstrate that the experimental therapy has advantages over the standard of care, with acceptable loss of efficacy. We evaluated the purposes underlying the selection of a non-inferiority design in oncology and the size of their non-inferiority margins (NIFm's). All NIFCTs of cancer-directed therapies and supportive care agents published in a 10-year period were eligible. Two investigators extracted the data and independently classified the trials by their purpose to choose a non-inferiority design. Seventy-five were included: 43% received funds from industry, overall survival was the most common primary end point and 73% reported positive results. The most frequent purposes underlying the selection of a non-inferiority design were to test more conveniently administered schedules and/or less toxic treatments. In 13 (17%) trials, a clear purpose was not identified. Among the trials that reported a pre-specified NIFm, the median value was 12.5% (range 4%-25%) for trials with binary primary end points and Hazard Ratio of 1.25 (range 1.10-1.50) for trials that used time-to-event primary outcomes. Cancer NIFCT harbor serious methodological and ethical issues. Many use large NIFm and nearly one-fifth did not state a clear purpose for selecting a non-inferiority design.

Inferior ectopic pupil and typical ocular coloboma in RCS rats.

PubMed

Tsuji, Naho; Ozaki, Kiyokazu; Narama, Isao; Matsuura, Tetsuro

2011-08-01

Ocular coloboma is sometimes accompanied by corectopia in humans and therefore ectopic pupil may indicate ocular coloboma in experimental animals. The RCS strain of rats has a low incidence of microphthalmia. We found that inferior ectopic pupil is associated exclusively with small-sized eyes in this strain. The objective of the current study was to evaluate whether inferior ectopic pupil is associated with iridal coloboma and other types of ocular coloboma in RCS rats. Both eyes of RCS rats were examined clinically, and those with inferior ectopic pupils underwent morphologic and morphometric examinations. In a prenatal study, coronal serial sections of eyeballs from fetuses at gestational day 16.5 were examined by using light microscopy. Ectopic pupils in RCS rats were found exclusively in an inferior position, where the iris was shortened. Fundic examination revealed severe chorioretinal coloboma in all cases of inferior ectopic pupil. The morphologic characteristics closely resembled those of chorioretinal coloboma in humans. Histopathologic examination of primordia showed incomplete closure of the optic fissure in 4 eyeballs of RCS fetuses. Neither F(1) rats nor N(2) (progeny of RCS × BN matings) displayed any ocular anomalies, including ectopic pupils. The RCS strain is a suitable model for human ocular coloboma, and inferior ectopic pupil appears to be a strong indicator of ocular coloboma.

Inferior Ectopic Pupil and Typical Ocular Coloboma in RCS Rats

PubMed Central

Tsuji, Naho; Ozaki, Kiyokazu; Narama, Isao; Matsuura, Tetsuro

2011-01-01

Ocular coloboma is sometimes accompanied by corectopia in humans and therefore ectopic pupil may indicate ocular coloboma in experimental animals. The RCS strain of rats has a low incidence of microphthalmia. We found that inferior ectopic pupil is associated exclusively with small-sized eyes in this strain. The objective of the current study was to evaluate whether inferior ectopic pupil is associated with iridal coloboma and other types of ocular coloboma in RCS rats. Both eyes of RCS rats were examined clinically, and those with inferior ectopic pupils underwent morphologic and morphometric examinations. In a prenatal study, coronal serial sections of eyeballs from fetuses at gestational day 16.5 were examined by using light microscopy. Ectopic pupils in RCS rats were found exclusively in an inferior position, where the iris was shortened. Fundic examination revealed severe chorioretinal coloboma in all cases of inferior ectopic pupil. The morphologic characteristics closely resembled those of chorioretinal coloboma in humans. Histopathologic examination of primordia showed incomplete closure of the optic fissure in 4 eyeballs of RCS fetuses. Neither F1 rats nor N2 (progeny of RCS × BN matings) displayed any ocular anomalies, including ectopic pupils. The RCS strain is a suitable model for human ocular coloboma, and inferior ectopic pupil appears to be a strong indicator of ocular coloboma. PMID:22330254

Las ideologias, las ciencias naturales y sus implicaciones en la educacion cientifica

NASA Astrophysics Data System (ADS)

Lozada Roldan, Sandra

Este estudio ausculto las concepciones epistemologicas de los docentes de ciencia del nivel secundario con relacion a las ideologias y las ciencias naturales. Tambien examino las posiciones de los docentes ante asuntos publicos relacionados a la ciencia. Para propositos de este estudio se diseno y se valido el cuestionario con el cual se obtuvieron los resultados. La investigacion es de tipo cuantitativa y se utilizo como diseno la encuesta. El cuestionario se administro en varias actividades de desarrollo profesional para maestros de ciencia. Un total de 78 maestros del nivel secundario respondieron el cuestionario. Para analizar los datos obtenidos se utilizaron estadisticas descriptivas como la distribucion de frecuencia y el porciento. Ademas se establecieron codigos y categorias para describir las posiciones de los maestros ante asuntos publicos relacionados a la ciencia. Los analisis demostraron que entre los docentes participantes de este estudio prevalecen ciertas concepciones epistemologicas adecuadas acerca de las ciencias naturales, a la luz de la literatura consultada. Entre estas concepciones se destacan las siguientes: a) la filosofia materialista de las ciencias naturales, b) la naturaleza tentativa y constructivista del conocimiento cientifico, c) el uso de una metodologia que garantiza cierto grado de objetividad y con el que se justifican y validan los enunciados cientificos y d) la funcion instrumental del conocimiento cientifico. Sin embargo, entre los docentes participantes de este estudio prevalecen ciertas concepciones epistemologicas erroneas acerca de las ciencias naturales, a la luz de la literatura consultada. Entre estas concepciones se destacan las siguientes: a) tendencia inductivista en el que las teorias cientificas comienzan con observaciones que establecen generalizaciones, b) secuencia jerarquica de la metodologia cientifica. Ademas, entre los docentes participantes de este estudio prevalecen concepciones epistemologicas adecuadas acerca de las ideologias, a la luz de la literatura consultada. Entre estas concepciones se destacan las siguientes: a) la funcion de las ideologias y b) la ausencia de validez ante el conocimiento cientifico. Sin embargo, en cuanto a considerar las ciencias naturales como una ideologia mas conocida como cientificismo, no hubo consistencia en las respuestas de los participantes por lo que no es posible afirmarlo o negarlo. Los hallazgos tambien revelaron que entre los docentes participantes hubo posiciones a favor y en contra para las dos situaciones sobre asuntos publicos relacionados a la ciencia que se presentaron. Estas posiciones fueron justificadas con argumentos cientificos y argumentos ideologicos, entre estos, los morales y los economicos. Con este dato se puede afirmar el uso de las ideologias en asuntos publicos relacionados a la ciencia.

Oculopalatal tremor explained by a model of inferior olivary hypertrophy and cerebellar plasticity

PubMed Central

Shaikh, Aasef G.; Hong, Simon; Liao, Ke; Tian, Jing; Solomon, David; Zee, David S.; Leigh, R. John

2010-01-01

The inferior olivary nuclei clearly play a role in creating oculopalatal tremor, but the exact mechanism is unknown. Oculopalatal tremor develops some time after a lesion in the brain that interrupts inhibition of the inferior olive by the deep cerebellar nuclei. Over time the inferior olive gradually becomes hypertrophic and its neurons enlarge developing abnormal soma-somatic gap junctions. However, results from several experimental studies have confounded the issue because they seem inconsistent with a role for the inferior olive in oculopalatal tremor, or because they ascribe the tremor to other brain areas. Here we look at 3D binocular eye movements in 15 oculopalatal tremor patients and compare their behaviour to the output of our recent mathematical model of oculopalatal tremor. This model has two mechanisms that interact to create oculopalatal tremor: an oscillator in the inferior olive and a modulator in the cerebellum. Here we show that this dual mechanism model can reproduce the basic features of oculopalatal tremor and plausibly refute the confounding experimental results. Oscillations in all patients and simulations were aperiodic, with a complicated frequency spectrum showing dominant components from 1 to 3 Hz. The model’s synchronized inferior olive output was too small to induce noticeable ocular oscillations, requiring amplification by the cerebellar cortex. Simulations show that reducing the influence of the cerebellar cortex on the oculomotor pathway reduces the amplitude of ocular tremor, makes it more periodic and pulse-like, but leaves its frequency unchanged. Reducing the coupling among cells in the inferior olive decreases the oscillation’s amplitude until they stop (at ∼20% of full coupling strength), but does not change their frequency. The dual-mechanism model accounts for many of the properties of oculopalatal tremor. Simulations suggest that drug therapies designed to reduce electrotonic coupling within the inferior olive or reduce the disinhibition of the cerebellar cortex on the deep cerebellar nuclei could treat oculopalatal tremor. We conclude that oculopalatal tremor oscillations originate in the hypertrophic inferior olive and are amplified by learning in the cerebellum. PMID:20080879

Correlation between remnant inferior turbinate volume and symptom severity of empty nose syndrome.

PubMed

Hong, Hye Ran; Jang, Yong Ju

2016-06-01

Empty nose syndrome (ENS) is an iatrogenic disorder caused by turbinate reduction procedures, which results in considerable nasal dysfunction and severely impaired quality of life. However, there is a lack of data that explains the relationship between the degree of turbinate reduction and subjective symptoms. The aim of this study was to evaluate the effects of remnant inferior turbinate volume on symptom severity. We retrospectively analyzed data from 34 patients who were diagnosed with ENS. All patients underwent computed tomography scanning and completed the SNOT-25 questionnaire. The control group consisted of 10 patients with pituitary adenoma who did not have any sinonasal symptoms or abnormalities. The inferior turbinate volumes were compared between groups, and the correlation between inferior turbinate volumes (ITVs) and Sino-Nasal Outcome Test-25 (SNOT-25) was also evaluated. The ENS group presented with a significantly smaller inferior turbinate volume than the control group (P < 0.001). The overall SNOT-25 score demonstrated no statistically significant correlation with anterior, posterior, or total ITV (P > 0.05, respectively). Among the various items on SNOT-25, a high dryness score was significantly correlated with a smaller total inferior turbinate volume (P = 0.030). Facial pain was significantly correlated with smaller anterior ITV (P = 0.011). In addition, patients who had smaller posterior inferior turbinate volume demonstrated higher scores on specific SNOT-25 items. A smaller inferior turbinate volume is significantly associated with specific SNOT-25 items in ENS patients. 4. Laryngoscope, 126:1290-1295, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Inferior sinus venosus defect: echocardiographic diagnosis and surgical approach.

PubMed

Crystal, Matthew A; Al Najashi, Khaled; Williams, William G; Redington, Andrew N; Anderson, Robert H

2009-06-01

We sought to define the inferior sinus venosus defect anatomically and document successful surgical approaches. We identified all patients previously given a diagnosis of an inferior sinus venosus defect at the Hospital for Sick Children, Toronto, Canada, between 1982 and 2005 by interrogating the cardiology and cardiac surgery databases. We included those having interatrial communications in which 1 or more of the right pulmonary veins drained to the inferior caval vein but retained connection with the left atrium, the rims of the oval fossa, and the walls of the coronary sinus, both being intact. We identified 11 children who had an interatrial communication meeting the criteria for and undergoing surgical repair of an inferior sinus venosus defect. Median age was 1.2 years; 6 (55%) subjects were male, and none were cyanotic. Transthoracic echocardiographic analysis was performed preoperatively in all children, revealing right ventricular dilation in all. Surgical repair was accomplished with a pericardial patch. A complex baffle was needed in 3 children to maintain unobstructed inferior caval and pulmonary venous return. The echocardiographic diagnosis was complete in only 5 patients, but all diagnoses were correct since the year 2000. In all children the observations at surgical intervention showed that the defect was a venoatrial communication involving drainage of the right pulmonary veins to the inferior caval vein while retaining connection to the left atrium. Transthoracic echocardiographic analysis should remain the modality of choice for diagnosis of the inferior sinus venosus defect. We report excellent surgical results with a patch or baffle, correctly redirecting the anomalous venoatrial connections.

Right ventricular myocardial infarction: presentation and acute outcomes.

PubMed

Chockalingam, Anand; Gnanavelu, G; Subramaniam, T; Dorairajan, Smrita; Chockalingam, V

2005-01-01

Acute inferior wall myocardial infarction can be complicated by right ventricular myocardial infarction (RVMI), and the excess mortality cannot be fully explained by mechanical reasons. The authors try to systematically assess the incidence, clinical presentation and early outcomes of right ventricular infarction in a tertiary-care setup. Their study was a prospective observational series of consecutive patients with RVMI. All patients with acute inferior myocardial infarction (n=135) were enlisted. RVMI was diagnosed by > or = 1 mm ST elevation in lead V(4R) in a right-sided electrocardiogram. Right ventricular (RV) infarction occurred in 37% (n=50) of patients with acute inferior infarctions. Patients with isolated inferior infarction served as controls (n=85). Echocardiography was performed within 24 hours of admission. From both groups, 66% qualified for thrombolysis. The incidence of hypotension-bradycardia and heart blocks requiring pacing support was much higher in right ventricular infarction (n=21) than in inferior infarction (n=13). Clinically manifest RV dysfunction (raised jugular venous pulse [JVP], hypotension, tricuspid regurgitation) and right ventricular dilation detected by echocardiography were seen in only 13 patients. The in-hospital mortality rate was significantly higher (n=8, 16%) in right ventricular infarction group than in inferior infarction group (n=3, 3.5%). Right ventricular infarction was seen in a third of inferior myocardial infarctions (IMIs), but hemodynamically evident right ventricular dysfunction occurred in only a tenth of acute IMIs. Nevertheless, the acute in-hospital mortality rate of patients with right ventricular infarction was much higher than in those with inferior infarction owing to arrhythmic and mechanical complications.

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…

Generalizing Screen Inferiority--Does the Medium, Screen versus Paper, Affect Performance Even with Brief Tasks?

ERIC Educational Resources Information Center

Sidi, Yael; Ophir, Yael; Ackerman, Rakefet

2016-01-01

Screen inferiority in performance and metacognitive processes has been repeatedly found with text learning. Common explanations for screen inferiority relate to technological and physiological disadvantages associated with extensive reading on screen. However, recent studies point to lesser recruitment of mental effort on screen than on paper.…

A basic review on the inferior alveolar nerve block techniques.

PubMed

Khalil, Hesham

2014-01-01

The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.

A basic review on the inferior alveolar nerve block techniques

PubMed Central

Khalil, Hesham

2014-01-01

The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned. PMID:25886095

Surgical management of strabismus after rupture of the inferior rectus muscle.

PubMed

Paysse, E A; Saunders, R A; Coats, D K

2000-06-01

Rupture of an inferior rectus muscle is an uncommon problem. The resulting absence of infraduction and large hypertropia that result when the muscle cannot be repaired are challenging to manage surgically. We treated 2 patients who had traumatic rupture of the inferior rectus muscle. Both patients underwent an inferior transposition of the inferior halves of the medial and lateral rectus muscles without disinsertion (modified Jensen transposition procedure). Both patients had a persistent small overcorrection in the primary gaze position. One patient was treated with a second strabismus surgery consisting of a recession of the contralateral superior rectus muscle; the other was treated with prism glasses. Both achieved restoration of depression to approximately 40 degrees and single binocular vision in the primary position at distance, near, and in the reading position. This modified Jensen transposition procedure of the horizontal rectus muscles appears to be highly effective in the treatment of the hypertropia and infraduction deficit produced by rupture of the inferior rectus muscle. It also appears to be suitable for use in situations when other rectus muscles are absent or unavailable for surgical manipulation.

Non-recurrent inferior laryngeal nerve identification during robotic thyroidectomy.

PubMed

Wang, C-C; Wu, C-H

2014-02-01

A non-recurrent inferior laryngeal nerve is a rare anomaly in which the nerve enters the larynx directly off the cervical vagus nerve, without descending to the thoracic level. It is very susceptible to damage during surgery. This report describes the important pre-operative radiological evaluations and surgical landmarks in a case of a non-recurrent inferior laryngeal nerve, identified during the recently developed technique of robotic thyroidectomy. A 38-year-old woman presented with suspected papillary microcarcinoma, as indicated by aspiration cytology. Pre-operative computed tomography showed a right aberrant subclavian artery that indicated a possible right non-recurrent inferior laryngeal nerve. Using robotic thyroidectomy methods, it was possible to carefully dissect along the thyroid capsule. The laryngeal entrance point of the right non-recurrent inferior laryngeal nerve (a constant anatomical landmark) was successfully identified via the three-dimensional, high-magnification views provided by the robotic endoscope. With proper knowledge of radiological and surgical anatomy, and the benefits of high-magnification endoscopic views, a non-recurrent inferior laryngeal nerve can be safely preserved during robotic surgery.

Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct.

PubMed

Nakayama, Tsuguhisa; Asaka, Daiya; Okushi, Tetsushi; Yoshikawa, Mamoru; Moriyama, Hiroshi; Otori, Nobuyoshi

2012-01-01

Endoscopic medial maxillectomy (EMM) is a safe and effective procedure for treatment of inverted papilloma (IP) originating from the maxillary sinus. However, EMM usually removes the inferior turbinate and nasolacrimal duct. The inferior turbinate has a critical function in conditioning of the nasal airflow, and resection of the nasolacrimal ducts has a risk of epiphora. We developed a newly derived surgical technique, endoscopic modified medial maxillectomy (EMMM), which enables preservation of the inferior turbinate and nasolacrimal duct. A retrospective case series of six patients with IP and nine patients with mucoceles of the maxillary sinus after a Caldwell-Luc operation, who underwent surgery using the EMMM technique, were reviewed. In patients with IP, there were no recurrences for a mean follow-up of 16.7 months. Eight of nine patients with mucoceles of the maxillary sinus showed patency. All patients showed preservation of the inferior turbinate. One patient with mucocele was referred for dacryocystorhinostomy because of epiphora. EMMM produces access to the maxillary sinus identically to conventional EMM, despite preservation of the inferior turbinate and nasolacrimal duct.

A case of residual inferior sinus venosus defect after ineffective surgical closure.

PubMed

Uga, Sayuri; Hidaka, Takayuki; Takasaki, Taiichi; Kihara, Yasuki

2014-10-03

A 38-year-old woman presented with cyanosis and heart failure 34 years after patch closure of an atrial septal defect and partial anomalous pulmonary venous connection. CT and cardiac catheterisation showed a residual defect that caused right-to-left shunting. The patch almost blocked the inferior vena cava from the right atrium, resulting in uncommon drainage of the inferior vena cava into the left atrium. Other anomalies included the coronary-to-pulmonary artery fistula and duplicate inferior vena cava with dilated azygos venous system. A second surgery was performed, and we confirmed an inferior sinus venosus defect, which is rare and can be misdiagnosed. The ineffective patch closure had caused a haemodynamic status that rarely occurs. We describe the diagnostic process and emphasise the importance of correctly understanding the entity. 2014 BMJ Publishing Group Ltd.

Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks.

PubMed

Khoury, J N; Mihailidis, S; Ghabriel, M; Townsend, G

2011-06-01

A thorough knowledge of the anatomy of the pterygomandibular space is essential for the successful administration of the inferior alveolar nerve block. In addition to the inferior alveolar and lingual nerves, other structures in this space are of particular significance for local anaesthesia, including the inferior alveolar vessels, the sphenomandibular ligament and the interpterygoid fascia. These structures can all potentially have an impact on the effectiveness of local anaesthesia in this area. Greater understanding of the nature and extent of variation in intraoral landmarks and underlying structures should lead to improved success rates, and provide safer and more effective anaesthesia. The direct technique for the inferior alveolar nerve block is used frequently by most clinicians in Australia and this review evaluates its anatomical rationale and provides possible explanations for anaesthetic failures. © 2011 Australian Dental Association.

Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury.

PubMed

Abdel-Aal, Ahmed Kamel; Ezzeldin, Islam B; Moustafa, Amr Soliman; Ertel, Nathan; Oser, Rachel

2015-12-01

We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple's pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure.

The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum.

PubMed

Tomblinson, C M; Cheng, M-R; Lal, D; Hoxworth, J M

2016-07-01

Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation. The electronic medical record was used to identify sinus CT scans exhibiting nasal septal deviation for 100 adult subjects without and 100 subjects with unilateral middle turbinate concha bullosa. Exclusion criteria included previous sinonasal surgery, tumor, sinusitis, septal perforation, and craniofacial trauma. Nasal septal deviation was characterized in the coronal plane by distance from the midline (severity) and height from the nasal floor. Measurement differences between sides for inferior turbinate width (overall and bone), medial mucosa, and distance to the lateral nasal wall were calculated as inferior turbinate hypertrophy indicators. The cohorts with and without concha bullosa were similarly matched for age, sex, and nasal septal deviation severity, though nasal septal deviation height was greater in the cohort with concha bullosa than in the cohort without concha bullosa (19.1 ± 4.3 mm versus 13.5 ± 4.1 mm, P < .001). Compensatory inferior turbinate hypertrophy was significantly greater in the cohort without concha bullosa than in the cohort with it as measured by side-to-side differences in turbinate overall width, bone width, and distance to the lateral nasal wall (P < .01), but not the medial mucosa. Multiple linear regression analyses found nasal septal deviation severity and height to be significant predictors of inferior turbinate hypertrophy with positive and negative relationships, respectively (P < .001). Inferior turbinate hypertrophy is directly proportional to nasal septal deviation severity and inversely proportional to nasal septal deviation height. The effect of a concha bullosa on inferior turbinate hypertrophy is primarily mediated through influence on septal morphology, because the nasal septal deviation apex tends to be positioned more superior from the nasal floor in these patients. © 2016 by American Journal of Neuroradiology.

[Investigation of the age-dependent development of brachygnathia inferior in the East Friesian milk sheep].

PubMed

Pielmeier, Ricarda; Kerkmann, Andrea; Distl, Ottmar

2012-01-01

Shortness of the lower jaw (brachygnathia inferior, underbite) is a common anomaly in sheep. In order to study the age-dependent development of brachygnathia inferior, data of 73 East Friesian milk sheep from a breeding experiment over six generations were analysed. Data were recorded in regular intervals of four weeks from birth up to an age of at least 25 weeks. Brachygnathia inferior was determined by the distance between the edge of the central incisor of the lower jaw and the anterior surrounding of the upper jaw (DIFF-UK) using a measuring tape. Four main types of brachygnathia inferior were distinguished using means, standard deviations and maximum values of the individual animals.The thresholds were a maximum and mean DIFF-UK of 0.5 cm and a standard deviation of 0.266 cm. A total of 14 sheep (main types 3 and 4) showed an obvious brachygnathia inferior with mean DIFF-UK larger than 0.5 cm whereof ten animals showed a large variation of DIFF-UK values (standard deviation > 0.226 cm). Mean DIFF-UK values of 59 sheep were smaller than 0.5 cm (main types 1 and 2). One of these 59 animals had during the first four weeks of life DIFF-UK values of 1 cm and than decreasing values reaching zero within the next nine months (main type 2). Five of the 58 animals with main type 1 had a perfect occlusion of jaws, all with DIFF-UK values at zero during the whole recording period. Parents with severe or mild brachygnathia inferior had severely affected progeny. Selection of sheep for breeding with a perfect occlusion of jaws decreases the risk to pass on the hereditary disposition for brachygnathia inferior. An early inspection of potential breeding animals is advisable to detect all cases of brachygnathia inferior even if the underbite decreases in the first year of life.

Non-inferiority trials: are they inferior? A systematic review of reporting in major medical journals

PubMed Central

Morris, Tim P; Fielding, Katherine; Carpenter, James R; Phillips, Patrick P J

2016-01-01

Objective To assess the adequacy of reporting of non-inferiority trials alongside the consistency and utility of current recommended analyses and guidelines. Design Review of randomised clinical trials that used a non-inferiority design published between January 2010 and May 2015 in medical journals that had an impact factor >10 (JAMA Internal Medicine, Archives Internal Medicine, PLOS Medicine, Annals of Internal Medicine, BMJ, JAMA, Lancet and New England Journal of Medicine). Data sources Ovid (MEDLINE). Methods We searched for non-inferiority trials and assessed the following: choice of non-inferiority margin and justification of margin; power and significance level for sample size; patient population used and how this was defined; any missing data methods used and assumptions declared and any sensitivity analyses used. Results A total of 168 trial publications were included. Most trials concluded non-inferiority (132; 79%). The non-inferiority margin was reported for 98% (164), but less than half reported any justification for the margin (77; 46%). While most chose two different analyses (91; 54%) the most common being intention-to-treat (ITT) or modified ITT and per-protocol, a large number of articles only chose to conduct and report one analysis (65; 39%), most commonly the ITT analysis. There was lack of clarity or inconsistency between the type I error rate and corresponding CIs for 73 (43%) articles. Missing data were rarely considered with (99; 59%) not declaring whether imputation techniques were used. Conclusions Reporting and conduct of non-inferiority trials is inconsistent and does not follow the recommendations in available statistical guidelines, which are not wholly consistent themselves. Authors should clearly describe the methods used and provide clear descriptions of and justifications for their design and primary analysis. Failure to do this risks misleading conclusions being drawn, with consequent effects on clinical practice. PMID:27855102

Efectos de la radiación UV en la salud

EPA Pesticide Factsheets

La reducción de la capa de ozono disminuye la protección natural que ofrece nuestra atmósfera contra la radiación ultravioleta (UV) perjudicial del sol. Esta página web proporciona una descripción general de los principales problemas de salud relacionados

Complications following total inferior turbinectomy: facts or myths?

PubMed

Odetoyinbo, O

1987-10-01

Various surgical procedures have been described for the relief of chronic nasal obstruction due to inferior turbinate hypertrophy, but none has been consistently satisfactory. We have performed total inferior turbinectomy for this condition for 5 years. Of the 39 patients followed for at least 2 years, 90% were relieved permanently of nasal obstruction. However, only 36% and 61% of patients with rhinorrhoea and anosmia respectively were relieved of these symptoms. Complications were minimal. It is concluded that even in a dry, dusty tropical climate, inferior turbinectomy does not appear to disturb the function of the nasal cavity appreciably.

Opioid modulation of GABA release in the rat inferior colliculus

PubMed Central

Tongjaroenbungam, Walaiporn; Jongkamonwiwat, Nopporn; Cunningham, Joanna; Phansuwan-Pujito, Pansiri; Dodson, Hilary C; Forge, Andrew; Govitrapong, Piyarat; Casalotti, Stefano O

2004-01-01

Background The inferior colliculus, which receives almost all ascending and descending auditory signals, plays a crucial role in the processing of auditory information. While the majority of the recorded activities in the inferior colliculus are attributed to GABAergic and glutamatergic signalling, other neurotransmitter systems are expressed in this brain area including opiate peptides and their receptors which may play a modulatory role in neuronal communication. Results Using a perfusion protocol we demonstrate that morphine can inhibit KCl-induced release of [3H]GABA from rat inferior colliculus slices. DAMGO ([D-Ala(2), N-Me-Phe(4), Gly(5)-ol]-enkephalin) but not DADLE ([D-Ala2, D-Leu5]-enkephalin or U69593 has the same effect as morphine indicating that μ rather than δ or κ opioid receptors mediate this action. [3H]GABA release was diminished by 16%, and this was not altered by the protein kinase C inhibitor bisindolylmaleimide I. Immunostaining of inferior colliculus cryosections shows extensive staining for glutamic acid decarboxylase, more limited staining for μ opiate receptors and relatively few neurons co-stained for both proteins. Conclusion The results suggest that μ-opioid receptor ligands can modify neurotransmitter release in a sub population of GABAergic neurons of the inferior colliculus. This could have important physiological implications in the processing of hearing information and/or other functions attributed to the inferior colliculus such as audiogenic seizures and aversive behaviour. PMID:15353008

Heat Stress Is More Damaging to Superior Spikelets than Inferiors of Rice (Oryza sativa L.) due to Their Different Organ Temperatures

PubMed Central

Fu, Guanfu; Feng, Baohua; Zhang, Caixia; Yang, Yongjie; Yang, Xueqin; Chen, Tingting; Zhao, Xia; Zhang, Xiufu; Jin, Qianyu; Tao, Longxing

2016-01-01

In general, the fertility and kernel weight of inferior spikelets of rice (Oryza Sativa L.) are obviously lower than those of superior spikelets, especially under abiotic stress. However, different responses to heat stress are seemed to show between the superior and inferior spikelet, and this response is scarcely documented that the intrinsic factors remain elusive. In order to reveal the mechanism underlying, two rice plants with different heat tolerance were subjected to heat stress of 40°C at anthesis. The results indicated that a greater decrease in fertility and kernel weight was observed in superior spikelets compared to inferior spikelets. This decrease was primarily ascribed to their different organ temperatures, in which the temperature of the superior spikelets was significantly higher than that of inferior spikelets. We inferred the differences in canopy temperature, light intensity and panicle types, were the primary reasons for the temperature difference between superior and inferior spikelets. Under heat stress, the fertility and kernel weight of superior and inferior spikelets decreased as the panicle numbers per plant were reduced, which was accompanied by significantly increasing the canopy temperatures. Thus, it was suggested that the rice plant with characteristic features of an upright growth habit and loose panicles might be more susceptible to heat stress resulting from their higher canopy and spikelets temperatures. PMID:27877180

Internal jugular vein sampling in adrenocorticotropic hormone-dependent Cushing's syndrome: a comparison with inferior petrosal sinus sampling.

PubMed

Erickson, Dana; Huston, John; Young, William F; Carpenter, Paul C; Wermers, Robert A; Bonelli, Frank S; Powell, Claudia C

2004-04-01

Distinguishing between pituitary-dependent Cushing's syndrome (CS) and occult ectopic ACTH syndrome can be extremely difficult. Bilateral inferior petrosal sinus sampling has been shown to have the highest diagnostic accuracy in this subtype evaluation. Internal jugular vein sampling (IJVS) has been reported as a potentially safer invasive alternative, but data are limited. Our objective was to compare the sensitivity and specificity of bilateral IJVS and bilateral inferior petrosal sinus sampling (IPSS) in patients with ACTH-dependent CS. We prospectively collected blood samples from the inferior petrosal sinus and internal jugular vein of consecutive patients with ACTH-dependent CS. The study group included 35 patients: 32 with pituitary-dependent CS (positive immunohistochemical findings for ACTH pituitary tumour or biochemical cure after pituitary surgery) and three with histologically proven ectopic ACTH syndrome. Inferior petrosal sinus sampling and bilateral IJVS were performed simultaneously before and after administration of corticotropin-releasing hormone (CRH), and ratios of central-to-peripheral ACTH concentrations were calculated. The basal IJVS central-to-peripheral ACTH ratios were diagnostic for pituitary-dependent CS (> 2) in 15 patients (46.9%), as were basal inferior petrosal sinus sampling central-to-peripheral ACTH ratios in 29 patients (90.6%). The post-CRH IJVS central-to-peripheral ACTH ratios were diagnostic for pituitary-dependent disease (> 3) in 24 patients (75%), as were post-CRH inferior petrosal sinus sampling central-to-peripheral ACTH ratios in 28 patients (87.5%). In the three patients with ectopic ACTH CS, the IJVS and inferior petrosal sinus sampling pre- and post-CRH ACTH ratios were correctly negative. The overall sensitivity of combined pre- or post-CRH was 81.3% for IJVS and 93.8% for inferior petrosal sinus sampling. Because of the difference between mean ratios in the two techniques, new criteria for IJVS were mathematically calculated: a pre-CRH central-to-peripheral ACTH ratio of 1.59 and a post-CRH central-to-peripheral ACTH ratio of 2.47 maximized sensitivity and specificity when both of these are equally taken into consideration. In conclusion, IJVS is not superior to inferior petrosal sinus sampling for establishing the cause of ACTH-dependent CS. When new criteria of basal (> 1.6) and post-CRH (> 2.5) central-to-peripheral ACTH gradients were applied to ACTH ratios from IJVS, the sensitivity of this test was maximized. However, confirmatory inferior petrosal sinus sampling is recommended when there is a lack of a central-to-peripheral ACTH gradient and when there is only a gradient above the cut-off on basal (pre-CRH) sampling.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study.

PubMed

Zuhur, Sayid Shafi; Ozel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Cil, Esra; Altuntas, Yüksel

2012-01-01

To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study

PubMed Central

Zuhur, Sayid Shafi; Özel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Çil, Esra; Altuntas, Yüksel

2012-01-01

OBJECTIVE: To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. METHODS: The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age- and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. RESULTS: The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. CONCLUSIONS: This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. PMID:22358236

Abstract Representations of Object-Directed Action in the Left Inferior Parietal Lobule.

PubMed

Chen, Quanjing; Garcea, Frank E; Jacobs, Robert A; Mahon, Bradford Z

2018-06-01

Prior neuroimaging and neuropsychological research indicates that the left inferior parietal lobule in the human brain is a critical substrate for representing object manipulation knowledge. In the present functional MRI study we used multivoxel pattern analyses to test whether action similarity among objects can be decoded in the inferior parietal lobule independent of the task applied to objects (identification or pantomime) and stimulus format in which stimuli are presented (pictures or printed words). Participants pantomimed the use of objects, cued by printed words, or identified pictures of objects. Classifiers were trained and tested across task (e.g., training data: pantomime; testing data: identification), stimulus format (e.g., training data: word format; testing format: picture) and specific objects (e.g., training data: scissors vs. corkscrew; testing data: pliers vs. screwdriver). The only brain region in which action relations among objects could be decoded across task, stimulus format and objects was the inferior parietal lobule. By contrast, medial aspects of the ventral surface of the left temporal lobe represented object function, albeit not at the same level of abstractness as actions in the inferior parietal lobule. These results suggest compulsory access to abstract action information in the inferior parietal lobe even when simply identifying objects.

Scala tympani cochleostomy II: topography and histology.

PubMed

Adunka, Oliver F; Radeloff, Andreas; Gstoettner, Wolfgang K; Pillsbury, Harold C; Buchman, Craig A

2007-12-01

To assess intracochlear trauma using two different round window-related cochleostomy techniques in human temporal bones. Twenty-eight human temporal bones were included in this study. In 21 specimens, cochleostomies were initiated inferior to the round window (RW) annulus. In seven bones, cochleostomies were drilled anterior-inferior to the RW annulus. Limited cochlear implant electrode insertions were performed in 19 bones. In each specimen, promontory anatomy and cochleostomy drilling were photographically documented. Basal cochlear damage was assessed histologically and electrode insertion properties were documented in implanted bones. All implanted specimens showed clear scala tympani electrode placements regardless of cochleostomy technique. All 21 inferior cochleostomies were atraumatic. Anterior-inferior cochleostomies resulted in various degrees of intracochlear trauma in all seven bones. For atraumatic opening of the scala tympani using a cochleostomy approach, initiation of drilling should proceed from inferior to the round window annulus, with gradual progression toward the undersurface of the lumen. While cochleostomies initiated anterior-inferior to the round window annulus resulted in scala tympani opening, many of these bones displayed varying degrees of intracochlear trauma that may result in hearing loss. When intracochlear drilling is avoided, the anterior bony margin of the cochleostomy remains a significant intracochlear impediment to in-line electrode insertion.

Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial

PubMed Central

Montserrat-Bosch, Marta; Nogueira-Magalhães, Pedro; Arnabat-Dominguez, Josep; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

2014-01-01

Objectives: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). Study Design: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. Results: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. Conclusions: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries. Key words:Dental anesthesia, inferior alveolar nerve block, lidocaine, third molar, intravascular injection. PMID:24608204

[Contralateral Recession of the Inferior Oblique Muscle in Grave's Disease Patients with Mild M. rectus inferior fibrosis].

PubMed

Eckstein, A; Raczynski, S; Dekowski, D; Esser, J

2015-10-01

The aim of this study was to evaluate the dose effect and the resulting binocular single vision for inferior oblique muscle recession in patients with Grave's orbitopathy. The evaluation covered all patients (n = 13) between 2010-2013 treated with recession of the inferior oblique muscle for vertical deviation caused by inferior fibrosis of the contralateral eye. The inclusion criterion was a small vertical squint angle with excyclotorsion. The corrected vertical squint angle was 3.75° [7 pdpt] (median, min 1.5° [3 pdpt], max 8° [16 pdpt]) in primary position and 5.5° in adduction [11pdpt] (median, min 3°[6 pdpt], max 9°[18pdpt]). Excyclotorsion was 4° [8 pdpt] (median, min 1° [2 pdpt], max 9° [18 pdpt]). Elevation was only slightly impaired and the side difference was 5° (median). The recession distance was preoperatively determined: 0.5° squint angle reduction per mm recession distance (calculation from patients who received surgery before 2010). Inferior oblique recession generated a good field of binocular single vision (BSV) for all patients. All patients reached BSV in the central area (20°) and within 30° of downgaze. Sixty nine percent of the patients were completely diplopia free in downgaze. Diplopia persisted in more than half of the patients in up gaze outside 15°. Squint reduction was 0.5° [1 pdpt] [0.45-0.67]/per mm recession distance in primary position and 0.65° [1.3 pdpt] [0.55-0.76]/per mm for the vertical deviation in adduction. Excyclotorsion was reduced to ≤ 2° in 77 % of the patients. Inferior oblique muscle recession can be very successfully performed on the contralateral eye in patients with mild inferior rectus muscle fibrosis. Surgery at the contralateral yoke muscle prevents the risk of overeffect with resulting diplopia in downgaze, which could occur if small distance recession had been performed at the inferior rectus muscle. An overeffect in relation to inferior oblique recession will only cause diplopia in upgaze, which is much less troublesome in daily routine. Georg Thieme Verlag KG Stuttgart · New York.

[In vivo anatomical study of inferior attachment of renal fascia in adult with acute pancreatitis as shown on multidetector computed tomography].

PubMed

Qi, Rui; Zhou, Xiangping; Yu, Jianqun; Li, Zhenlin

2014-04-01

This study aims to explore the inferior adhesion of the renal fascia (RF), and the inferior connectivity of the perirenal spaces (PS) with multidetector computed tomography (MDCT), and to investigate the diagnostic value of CT for showing this anatomy. From May to July 2012, eighty-two patients with acute pancreatitis presented in our hospital were enrolled into this study and underwent contrast-enhanced CT scans. All the image data were used to perform three dimensional reconstruction to show the inferior attachment of RF and the inferior connectivity of PS. The fusion of anterior renal fascia (ARF) and posterior renal fascia (PRF) next to the plane of iliac fossa were found on the left in 71.95% (59/82) cases, and on the right in 75.61% (62/82). In these cases, bilateral perirenal spaces, and anterior and posterior pararenal spaces were not found to be connected with each other. No fusion of ARF and PRF below the level of bilateral kidneys occurred on the left side in 28.05% (23/82) cases and on the right side in 24.39% (20/82). In these patients, the PS extended to the extraperitoneal space of the pelvic cavity and further to the inguinal region, and bilateral anterior and posterior pararenal spaces were not found to be connected with each other. Three-dimensional reconstruction on contrast-enhanced MDCT could be a valuable procedure for depicting inferior attachment of RF, and the inferior connectivity of PS.

Indications, complications and outcomes of inferior vena cava filters: A retrospective study.

PubMed

Wassef, Andrew; Lim, Wendy; Wu, Cynthia

2017-05-01

Inferior vena cava filters are used to prevent embolization of a lower extremity deep vein thrombosis when the risk of pulmonary embolism is thought to be high. However, evidence is lacking for their benefit and guidelines differ on the recommended indications for filter insertion. The study aim was to determine the reasons for inferior vena cava filter placement and subsequent complication rate. A retrospective cohort of patients receiving inferior vena cava filters in Edmonton, Alberta, Canada from 2007 to 2011. Main outcome was the indication of inferior vena cava filter insertion. Other measures include baseline demographic and medical history of patients, clinical outcomes and filter retrieval rates. 464 patients received inferior vena cava filters. An acute deep vein thrombosis with a contraindication to anticoagulation was the indication for 206 (44.4%) filter insertions. No contraindication to anticoagulation could be identified in 20.7% of filter placements. 30.6% were placed in those with active cancer, in which mortality was significantly higher. Only 38.9% of retrievable filters were successfully retrieved. Inferior vena cava filters were placed frequently in patients with weak or no guideline-supported indications for filter placement and in up to 20% of patients with no contraindication to anticoagulation. The high rates of cancer and the high mortality rate of the cohort raise the possibility that some filters are placed inappropriately in end of life settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dynamic diaschisis: anatomically remote and context-sensitive human brain lesions.

PubMed

Price, C J; Warburton, E A; Moore, C J; Frackowiak, R S; Friston, K J

2001-05-15

Functional neuroimaging was used to investigate how lesions to the Broca's area impair neuronal responses in remote undamaged cortical regions. Four patients with speech output problems, but relatively preserved comprehension, were scanned while viewing words relative to consonant letter strings. In normal subjects, this results in left lateralized activation in the posterior inferior frontal, middle temporal, and posterior inferior temporal cortices. Each patient activated normally in the middle temporal region but abnormally in the damaged posterior inferior frontal cortex and the undamaged posterior inferior temporal cortex. In the damaged frontal region, activity was insensitive to the presence of words but in the undamaged posterior inferior temporal region, activity decreased in the presence of words rather than increasing as it did in the normal individuals. The reversal of responses in the left posterior inferior temporal region illustrate the context-sensitive nature of the abnormality and that failure to activate the left posterior temporal region could not simply be accounted for by insufficient demands on the underlying function. We propose that, in normal individuals, visual word presentation changes the effective connectivity among reading areas and, in patients, posterior temporal responses are abnormal when they depend upon inputs from the damaged inferior frontal cortex. Our results serve to introduce the concept of dynamic diaschisis; the anatomically remote and context-sensitive effects of focal brain lesions. Dynamic diaschisis reveals abnormalities of functional integration that may have profound implications for neuropsychological inference, functional anatomy and, vicariously, cognitive rehabilitation.

Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.

PubMed

Gallatin, E; Stabile, P; Reader, A; Nist, R; Beck, M

2000-01-01

The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block. Through use of a repeated-measures design, each of 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were (1) an inferior alveolar nerve block (with 1.8 mL of 3% mepivacaine) + intraosseous injection with 1.8 mL of 3% mepivacaine and (2) an inferior alveolar nerve (with 1. 8 mL of 3% mepivacaine) + mock intraosseous injection. The first molar was blindly pulp tested at 2-minute cycles for 60 minutes postinjection. Anesthesia was considered successful with 2 consecutive 80 readings. Heart rate (pulse rate) was measured with a pulse oximeter. All subjects had lip numbness with both of the inferior alveolar nerve + intraosseous techniques. Anesthetic success for the first molar was significantly increased for 30 minutes with intraosseous injection of mepivacaine in comparison with the inferior alveolar nerve block alone (mock intraosseous injection). Subjects receiving the intraosseous injection of mepivacaine experienced minimal increases in heart rate. The intraosseous injection of 1.8 mL of 3% mepivacaine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success for 30 minutes in the first molar. The 3% mepivacaine had a minimal effect on heart rate and would be useful in patients with contraindications to epinephrine use.

Non-Invasive Methods of Cardiovascular Exploration in Aerospace Medicine.

DTIC Science & Technology

1983-12-01

inferior vena cava Aorta right atrium filling chamber of right ventricle. Trunk of pulmonary art cry Posterior border: almost vertical AP lower arch left ... left ventricle. Inferior Vena cava infundihbulum L Upper border aortic arch Lower border superimposed borders of the RV LV right and left ventricles...iliac aneurisms is possible. isotopic phlebography is useful in the investigation of the permeability of the inferior vena cava

Mechanical support of total cavopulmonary connection with an axial flow pump.

PubMed

Riemer, R Kirk; Amir, Gabriel; Reichenbach, Steven H; Reinhartz, Olaf

2005-08-01

Even under optimal circumstances, total cavopulmonary connection is associated with a continuous late risk of death. Hemodynamics are distinctly abnormal, with increased systemic venous pressures and frequent low cardiac output. Our study uses a sheep model of total cavopulmonary connection to test the response to axial flow pump (Thoratec HeartMate II; Thoratec Corporation (Pleasanton, Calif)) support of total cavopulmonary connection, which might be suitable to treat patients with failing Fontan circulation. Eight sheep (42-48 kg) were studied. After pilot studies in 3 animals, 5 underwent both pump-supported and nonsupported total cavopulmonary connection in alternating sequence for up to 2 hours. This was achieved with a 12-mm polytetrafluoroethylene graft from the (distally ligated) superior vena cava to the main pulmonary artery and a cannula placed in the inferior vena cava with an attached 16-mm Dacron graft to the main pulmonary artery. Pressures (arterial, inferior vena cava, left atrium, and pulmonary artery) and flows (ascending aorta and inferior vena cava) were recorded over 1 hour both with unsupported total cavopulmonary connection and after placing an axial flow pump (Thoratec HeartMate II) between the inferior vena caval inflow cannula and the main pulmonary artery. Under nonsupported total cavopulmonary connection circulation, inferior vena caval and aortic blood flow decreased by nearly 50%. Inferior vena caval pressure nearly doubled, whereas arterial pressure decreased by one third. Pulmonary artery pressure became nonpulsatile; however, mean pulmonary artery pressure and left atrial pressure did not change significantly. With pump-supported Fontan circulation, cardiac output, inferior vena caval flow, and arterial pressure returned to baseline. Inferior vena caval pressure decreased to below baseline levels. Mean pulmonary artery pressure and left atrial pressure again remained unchanged. Axial flow pump support from the inferior vena cava to the pulmonary artery can prevent the substantial decrease of aortic flow and pressure associated with total cavopulmonary connection and can reverse its poor hemodynamics. This is a simple model that can be used to further evaluate the potential of mechanical support as a treatment option in failing Fontan circulation.

Petrosal sinus sampling: technique and rationale.

PubMed

Miller, D L; Doppman, J L

1991-01-01

Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior petrosal sinuses can be catheterized in more than 98% of patients. The complication rate is low, and the theoretical risk of major morbidity or death is less than 1% (neither has yet occurred, to our knowledge). The most common complication is groin hematoma.

Variant Inferior Alveolar Nerves and Implications for Local Anesthesia

PubMed Central

Wolf, Kevin T.; Brokaw, Everett J.; Bell, Andrea; Joy, Anita

2016-01-01

A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure. PMID:27269666

Common and separate origins of the left and right inferior phrenic artery with a review of the literature.

PubMed

Terayama, H; Yi, S-Q; Tanaka, O; Kanazawa, T; Suyama, K; Kosemura, N; Tetsu, S; Yamazaki, H; Sakamoto, R; Kawakami, S; Suzuki, T; Sakabe, K

2017-01-01

In a 94-year-old male cadaver, upon which routine dissection was being conducted, a rare variation was found in the gastrophrenic trunk (GPT), the common trunk of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA); the GPT arises from the abdominal aorta. A hepatosplenic trunk accompanied the variation. In this variation, the RIPA first branched from the GPT and then to the LIPA and LGA. Variations in the common trunk of the LIPA and RIPA in the GPT are common, but to our knowledge, a variation (separate inferior phrenic artery in the GPT) similar to our findings has not been previously reported. We discuss the incidence and developmental and clinical significance of this variation with a detailed review of the literature. Knowledge of such a case has important clinical significance for invasive and non-invasive arterial procedures. Therefore, different variations concerning the LGA and inferior phrenic artery should be considered during surgical and non-surgical evaluations.

Management of maxillary sinus inverted papilloma via endoscopic partial medial maxillectomy with an inferior turbinate reversing approach.

PubMed

Wang, Feng; Yang, Yang; Wang, Shenqing; Chen, Haihong; Wang, Dehui; Wang, Qinying

2017-12-01

The aim of this study is to evaluate the efficacy of endoscopic treatment for maxillary inverted papilloma (IP) through partial medial maxillectomy with an inferior turbinate reversing approach. A retrospective analysis of patients treated in our institution for maxillary sinus IP between July 2011 and August 2015 was performed. Demographics, operative technique, characteristics of tumors, complications, postoperative follow-up, and recurrence were evaluated. Twenty-two patients were enrolled in the study. All tumor attachments were identified intraoperatively. Adequate visualization was obtained following our approach. All inferior turbinate and nasolacrimal ducts were preserved. The median follow-up time was 41 months. One recurrence occurred at the follow-up time of 27 months. Postoperative hemorrhage and numbness at the ipsilateral frontal teeth were reported in two and one patients, respectively. Endoscopic surgery through partial medial maxillectomy using an inferior turbinate reversing approach provides full access to the maxillary sinus and preserves the inferior turbinate and nasolacrimal duct.

Laterality patterns of brain functional connectivity: gender effects.

PubMed

Tomasi, Dardo; Volkow, Nora D

2012-06-01

Lateralization of brain connectivity may be essential for normal brain function and may be sexually dimorphic. Here, we study the laterality patterns of short-range (implicated in functional specialization) and long-range (implicated in functional integration) connectivity and the gender effects on these laterality patterns. Parallel computing was used to quantify short- and long-range functional connectivity densities in 913 healthy subjects. Short-range connectivity was rightward lateralized and most asymmetrical in areas around the lateral sulcus, whereas long-range connectivity was rightward lateralized in lateral sulcus and leftward lateralizated in inferior prefrontal cortex and angular gyrus. The posterior inferior occipital cortex was leftward lateralized (short- and long-range connectivity). Males had greater rightward lateralization of brain connectivity in superior temporal (short- and long-range), inferior frontal, and inferior occipital cortices (short-range), whereas females had greater leftward lateralization of long-range connectivity in the inferior frontal cortex. The greater lateralization of the male's brain (rightward and predominantly short-range) may underlie their greater vulnerability to disorders with disrupted brain asymmetries (schizophrenia, autism).

Laterality Patterns of Brain Functional Connectivity: Gender Effects

PubMed Central

Tomasi, Dardo; Volkow, Nora D.

2012-01-01

Lateralization of brain connectivity may be essential for normal brain function and may be sexually dimorphic. Here, we study the laterality patterns of short-range (implicated in functional specialization) and long-range (implicated in functional integration) connectivity and the gender effects on these laterality patterns. Parallel computing was used to quantify short- and long-range functional connectivity densities in 913 healthy subjects. Short-range connectivity was rightward lateralized and most asymmetrical in areas around the lateral sulcus, whereas long-range connectivity was rightward lateralized in lateral sulcus and leftward lateralizated in inferior prefrontal cortex and angular gyrus. The posterior inferior occipital cortex was leftward lateralized (short- and long-range connectivity). Males had greater rightward lateralization of brain connectivity in superior temporal (short- and long-range), inferior frontal, and inferior occipital cortices (short-range), whereas females had greater leftward lateralization of long-range connectivity in the inferior frontal cortex. The greater lateralization of the male's brain (rightward and predominantly short-range) may underlie their greater vulnerability to disorders with disrupted brain asymmetries (schizophrenia, autism). PMID:21878483

Fluoroscopy and Sonographic Guided Injection of Obliquus Capitis Inferior Muscle in an Intractable Occipital Neuralgia

PubMed Central

Kim, Ok Sun; Jeong, Seung Min; Ro, Ji Young; Kim, Duck Kyoung; Koh, Young Cho; Ko, Young Sin; Lim, So Dug; Kim, Hae Kyoung

2010-01-01

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles. PMID:20552081

Annual Progress Report Fiscal Year 1989

DTIC Science & Technology

1989-09-30

thopaedics, Las Vegas, NV, February, 1989 clusion of the common iliac veins and inferior vena cava H following vaginal hysterectomy. A case report...The aorta and inferior vena cava will be transected and cannulated. Using techniques prescribed in the Microill product literature the aorta and both...via the inferior vena cava . At that point the animals will be refrigerated to allow overnight curing of the Microfil. As each animal has had only one

Shallow Inferior Conjunctival Fornix in Contracted Socket and Anophthalmic Socket Syndrome: A Novel Technique to Deepen the Fornix Using Fascia Lata Strips

PubMed Central

Ibrahiem, Mohamed F. K.; Abdelaziz, Sahar T. A.

2016-01-01

Purpose. To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. Methods. A prospective controlled study in which 24 sockets of 24 patients who were unable to wear and retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes (9 patients) and contracted sockets (15 patients). Another 24 patients who underwent evisceration or enucleation with healthy sockets and can wear and retain their prosthesis comfortably were chosen as a control group. Deepening of the fornix was performed using fascia lata strips under general anesthesia. Central depth of the inferior fornix was measured preoperatively and postoperatively. Results. A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. 100% of anophthalmic sockets and 93.3% of contracted sockets achieved satisfactory results during the follow-up period with no postoperative lower eyelid malposition or obvious skin scar. Conclusion. Fascia lata technique is a new alternative and effective procedure to deepen the shallow inferior fornix that can be used in moderate to severe contracted sockets or anophthalmic socket syndrome with minimal lower eyelid or socket complications. PMID:27313868

Shallow Inferior Conjunctival Fornix in Contracted Socket and Anophthalmic Socket Syndrome: A Novel Technique to Deepen the Fornix Using Fascia Lata Strips.

PubMed

Ibrahiem, Mohamed F K; Abdelaziz, Sahar T A

2016-01-01

Purpose. To evaluate a new surgical technique using fascia lata to deepen the shallow inferior conjunctival fornix in contracted socket and anophthalmic socket syndrome. Methods. A prospective controlled study in which 24 sockets of 24 patients who were unable to wear and retain their ocular prosthesis due to shallow inferior fornix were enrolled and categorized into anophthalmic socket syndromes (9 patients) and contracted sockets (15 patients). Another 24 patients who underwent evisceration or enucleation with healthy sockets and can wear and retain their prosthesis comfortably were chosen as a control group. Deepening of the fornix was performed using fascia lata strips under general anesthesia. Central depth of the inferior fornix was measured preoperatively and postoperatively. Results. A statistically significant improvement of the postoperative central inferior fornix depth was reported which was marked in anophthalmic subgroup. 100% of anophthalmic sockets and 93.3% of contracted sockets achieved satisfactory results during the follow-up period with no postoperative lower eyelid malposition or obvious skin scar. Conclusion. Fascia lata technique is a new alternative and effective procedure to deepen the shallow inferior fornix that can be used in moderate to severe contracted sockets or anophthalmic socket syndrome with minimal lower eyelid or socket complications.

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy.

PubMed

Bahadir, Osman; Kosucu, Polat

2012-12-01

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy. Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides. The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45±1.48 to 3.54±1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55±1.62cm(3) vs. 5.10±1.47cm(3), (P<0.01); left: 6.72±1.53cm(3) vs. 5.00±1.37cm(3), (P<0.01)] respectively. Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Can We Perform CT of the Appendix with Less Than 1 mSv? A De-escalating Dose-simulation Study.

PubMed

Park, Ji Hoon; Jeon, Jong-June; Lee, Sung Soo; Dhanantwari, Amar C; Sim, Ji Ye; Kim, Hae Young; Lee, Kyoung Ho

2018-05-01

To systematically explore the lowest reasonably achievable radiation dose for appendiceal CT using an iterative reconstruction (IR) in young adults. We prospectively included 30 patients who underwent 2.0-mSv CT for suspected appendicitis. From the helical projection data, 1.5-, 1.0- and 0.5-mSv CTs were generated using a low-dose simulation tool and the knowledge-based IR. We performed step-wise non-inferiority tests sequentially comparing 2.0-mSv CT with each of 1.5-, 1.0- and 0.5-mSv CT, with a predetermined non-inferiority margin of 0.06. The primary end point was the pooled area under the receiver-operating-characteristic curve (AUC) for three abdominal and three non-abdominal radiologists. For the abdominal radiologists, the non-inferiorities of 1.5-, 1.0- and 0.5-mSv CT to 2.0-mSv CT were sequentially accepted [pooled AUC difference: 2.0 vs. 0.5 mSv, 0.017 (95% CI: -0.016, 0.050)]. For the non-abdominal radiologists, the non-inferiorities of 1.5- and 1.0-mSv CT were accepted; however, the non-inferiority of 0.5-mSv CT could not be proved [pooled AUC difference: 2.0 vs. 1.0 mSv, -0.017 (-0.070, 0.035) and 2.0 vs. 0.5 mSv, 0.045 (-0.071, 0.161)]. The 1.0-mSv appendiceal CT was non-inferior to 2.0-mSv CT in terms of diagnostic performance for both abdominal and non-abdominal radiologists; 0.5-mSv appendiceal CT was non-inferior only for abdominal radiologists. • For both abdominal and non-abdominal radiologists, 1.0-mSv appendiceal CT could be feasible. • The 0.5-mSv CT was non-inferior to 2.0-mSv CT only for expert abdominal radiologists. • Reader experience is an important factor affecting diagnostic impairment by low-dose CT.

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 to elucidate more anatomical details of the IFOF. And we provides a new framework for subdividing the IFOF for better understanding its functional role in the human brain. PMID:27721745

Determining the sample size required to establish whether a medical device is non-inferior to an external benchmark.

PubMed

Sayers, Adrian; Crowther, Michael J; Judge, Andrew; Whitehouse, Michael R; Blom, Ashley W

2017-08-28

The use of benchmarks to assess the performance of implants such as those used in arthroplasty surgery is a widespread practice. It provides surgeons, patients and regulatory authorities with the reassurance that implants used are safe and effective. However, it is not currently clear how or how many implants should be statistically compared with a benchmark to assess whether or not that implant is superior, equivalent, non-inferior or inferior to the performance benchmark of interest.We aim to describe the methods and sample size required to conduct a one-sample non-inferiority study of a medical device for the purposes of benchmarking. Simulation study. Simulation study of a national register of medical devices. We simulated data, with and without a non-informative competing risk, to represent an arthroplasty population and describe three methods of analysis (z-test, 1-Kaplan-Meier and competing risks) commonly used in surgical research. We evaluate the performance of each method using power, bias, root-mean-square error, coverage and CI width. 1-Kaplan-Meier provides an unbiased estimate of implant net failure, which can be used to assess if a surgical device is non-inferior to an external benchmark. Small non-inferiority margins require significantly more individuals to be at risk compared with current benchmarking standards. A non-inferiority testing paradigm provides a useful framework for determining if an implant meets the required performance defined by an external benchmark. Current contemporary benchmarking standards have limited power to detect non-inferiority, and substantially larger samples sizes, in excess of 3200 procedures, are required to achieve a power greater than 60%. It is clear when benchmarking implant performance, net failure estimated using 1-KM is preferential to crude failure estimated by competing risk models. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Permanent nerve damage from inferior alveolar nerve blocks: a current update.

PubMed

Pogrel, M Anthony

2012-10-01

Permanent nerve involvement has been reported following inferior alveolar nerve blocks. This study provides an update on cases reported to one unit in the preceding six years. Lidocaine was associated with 25 percent of cases, articaine with 33 percent of cases, and prilocaine with 34 percent of cases. It does appear that inferior alveolar nerve blocks can cause permanent nerve damage with any local anesthetic, but the incidences may vary.

Pressure-Guided Positioning of Bicaval Dual-Lumen Catheters for Venovenous Extracorporeal Gas Exchange

DTIC Science & Technology

2013-01-01

inferior venae cavae , pumped through a respiratory mem- brane, and returned into the right atrium . The insertion of these cathe- ters is...sheath and advanced through the superior vena cava and the right atrium into the inferior vena cava . Correct position was confirmed via fluoroscopy...these catheters, blood is drained from the superior and inferior venae cavae through two dedicated ports and is pumped through a respiratory

Anteriorization of the Normally Acting Inferior Oblique Muscles to Treat Dissociated Vertical Deviation Associated With Juvenile Glaucoma.

PubMed

Kassem, Rehab Rashad

2017-10-09

A case of dissociated vertical deviation, ptosis, and juvenile glaucoma is described. J deformity anteriorization of the normally acting inferior oblique muscles was chosen to preserve the superior fornix for glaucoma surgeries by avoiding superior rectus recession and to prevent narrowing of the palpebral fissure by avoiding an inferior rectus tuck. [J Pediatr Ophthalmol Strabismus. 2017;54:e63-e66.]. Copyright 2017, SLACK Incorporated.

Traumatic Inferior Gluteal Artery Pseudoaneurysm and Arteriovenous Fistula Managed with Emergency Transcatheter Embolization

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

Keeling, A. N.; Naughton, P. A.; Leahy, A. L.

We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.

Lateralization Technique and Inferior Alveolar Nerve Transposition

PubMed Central

Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

2016-01-01

Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state.

PubMed

Troisi, Nicola; Esposito, Giovanni; Cefalì, Pietro; Setti, Marco

2011-07-01

Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Servicios Relacionados. 2nd Edicion. NICHCY News Digest (Related Services. 2nd Edition. NICHCY News Digest).

ERIC Educational Resources Information Center

Mattson, Beverly

This publication, written in Spanish, examines the requirement under the Individuals with Disabilities Education Act (IDEA) that mandates that all children with disabilities have available to them special education and related services designed to meet their unique needs and prepare them for employment and independent living. It investigates what…

Detailed anatomy of the abducens nerve in the lateral rectus muscle.

PubMed

Nam, Yong Seok; Kim, In-Beom; Shin, Sun Young

2017-10-01

The aims of this study were to elucidate the detailed anatomy of the abducens nerve in the lateral rectus muscle (LRM) and the intramuscular innervation pattern using Sihler staining. In this cohort study, 32 eyes of 16 cadavers were assessed. Dissection was performed from the LRM origin to its insertion. The following distances were measured: from LRM insertion to the bifurcation point of the abducens nerve, from LRM insertion to the entry site of the superior branch or inferior branch, from the upper border of the LRM to the entry site of the superior branch, from the lower border of LRM to the entry site of inferior branch, and the widths of the main trunk and superior and inferior branches. The single trunk of the abducens nerve divided into two branches 37 mm from insertion of the LRM, and 22 of 32 (68.8%) orbits showed only two superior and inferior branches with no subdivision. The superior branch entered the LRM more anteriorly (P = 0.037) and the superior branch was thinner than the inferior branch (P = 0.040). The most distally located intramuscular nerve ending was observed at 52.9 ± 3.5% of the length of each muscle. Non-overlap between the superior and inferior intramuscular arborization of the nerve was detected in 27 of 32 cases (84.4%). Five cases (15.6%) showed definite overlap of the superior and inferior zones. This study revealed the detailed anatomy of the abducens nerve in the LRM and provides helpful information to understand abducens nerve palsy. Clin. Anat. 30:873-877, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Inferior retinal light exposure is more effective than superior retinal exposure in suppressing melatonin in humans

NASA Technical Reports Server (NTRS)

Glickman, Gena; Hanifin, John P.; Rollag, Mark D.; Wang, Jenny; Cooper, Howard; Brainard, George C.

2003-01-01

Illumination of different areas of the human retina elicits differences in acute light-induced suppression of melatonin. The aim of this study was to compare changes in plasma melatonin levels when light exposures of equal illuminance and equal photon dose were administered to superior, inferior, and full retinal fields. Nine healthy subjects participated in the study. Plexiglass eye shields were modified to permit selective exposure of the superior and inferior halves of the retinas of each subject. The Humphrey Visual Field Analyzer was used both to confirm intact full visual fields and to quantify exposure of upper and lower visual fields. On study nights, eyes were dilated, and subjects were exposed to patternless white light for 90 min between 0200 and 0330 under five conditions: (1) full retinal exposure at 200 lux, (2) full retinal exposure at 100 lux, (3) inferior retinal exposure at 200 lux, (4) superior retinal exposure at 200 lux, and (5) a dark-exposed control. Plasma melatonin levels were determined by radioimmunoassay. ANOVA demonstrated a significant effect of exposure condition (F = 5.91, p < 0.005). Post hoc Fisher PLSD tests showed significant (p < 0.05) melatonin suppression of both full retinal exposures as well as the inferior retinal exposure; however, superior retinal exposure was significantly less effective in suppressing melatonin. Furthermore, suppression with superior retinal exposure was not significantly different from that of the dark control condition. The results indicate that the inferior retina contributes more to the light-induced suppression of melatonin than the superior retina at the photon dosages tested in this study. Findings suggest a greater sensitivity or denser distribution of photoreceptors in the inferior retina are involved in light detection for the retinohypothalamic tract of humans.

The role of thyroid eye disease and other factors in the overcorrection of hypotropia following unilateral adjustable suture recession of the inferior rectus (an American Ophthalmological Society thesis).

PubMed

Kerr, Natalie C

2011-12-01

Overcorrection of hypotropia subsequent to adjustable suture surgery following inferior rectus recession is undesirable, often resulting in persistent diplopia and reoperation. I hypothesized that overcorrection shift after suture adjustment may be unique to thyroid eye disease, and the use of a nonabsorbable suture may reduce the occurrence of overcorrection. A retrospective chart review of adult patients who had undergone eye muscle surgery with an adjustable suture technique was performed. Overcorrection shifts that occurred between the time of suture adjustment and 2 months postoperatively were examined. Descriptive statistics, linear regression, Anderson-Darling tests, generalized Pareto distributions, odds ratios, and Fisher tests were performed for two overcorrection shift thresholds (>2 and >5 prism diopters [PD]). Seventy-seven patients were found: 34 had thyroid eye disease and inferior rectus recession, 30 had no thyroid eye disease and inferior rectus recession, and 13 patients had thyroid eye disease and medial rectus recession. Eighteen cases exceeded the 2 PD threshold, and 12 exceeded the 5 PD threshold. Statistical analyses indicated that overcorrection was associated with thyroid eye disease (P=6.7E-06), inferior rectus surgery (P=6.7E-06), and absorbable sutures (>2 PD: OR=3.7, 95% CI=0.4-35.0, P=0.19; and >5 PD: OR=6.0, 95% CI=1.1-33.5, P=0.041). After unilateral muscle recession for hypotropia, overcorrection shifts are associated with thyroid eye disease, surgery of the inferior rectus, and use of absorbable sutures. Surgeons performing unilateral inferior rectus recession on adjustable suture in the setting of thyroid eye disease should consider using a nonabsorbable suture to reduce the incidence of postoperative overcorrection.

Statistical issues in the design, conduct and analysis of two large safety studies.

PubMed

Gaffney, Michael

2016-10-01

The emergence, post approval, of serious medical events, which may be associated with the use of a particular drug or class of drugs, is an important public health and regulatory issue. The best method to address this issue is through a large, rigorously designed safety study. Therefore, it is important to elucidate the statistical issues involved in these large safety studies. Two such studies are PRECISION and EAGLES. PRECISION is the primary focus of this article. PRECISION is a non-inferiority design with a clinically relevant non-inferiority margin. Statistical issues in the design, conduct and analysis of PRECISION are discussed. Quantitative and clinical aspects of the selection of the composite primary endpoint, the determination and role of the non-inferiority margin in a large safety study and the intent-to-treat and modified intent-to-treat analyses in a non-inferiority safety study are shown. Protocol changes that were necessary during the conduct of PRECISION are discussed from a statistical perspective. Issues regarding the complex analysis and interpretation of the results of PRECISION are outlined. EAGLES is presented as a large, rigorously designed safety study when a non-inferiority margin was not able to be determined by a strong clinical/scientific method. In general, when a non-inferiority margin is not able to be determined, the width of the 95% confidence interval is a way to size the study and to assess the cost-benefit of relative trial size. A non-inferiority margin, when able to be determined by a strong scientific method, should be included in a large safety study. Although these studies could not be called "pragmatic," they are examples of best real-world designs to address safety and regulatory concerns. © The Author(s) 2016.

The Role of Thyroid Eye Disease and Other Factors in the Overcorrection of Hypotropia Following Unilateral Adjustable Suture Recession of the Inferior Rectus (An American Ophthalmological Society Thesis)

PubMed Central

Kerr, Natalie C.

2011-01-01

Purpose Overcorrection of hypotropia subsequent to adjustable suture surgery following inferior rectus recession is undesirable, often resulting in persistent diplopia and reoperation. I hypothesized that overcorrection shift after suture adjustment may be unique to thyroid eye disease, and the use of a nonabsorbable suture may reduce the occurrence of overcorrection. Methods A retrospective chart review of adult patients who had undergone eye muscle surgery with an adjustable suture technique was performed. Overcorrection shifts that occurred between the time of suture adjustment and 2 months postoperatively were examined. Descriptive statistics, linear regression, Anderson-Darling tests, generalized Pareto distributions, odds ratios, and Fisher tests were performed for two overcorrection shift thresholds (>2 and >5 prism diopters [PD]). Results Seventy-seven patients were found: 34 had thyroid eye disease and inferior rectus recession, 30 had no thyroid eye disease and inferior rectus recession, and 13 patients had thyroid eye disease and medial rectus recession. Eighteen cases exceeded the 2 PD threshold, and 12 exceeded the 5 PD threshold. Statistical analyses indicated that overcorrection was associated with thyroid eye disease (P=6.7E-06), inferior rectus surgery (P=6.7E-06), and absorbable sutures (>2 PD: OR=3.7, 95% CI=0.4–35.0, P=0.19; and >5 PD: OR=6.0, 95% CI=1.1–33.5, P=0.041). Conclusions After unilateral muscle recession for hypotropia, overcorrection shifts are associated with thyroid eye disease, surgery of the inferior rectus, and use of absorbable sutures. Surgeons performing unilateral inferior rectus recession on adjustable suture in the setting of thyroid eye disease should consider using a nonabsorbable suture to reduce the incidence of postoperative overcorrection. PMID:22253487

Network modulation during complex syntactic processing

PubMed Central

den Ouden, Dirk-Bart; Saur, Dorothee; Mader, Wolfgang; Schelter, Björn; Lukic, Sladjana; Wali, Eisha; Timmer, Jens; Thompson, Cynthia K.

2011-01-01

Complex sentence processing is supported by a left-lateralized neural network including inferior frontal cortex and posterior superior temporal cortex. This study investigates the pattern of connectivity and information flow within this network. We used fMRI BOLD data derived from 12 healthy participants reported in an earlier study (Thompson, C. K., Den Ouden, D. B., Bonakdarpour, B., Garibaldi, K., & Parrish, T. B. (2010b). Neural plasticity and treatment-induced recovery of sentence processing in agrammatism. Neuropsychologia, 48(11), 3211-3227) to identify activation peaks associated with object-cleft over syntactically less complex subject-cleft processing. Directed Partial Correlation Analysis was conducted on time series extracted from participant-specific activation peaks and showed evidence of functional connectivity between four regions, linearly between premotor cortex, inferior frontal gyrus, posterior superior temporal sulcus and anterior middle temporal gyrus. This pattern served as the basis for Dynamic Causal Modeling of networks with a driving input to posterior superior temporal cortex, which likely supports thematic role assignment, and networks with a driving input to inferior frontal cortex, a core region associated with syntactic computation. The optimal model was determined through both frequentist and Bayesian model selection and turned out to reflect a network with a primary drive from inferior frontal cortex and modulation of the connection between inferior frontal and posterior superior temporal cortex by complex sentence processing. The winning model also showed a substantive role for a feedback mechanism from posterior superior temporal cortex back to inferior frontal cortex. We suggest that complex syntactic processing is driven by word-order analysis, supported by inferior frontal cortex, in an interactive relation with posterior superior temporal cortex, which supports verb argument structure processing. PMID:21820518

Stereotactic topography of the greater and third occipital nerves and its clinical implication.

PubMed

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

2018-01-17

This study aimed to provide topographic information of the greater occipital (GON) and third occipital (3ON) nerves, with the three-dimensional locations of their emerging points on the back muscles (60 sides, 30 cadavers) and their spatial relationship with muscle layers, using a 3D digitizer (Microscribe G2X, Immersion Corp, San Jose CA, USA). With reference to the external occipital protuberance (EOP), GON pierced the trapezius at a point 22.6 ± 7.4 mm lateral and 16.3 ± 5.9 mm inferior and the semispinalis capitis (SSC) at a point 13.1 ± 6.0 mm lateral and 27.7 ± 9.9 mm inferior. With the same reference, 3ON pierced, the trapezius at a point 12.9 ± 9.3 mm lateral and 44.2 ± 21.4 mm inferior, the splenius capitis at a point 10.0 ± 5.3 mm lateral and 59.2 ± 19.8 mm inferior, and SSC at a point 11.5 ± 9.9 mm lateral and 61.4 ± 15.3 mm inferior. Additionally, GON arose, winding up the obliquus capitis inferior, with the winding point located 52.3 ± 11.7 mm inferior to EOP and 30.2 ± 8.9 mm lateral to the midsagittal line. Knowing the course of GON and 3ON, from their emergence between vertebrae to the subcutaneous layer, is necessary for reliable nerve detection and precise analgesic injections. Moreover, stereotactic measurement using the 3D digitizer seems useful and accurate for neurovascular structure study.

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.

[Inferior vestibular neuritis: diagnosis using VEMP].

PubMed

Walther, L E; Repik, I

2012-02-01

Vestibular evoked myogenic potentials (VEMP) are a new method to establish the functional status of the otolith organs. The sacculocollic reflex of the cervical VEMP to air conduction (AC) reflects predominantly saccular function due to saccular afferents to the inferior vestibular nerve. We describe a case of inferior vestibular neuritis as a rare differential diagnosis of vestibular neuritis. Clinical signs were a normal caloric response, unilaterally absent AC cVEMPs and bilaterally preserved ocular VEMPs (AC oVEMPs).

ISOLATED ANOMALOUS INFERIOR VENA CAVA CONNECTION TO THE LEFT ATRIUM: REPORT OF A SUCCESSFUL SURGICAL CASE AND REVIEW OF THE LITERATURE.

PubMed

Richardson, James V.; Doty, Donald B.

1979-03-01

This report describes a rare case of isolated anomalous connection of the inferior vena cava to the left atrium. Patching of a surgically-created atrial septal defect and rerouting of caval drainage ino the right atrium effected a successful correction. This case brings to 18 the total number of reported cases in the literature in which the inferior vena cava was connected to the left atrium.

Inferior oblique muscle paresis as a sign of myasthenia gravis.

PubMed

Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

2016-03-01

Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (p<0.01). Eighteen (60%) patients had ptosis, six (20%) of whom had bilateral ptosis. Diagnosing myasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effects of inferior olive lesion on strychnine seizure

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

Anderson, M.C.; Chung, E.Y.; Van Woert, M.H.

1990-10-01

Bilateral inferior olive lesions, produced by systemic administration of the neurotoxin 3-acetylpyridine (3AP) produce a proconvulsant state specific for strychnine-induced seizures and myoclonus. We have proposed that these phenomena are mediated through increased excitation of cerebellar Purkinje cells, through activation of glutamate receptors, in response to climbing fiber deafferentation. An increase in quisqualic acid (QA)-displaceable ({sup 3}H)AMPA ((RS)-alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid) binding in cerebella from inferior olive-lesioned rats was observed, but no difference in ({sup 3}H)AMPA binding displaced by glutamate, kainic acid (KA) or glutamate diethylester (GDEE) was seen. The excitatory amino acid antagonists GDEE and MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclo-hepten-5,10 imine) were tested asmore » anticonvulsants for strychnine-induced seizures in 3AP inferior olive-lesioned and control rats. Neither drug effected seizures in control rats, however, both GDEE and MK-801 produced a leftward shift in the strychnine-seizure dose-response curve in 3AP inferior olive-lesioned rats. GDEE also inhibited strychnine-induced myoclonus in the lesioned group, while MK-801 had no effect on myoclonus. The decreased threshold for strychnine-induced seizures and myoclonus in the 3AP-inferior olive-lesioned rats may be due to an increase in glutamate receptors as suggested by the ({sup 3}H)AMPA binding data.« less

Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial.

PubMed

Montserrat-Bosch, Marta; Figueiredo, Rui; Nogueira-Magalhães, Pedro; Arnabat-Dominguez, Josep; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

2014-07-01

To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries.

The role of left inferior frontal cortex during audiovisual speech perception in infants.

PubMed

Altvater-Mackensen, Nicole; Grossmann, Tobias

2016-06-01

In the first year of life, infants' speech perception attunes to their native language. While the behavioral changes associated with native language attunement are fairly well mapped, the underlying mechanisms and neural processes are still only poorly understood. Using fNIRS and eye tracking, the current study investigated 6-month-old infants' processing of audiovisual speech that contained matching or mismatching auditory and visual speech cues. Our results revealed that infants' speech-sensitive brain responses in inferior frontal brain regions were lateralized to the left hemisphere. Critically, our results further revealed that speech-sensitive left inferior frontal regions showed enhanced responses to matching when compared to mismatching audiovisual speech, and that infants with a preference to look at the speaker's mouth showed an enhanced left inferior frontal response to speech compared to infants with a preference to look at the speaker's eyes. These results suggest that left inferior frontal regions play a crucial role in associating information from different modalities during native language attunement, fostering the formation of multimodal phonological categories. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomized controlled non-inferiority study comparing the antiemetic effect between intravenous granisetron and oral azasetron based on estimated 5-HT3 receptor occupancy.

PubMed

Endo, Junki; Iihara, Hirotoshi; Yamada, Maya; Yanase, Koumei; Kamiya, Fumihiko; Ito, Fumitaka; Funaguchi, Norihiko; Ohno, Yasushi; Minatoguchi, Shinya; Itoh, Yoshinori

2012-09-01

The acute antiemetic effect was compared between oral azasetron and intravenous granisetron based on the 5-hydroxytryptamine(3) (5-HT(3)) receptor occupancy theory. Receptor occupancy was estimated from reported data on plasma concentrations and affinity constants to 5-HT(3) receptor. A randomized non-inferiority study comparing acute antiemetic effects between oral azasetron and intravenous granisetron was performed in 105 patients receiving the first course of carboplatin-based chemotherapy for lung cancer. Azasetron exhibited the highest 5-HT(3) receptor occupancy among various first-generation 5-HT(3) antagonists. The complete response to oral azasetron was shown to be non-inferior to that of intravenous granisetron, in which the risk difference was 0.0004 (95% confidence interval: -0.0519-0.0527). The lower limit of the confidence intervals did not exceed the negative non-inferiority margin (-0.1). The complete response during the overall period was not different (68% versus 67%). Oral azasetron was found to be non-inferior to intravenous granisetron in the acute antiemetic effect against moderately emetogenic chemotherapy.

Longitudinal development of prefrontal function during early childhood.

PubMed

Moriguchi, Yusuke; Hiraki, Kazuo

2011-04-01

This is a longitudinal study on development of prefrontal function in young children. Prefrontal areas have been observed to develop dramatically during early childhood. To elucidate this development, we gave children cognitive shifting tasks related to prefrontal function at 3 years of age (Time 1) and 4 years of age (Time 2). We then monitored developmental changes in behavioral performance and examined prefrontal activation using near infrared spectroscopy. We found that children showed better behavioral performance and significantly stronger inferior prefrontal activation at Time 2 than they did at Time 1. Moreover, we demonstrated individual differences in prefrontal activation for the same behavioral tasks. Children who performed better in tasks at Time 1 showed significant activation of the right inferior prefrontal regions at Time 1 and significant activation of the bilateral inferior prefrontal regions at Time 2. Children who showed poorer performance at Time 1 exhibited no significant inferior prefrontal activation at Time 1 but significant left inferior prefrontal activation at Time 2. These results indicate the importance of the longitudinal method to address the link between cognitive and neural development. Copyright © 2011 Elsevier Ltd. All rights reserved.

Patellar Shape-Memory Fixator for the Treatment of Comminuted Fractures of the Inferior Pole of the Patella

NASA Astrophysics Data System (ADS)

Liu, Xin-Wei; Shang, Hui-Juan; Xu, Shuo-Gui; Wang, Zhi-Wei; Zhang, Chun-Cai; Fu, Qing-Ge

2011-07-01

Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. The purpose of this study is to evaluate the clinical effectiveness of the internal fixation technique with Patellar Shape-Memory Fixator (PSMF) in acute comminuted fractures of the inferior pole of the patella. We retrospectively studied 25 patients with comminuted fractures of the inferior pole of the patella who were treated with PSMF and followed up for a mean period of 26 months (14 to 60). All the fractures healed at a mean of 6 weeks (5 to 7). The mean grading at the final follow-up was 29.5 points (27 to 30) using the Bostman score, with no observable restriction of movement. No breakage of the PSMF or infection occurred. No delayed union, nonunion, and infection were seen. This technique preserved the length of the patella, reduced the comminuted fragments of the inferior pole and avoided long-term immobilization of the knee.

Modality specificity in the cerebro-cerebellar neurocircuitry during working memory.

PubMed

Ng, H B Tommy; Kao, K-L Cathy; Chan, Y C; Chew, Effie; Chuang, K H; Chen, S H Annabel

2016-05-15

Previous studies have suggested cerebro-cerebellar circuitry in working memory. The present fMRI study aims to distinguish differential cerebro-cerebellar activation patterns in verbal and visual working memory, and employs a quantitative analysis to deterimine lateralization of the activation patterns observed. Consistent with Chen and Desmond (2005a,b) predictions, verbal working memory activated a cerebro-cerebellar circuitry that comprised left-lateralized language-related brain regions including the inferior frontal and posterior parietal areas, and subcortically, right-lateralized superior (lobule VI) and inferior cerebellar (lobule VIIIA/VIIB) areas. In contrast, a distributed network of bilateral inferior frontal and inferior temporal areas, and bilateral superior (lobule VI) and inferior (lobule VIIB) cerebellar areas, was recruited during visual working memory. Results of the study verified that a distinct cross cerebro-cerebellar circuitry underlies verbal working memory. However, a neural circuitry involving specialized brain areas in bilateral neocortical and bilateral cerebellar hemispheres subserving visual working memory is observed. Findings are discussed in the light of current models of working memory and data from related neuroimaging studies. Copyright © 2016 Elsevier B.V. All rights reserved.

Diffusion tensor imaging of the inferior colliculus and brainstem auditory-evoked potentials in preterm infants.

PubMed

Reiman, Milla; Parkkola, Riitta; Johansson, Reijo; Jääskeläinen, Satu K; Kujari, Harry; Lehtonen, Liisa; Haataja, Leena; Lapinleimu, Helena

2009-08-01

Preterm and low-birth-weight infants have an increased risk of sensorineural hearing loss. Brainstem auditory-evoked potentials (BAEP) are an effective method to detect subtle deficits in impulse conduction in the auditory pathway. Abnormalities on diffusion tensor imaging (DTI) have been shown to be associated with perinatal white-matter injury and reduced fractional anisotropy (FA) has been reported in patients with sensorineural hearing loss. To evaluate the possibility of a correlation between BAEP and DTI of the inferior colliculus in preterm infants. DTI at term age and BAEP measurements were performed on all very-low-birth-weight or very preterm study infants (n=56). FA and apparent diffusion coefficient (ADC) of the inferior colliculus were measured from the DTI. Shorter BAEP wave I, III, and V latencies and I-III and I-V intervals and higher wave V amplitude correlated with higher FA of the inferior colliculus. The association between the DTI findings of the inferior colliculus and BAEP responses suggests that DTI can be used to assess the integrity of the auditory pathway in preterm infants.

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

PubMed

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

2017-02-01

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

The ABC of non-inferiority margin setting from indirect comparisons.

PubMed

Julious, Steven A

2011-01-01

In a non-inferiority trial to assess a new investigative treatment, there may need to be consideration of an indirect comparison with placebo using the active control in the current trial. We can, therefore, use the fact that there is a common active control in the comparisons of the investigative treatment and placebo. In analysing a non-inferiority trial, the ABC of: Assay sensitivity, Bias minimisation and Constancy assumption needs to be considered. It is highlighted how the ABC assumptions can potentially fail when there is placebo creep or a patient population shift. In this situation, the belief about the placebo response expressed in terms of a prior probability in Bayesian formulation could be used with the observed treatment effects to set the non-inferiority limit. Copyright © 2011 John Wiley & Sons, Ltd.

Histologic consequences of inferior oblique anastomosis to denervated lateral rectus muscle.

PubMed

Christiansen, S; Madhat, M; Baker, R S

1987-01-01

Secondary muscular neurotization has been proposed as a means of restoring contractility to paretic extraocular muscle. We studied this technique by anastomosing healthy inferior oblique muscle to lateral rectus muscle that had been denervated either orbitally or intracranially in 20 dogs. Nerve and muscle fiber growth from the inferior oblique to the lateral rectus was demonstrated but no new neuromuscular junctions were formed. Regeneration of the lesioned sixth nerve occurred frequently and may explain the restoration of function claimed after this procedure.

Hepatic venous connection to a persistent inferior caval vein in left isomerism.

PubMed

Guenthard, J; Carvalho, J S; Anderson, R H; Rigby, M L

1990-09-01

In 22 cases of left atrial isomerism studied at the Brompton Hospital, four cases were found to have an unusual arrangement of the abdominal vessels. There was persistence of an inferior caval vein, partially anomalous hepatic venous connection and additional continuation of part of the venous return from the lower body through the azygos venous system. This venous pattern had surgical implications in our index case, since redirection of the inferior caval venous return was necessary.

The Anatomical Nature of Dental Paresthesia: A Quick Review

PubMed Central

Ahmad, Maha

2018-01-01

Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment. This review examines inferior alveolar block paresthesia symptoms, side effect and complications. Understanding the anatomy of the pterygomandibular fossa will help in understanding the nature and causes of the dental paresthesia. In this review, we review the anatomy of the region surrounding inferior alveolar injections, anesthetic agents and also will look also into the histology and injury process of the inferior alveolar nerve. PMID:29541262

Inferior turbinate classification system, grades 1 to 4: development and validation study.

PubMed

Camacho, Macario; Zaghi, Soroush; Certal, Victor; Abdullatif, Jose; Means, Casey; Acevedo, Jason; Liu, Stanley; Brietzke, Scott E; Kushida, Clete A; Capasso, Robson

2015-02-01

To develop a validated inferior turbinate grading scale. Development and validation study. Phase 1 development (alpha test) consisted of a proposal of 10 different inferior turbinate grading scales (>1,000 clinic patients). Phase 2 validation (beta test) utilized 10 providers grading 27 standardized endoscopic photos of inferior turbinates using two different classification systems. Phase 3 validation (pilot study) consisted of 100 live consecutive clinic patients (n = 200 inferior turbinates) who were each prospectively graded by 18 different combinations of two independent raters, and grading was repeated by each of the same two raters, two separate times for each patient. In the development phase, 25% (grades 1-4) and 33% (grades 1-4) were the most useful systems. In the validation phase, the 25% classification system was found to be the best balance between potential clinical utility and ability to grade; the photo grading demonstrated a Cohen's kappa (κ) = 0.4671 ± 0.0082 (moderate inter-rater agreement). Live-patient grading with the 25% classification system demonstrated an overall inter-rater reliability of 71.5% (95% confidence interval [CI]: 64.8-77.3), with overall substantial agreement (κ = 0.704 ± 0.028). Intrarater reliability was 91.5% (95% CI: 88.7-94.3). Distribution for the 200 inferior turbinates was as follows: 25% quartile = grade 1, 50% quartile (median) = grade 2, 75% quartile = grade 3, and 90% quartile = grade 4. Mean turbinate size was 2.22 (95% CI: 2.07-2.34; standard deviation 1.02). Categorical κ was as follows: grade 1, 0.8541 ± 0.0289; grade 2, 0.7310 ± 0.0289; grade 3, 0.6997 ± 0.0289, and grade 4, 0.7760 ± 0.0289. The 25% (grades 1-4) inferior turbinate classification system is a validated grading scale with high intrarater and inter-rater reliability. This system can facilitate future research by tracking the effect of interventions on inferior turbinates. 2c. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Anesthetic efficacy of the intraosseous injection of 0.9 mL of 2% lidocaine (1:100,000 epinephrine) to augment an inferior alveolar nerve block.

PubMed

Reitz, J; Reader, A; Nist, R; Beck, M; Meyers, W J

1998-11-01

The purpose of this study was to determine the anesthetic efficacy of an intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine to augment an inferior alveolar nerve block in mandibular posterior teeth. With the use of a repeated-measures design, each of 38 subjects randomly received one or the other of 2 combinations of injections at 2 separate appointments. The combinations were inferior alveolar nerve block + intraosseous injection (on the distal of the second premolar) through use of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine and inferior alveolar nerve block + mock intraosseous injection. The first molar, second premolar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-minute cycles for 120 minutes postinjection. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. One hundred percent of the subjects had lip numbness with the inferior alveolar nerve block + intraosseous injection combination technique. The respective anesthetic success rates for the inferior alveolar nerve block + mock intraosseous injection combination and the inferior alveolar nerve block + intraosseous injection combination were 60% and 100% for the second premolar, 71% and 95% for the first molar, and 74% and 87% for the second molar. The differences were significant (P < .05) for the second premolar through 50 minutes and for the first molar through 20 minutes. There were no significant (P > .05) differences for the second molar. Sixty-eight percent of the subjects had a subjective increase in heart rate with the intraosseous injection. The results of this study indicate that the supplemental intraosseous injection of 0.9 mL of 2% lidocaine with 1:100,000 epinephrine, given distal to the second premolar, significantly increased the success of pulpal anesthesia in the second premolar (for 50 minutes) and first molar (for 20 minutes) in comparison with the inferior alveolar nerve block alone. The intraosseous injection did not statistically increase success in the second molar.

Informe: La Región 2 debe mejorar sus procesos internos relacionados con los acuerdos de asistencia de Puerto Rico

EPA Pesticide Factsheets

Informe #17-P-0402, 25 de sept de 2017 . La Región 2 pudo haber utilizado ineficientemente más de $217,000 en fondos públicos al no confirmar que se usó el equipo tal como estaba planeado ni que obtuvo apoyo para costos complementarios previamente...

The Dyslexia Handbook: Procedures Concerning Dyslexia and Related Disorders = Manual sobre la dislexia: Procedimientos relacionados con la dislexia y otros desordenes.

ERIC Educational Resources Information Center

Texas Education Agency, Austin.

This handbook, available in English and Spanish, contains the Texas State Board of Education's approved procedures concerning dyslexia and related disorders and information regarding the state's dyslexia statutes and their relation to the federal Rehabilitation Act of 1973, Section 504, and the Individuals with Disabilities Education Act. Chapters…

Sex, Age, and Cognitive Correlates of Asymmetries in Thickness of the Cortical Mantle Across the Life Span

PubMed Central

Plessen, Kerstin J.; Hugdahl, Kenneth; Bansal, Ravi; Hao, Xuejun

2014-01-01

We assessed the correlations of age, sex, and cognitive performance with measures of asymmetry in cortical thickness on high-resolution MRIs in 215 healthy human children and adults, 7–59 years of age. A left > right asymmetry in thickness of the cortical mantle was present throughout the entire lateral, dorsal, and mesial surfaces of the frontal lobe, extending into primary sensory, superior parietal, and anterior superior temporal cortices. A right > left asymmetry was present in the lateral, mesial, and dorsal surfaces of the posterior temporal, parietal, and occipital cortices, as well as in the entire inferior surface of the brain. An exaggerated left > right asymmetry was detected in females in anterior brain regions, and an exaggerated right > left asymmetry was detected in males in the orbitofrontal, inferior parietal, and inferior occipital cortices. Weaker moderating effects of sex were scattered along the mesial surface of the brain. Age significantly moderated asymmetry measures in the inferior sensorimotor, inferior parietal, posterior temporal, and inferior occipital cortices. The age × asymmetry interaction derived from a steeper decline in cortical thickness with age in the right hemisphere than in the left on the lateral surface, whereas it derived from a steeper decline with age in the left hemisphere than in the right on the mesial surface. Finally, measures of performance on working memory and vocabulary tasks improved with increasing magnitudes of normal asymmetries in regions thought to support these cognitive capacities. PMID:24790200

A proof of concept phase II non-inferiority criterion.

PubMed

Neuenschwander, Beat; Rouyrre, Nicolas; Hollaender, Norbert; Zuber, Emmanuel; Branson, Michael

2011-06-15

Traditional phase III non-inferiority trials require compelling evidence that the treatment vs control effect bfθ is better than a pre-specified non-inferiority margin θ(NI) . The standard approach compares this margin to the 95 per cent confidence interval of the effect parameter. In the phase II setting, in order to declare Proof of Concept (PoC) for non-inferiority and proceed in the development of the drug, different criteria that are specifically tailored toward company internal decision making may be more appropriate. For example, less evidence may be needed as long as the effect estimate is reasonably convincing. We propose a non-inferiority design that addresses the specifics of the phase II setting. The requirements are that (1) the effect estimate be better than a critical threshold θ(C), and (2) the type I error with regard to θ(NI) is controlled at a pre-specified level. This design is compared with the traditional design from a frequentist as well as a Bayesian perspective, where the latter relies on the Level of Proof (LoP) metric, i.e. the probability that the true effect is better than effect values of interest. Clinical input is required to establish the value θ(C), which makes the design transparent and improves interactions within clinical teams. The proposed design is illustrated for a non-inferiority trial for a time-to-event endpoint in oncology. Copyright © 2011 John Wiley & Sons, Ltd.

Anterior inferior plating versus superior plating for clavicle fracture: a meta-analysis.

PubMed

Ai, Jie; Kan, Shun-Li; Li, Hai-Liang; Xu, Hong; Liu, Yang; Ning, Guang-Zhi; Feng, Shi-Qing

2017-04-18

The position of plate fixation for clavicle fracture remains controversial. Our objective was to perform a comprehensive review of the literature and quantify the surgical parameters and clinical indexes between the anterior inferior plating and superior plating for clavicle fracture. PubMed, EMBASE, and the Cochrane Library were searched for randomized and non-randomized studies that compared the anterior inferior plating with the superior plating for clavicle fracture. The relative risk or standardized mean difference with 95% confidence interval was calculated using either a fixed- or random-effects model. Four randomized controlled trials and eight observational studies were identified to compare the surgical parameters and clinical indexes. For the surgical parameters, the anterior inferior plating group was better than the superior plating group in operation time and blood loss (P < 0.05). Furthermore, in terms of clinical indexes, the anterior inferior plating was superior to the superior plating in reducing the union time, and the two kinds of plate fixation methods were comparable in constant score, and the rate of infection, nonunion, and complications (P > 0.05). Based on the current evidence, the anterior inferior plating may reduce the blood loss, the operation and union time, but no differences were observed in constant score, and the rate of infection, nonunion, and complications between the two groups. Given that some of the studies have low quality, more randomized controlled trails with high quality should be conduct to further verify the findings.

Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology

PubMed Central

Wang, Hom-Lay; Sabalys, Gintautas

2010-01-01

ABSTRACT Objectives It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery. Material and Methods Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed. Results In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle. Conclusions A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established. PMID:24421958

Initial experience with laparoscopic inferior epigastric vessel ligation for delayed transverse rectus abdominus musculocutaneous flap breast reconstruction.

PubMed

Trus, Thadeus L; Collins, E Dale; Demas, Christopher; Kerrigan, Carolyn

2007-04-01

Transverse rectus abdominus musculocutaneous (TRAM) flap breast reconstruction provides excellent cosmetic results. Pedicle flap viability is greatly enhanced by prereconstruction inferior epigastric vessel ligation, which encourages collateral arterial flow (delayed TRAM). We report our initial experience with laparoscopic inferior epigastric vessel ligation. Prospective case series. Tertiary academic center. Female patients with breast cancer who chose pedicle TRAM reconstruction. Vessel ligations were performed 7 to 14 days prior to reconstruction. Abdominal access was achieved with a 3-mm umbilical trocar. A 5-mm trocar was placed lateral to the rectus sheath in the right lower quadrant. Five-millimeter Teflon clips were used to ligate the vessels near their origin. Complications of surgery and subsequent flap viability. From January 2001 to July 2006, 130 patients had laparoscopic inferior epigastric vessel ligation, of whom 123 patients had bilateral ligation. Additional procedures in conjunction with vessel ligation were performed in 38 patients (sentinel node biopsy [27], bilateral oophorectomy [7], liver biopsy [2], breast biopsy [1], and Nissen fundoplication [1]). Median operative time for those patients undergoing ligation only was 32.6 minutes (range, 14-121 minutes). The inferior epigastric vessels were not identified in 2 patients. Metastatic breast cancer involving the liver was found in 1 patient. There were no conversions or complications. Subsequent TRAM flap viability was excellent in most cases, with 1 complete flap necrosis in a high-risk, morbidly obese patient. Laparoscopic inferior epigastric vessel ligation for delayed TRAM flap breast reconstruction is a safe, effective procedure.

Sex, age, and cognitive correlates of asymmetries in thickness of the cortical mantle across the life span.

PubMed

Plessen, Kerstin J; Hugdahl, Kenneth; Bansal, Ravi; Hao, Xuejun; Peterson, Bradley S

2014-04-30

We assessed the correlations of age, sex, and cognitive performance with measures of asymmetry in cortical thickness on high-resolution MRIs in 215 healthy human children and adults, 7-59 years of age. A left > right asymmetry in thickness of the cortical mantle was present throughout the entire lateral, dorsal, and mesial surfaces of the frontal lobe, extending into primary sensory, superior parietal, and anterior superior temporal cortices. A right > left asymmetry was present in the lateral, mesial, and dorsal surfaces of the posterior temporal, parietal, and occipital cortices, as well as in the entire inferior surface of the brain. An exaggerated left > right asymmetry was detected in females in anterior brain regions, and an exaggerated right > left asymmetry was detected in males in the orbitofrontal, inferior parietal, and inferior occipital cortices. Weaker moderating effects of sex were scattered along the mesial surface of the brain. Age significantly moderated asymmetry measures in the inferior sensorimotor, inferior parietal, posterior temporal, and inferior occipital cortices. The age × asymmetry interaction derived from a steeper decline in cortical thickness with age in the right hemisphere than in the left on the lateral surface, whereas it derived from a steeper decline with age in the left hemisphere than in the right on the mesial surface. Finally, measures of performance on working memory and vocabulary tasks improved with increasing magnitudes of normal asymmetries in regions thought to support these cognitive capacities.

Systematization of the vesical and uterovaginal efferences of the female inferior hypogastric plexus (pelvic): applications to pelvic surgery on women patients.

PubMed

Mauroy, B; Bizet, B; Bonnal, J L; Crombet, T; Duburcq, T; Hurt, C

2007-04-01

To locate and describe the various efferences of the plexus in order to make it easier to avoid nerve lesions during pelvic surgery on women patients through a better anatomical knowledge of the inferior hypogastric plexus (IHP). We dissected 27 formalin embalmed female anatomical subjects, none of which bore any stigmata of subumbilical surgery. The dissection was always performed using the same technique: identification of the inferior hypogastric plexus, whose posterior superior angle follows on from the hypogastric nerve and whose top, which is anterior and inferior, is located exactly at the ureter's point of entry into the base of the parametrium, underneath the posterior layer of the broad ligament. The IHP is located at the level of the posterior floor of the pelvis, opposite to the sacral concavity. Its top, which is anterior inferior, is at the point of contact with the ureter at its entry into the posterior layer of the broad ligament. The uterovaginal, vesical and rectal efferences originate in the paracervix. Three efferent nerves branch, two of them from its top and the third from its inferior edge: (1) A vaginal nerve, medial to the ureter, follows the uterine artery and divides into two groups: anterior thin, heading for the vagina and the uterus; posterior, voluminous, heading in a superior rectal direction (=superior rectal nerve). (2) A vesical nerve, lateral to the ureter, divides into two groups, lateral and medial. (3) The inferior rectal nerve emerges from the inferior edge of the IHP, between the fourth sacral root and the ureter's point of entry into the base of the parametrium. The ureter is the crucial point of reference for the IHP and its efferences and acts as a real guide for identifying the anterior inferior angle or top of the IHP, the origin of the vaginal nerve, the level of the ureterovesical junction and the division of the vesical nerve into its two medial and lateral branches. Dissecting underneath and inside the ureter and the uterine artery involves a risk of lesion of the vaginal nerve and its uterovaginal branches. Further forward, between the intersection and the ureterovesical junction, dissecting and/or coagulating under the ureter involves a risk of lesions to the vesical nerve, which are likely to explain the phenomena of denervation of the anterior floor encountered after certain hysterectomies and/or surgical treatments of vesicoureteral reflux.

Anatomical and Histological Evaluation of the Retroauricular Fascia Flap for Staged Auricular Reconstruction.

PubMed

Li, Yiyuan; Cui, Chunxiao; Zhang, Ruhong; Zhang, Qun; Xu, Zhicheng; Xu, Feng; Li, Datao

2018-06-01

The retroauricular fascia flap (RFF) is one of the most commonly used vascularized linings for auriculocephalic sulcus reconstruction in staged total auricular reconstruction. This study aims to investigate the histomorphometric features regarding the retroauricular fascia. Histological evaluation included qualitative observation and quantitative analysis of sections of RFF stained with hematoxylin and eosin, Masson's trichrome, Elastica van Gieson, CD31, and Lyve-1. Ultrasonographic evaluation included measurement of the thickness of the superficial layer of the retroauricular fascia (RFF origin) at three different positions in microtia patients. P < 0.05 was considered statistically significant. RFF was a thin, highly organized layer with mainly collagen fibers. From its superior to inferior portions, the percentage of collagen fibers differed significantly (superior 87.57 ± 10.85%, middle 68.29 ± 29.02%, inferior 53.31 ± 33.33%, p < 0.05). The percentages of elastic fibers in the superior (4.86 ± 5.17%) and middle (5.05 ± 5.37%) areas were higher than that in the inferior (2.14 ± 2.42%, p < 0.05). RFF blood vessel density (20× magnification) decreased significantly from the superior to inferior portions (superior 6.39 ± 1.18, middle 5.17 ± 1.15, inferior 2.67 ± 0.78, p < 0.05). Lymphatic vessel density (20× magnification) also decreased significantly from the superior to inferior regions (superior 6.80 ± 0.62, middle 5.26 ± 1.17, inferior 2.11 ± 0.46, p < 0.05). Thickness of the superficial layer of retroauricular fascia increased significantly from the superior to inferior regions (superior 0.29 ± 0.06 mm, middle 0.36 ± 0.09 mm, inferior 0.53 ± 0.14 mm, p < 0.001). From cranial to caudal, the RFF became thicker, less elastic, and less vascularized, and contained fewer lymphatic vessels. Therefore, when the retroauricular fascia is large enough, the superior portion would be preferred for RFF in auriculocephalic sulcus reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Anaesthetic Efficacy of 4% Articaine Primary Buccal Infiltration Versus 2% Lidocaine Inferior Alveolar Nerve Block in Symptomatic Mandibular First Molar Teeth.

PubMed

Zain, Muhammad; Rehman Khattak, Shakeel Ur; Sikandar, Huma; Shah, Shafqat Ali; Fayyaz

2016-01-01

To evaluate success of pulpal anaesthesia of mandibular 1st molar by using 4% articaine in buccal infiltration versus 2% lidocaine in inferior alveolar nerve block. Randomized control trial. Department of Operative Dentistry, Sardar Begum Dental College, Gandhara University, Peshawar, from March to August 2014. One hundred and fifty-six emergency patients, who had 1st molar diagnosed with irreversible pulpitis, participated in the study. Subjects were divided into two groups by random allocation. One group received 4% articaine buccal infiltration and the other group received inferior alveolar nerve block of 2% lidocaine. Subjects’self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anaesthetic administration during access cavity preparation and pulp extirpation. Mean age of subjects was 31.46 ±10.994 years. The success rate of 4% buccal infiltration was 76.9%; whereas the success rate of 2% lidocaine inferior alveolar nerve block was 62.8%. There was no statistically significant difference between the two groups. 4% articaine buccal infiltration can be considered a viable alternative to 2% lidocaine inferior alveolar nerve block in securing successful pulpal anaesthesia for endodontic therapy.

[The anesthetic effects of Gow-Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction].

PubMed

Yang, Jieping; Liu, Wei; Gao, Qinghong

2013-08-01

To evaluate the anesthetic effects and safety of Gow-Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction. A split-mouth study was designed. The bilateral impacted mandibular third molar of 32 participants were divided into Gow-Gates technique of inferior alveolar nerve block (Gow-Gates group) and conventional technique of inferior alveolar nerve block (conventional group) randomly with third molar extracted. The anesthetic effects and adverse events were recorded. All the participants completed the research. The anesthetic success rate was 96.9% in Gow-Gates group and 90.6% in conventional group with no statistical difference ( P= 0.317); but when comparing the anesthesia grade, Gow-Gates group had a 96.9% of grade A and B, and conventional group had a rate of 78.1% (P = 0.034). And the Gow-Gates group had a much lower withdrawn bleeding than conventional group (P = 0.025). Two groups had no hematoma. Gow-Gates technique had a reliable anesthesia effects and safety in impacted mandibular third molar extraction and could be chosen as a candidate for the conventional inferior alveolar nerve block.

Inferior gluteal artery pseudoaneurysm related to intramuscular injection

PubMed Central

Saad, Paulo Fernandes; Saad, Karen Ruggeri; Armstrong, Dinani Matoso Fialho de Oliveira; Soares, Bruno Leonardo de Freitas; de Almeida, Paulo Henrique Freitas; Razuk Filho, Álvaro

2014-01-01

INTRODUCTION Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. PRESENTATION OF CASE The authors present a case of pseudoaneurysm of the inferior gluteal artery related to an iatrogenic injury due to intramuscular injection of medication, which was treated with selective embolization of the artery during angiography. DISCUSSION The most common manifestation of an inferior gluteal artery pseudoaneurysm is the presence of a painful mass in the buttock that may or may not be associated with neurological symptoms due to compression of the sciatic nerve. Ultrasound with color Doppler and computerized tomography with multi-detectors are useful non-invasive tools for diagnosis. However, both diagnosis and therapy are facilitated by catheter angiography. CONCLUSION This case cautions that although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. It also illustrates the usefulness of a minimally invasive modality for treatment of these lesions. PMID:25506847

The short-term efficacy of vena cava filters for the prevention of pulmonary embolism in patients with venous thromboembolism receiving anticoagulation: Meta-analysis of randomized controlled trials.

PubMed

Jiang, Jun; Jiao, Yuanyong; Zhang, Xiwei

2017-10-01

Objectives To perform a meta-analysis of randomized controlled trials assessing the effectiveness of inferior vena cava filters in patients with deep vein thrombosis for preventing pulmonary embolism. Method Relevant randomized controlled trials of inferior vena cava filters for the prevention of pulmonary embolism were identified by searching electronic databases updated in February 2016. Relative risks of recurrent pulmonary embolism, recurrent deep vein thrombosis, and mortality at three months were analyzed. Results Three published randomized controlled trials were included involving a total of 863 deep vein thrombosis patients. No significant differences were detected with inferior vena cava filters placement with regard to the incidence of recurrent pulmonary embolism or fatal pulmonary embolism. There were also no significant differences in the incidence of recurrent deep vein thrombosis or mortality with inferior vena cava filters placement at three months. Conclusions Inferior vena cava filter in addition to anticoagulation was not associated with a reduction in the incidence of recurrent pulmonary embolism as compared with anticoagulation alone in patients with deep vein thrombosis in the short term.

Anatomical basis of the liver hanging maneuver.

PubMed

Trotovsek, Blaz; Belghiti, Jacques; Gadzijev, Eldar M; Ravnik, Dean; Hribernik, Marija

2005-01-01

The anterior approach to right hepatectomy using the liver hanging maneuver without liver mobilization claims to be anatomically evaluated. During this procedure a 4 to 6-cm blind dissection between the inferior vena cava and the liver is performed. Short subhepatic veins, entering the inferior vena cava could be torn and a hemorrhage, difficult to control, could occur. On 100 corrosive casts of livers the anterior surface of the inferior vena cava was studied to evaluate the position, diameter and draining area of short subhepatic veins and inferior right hepatic vein. The width of the narrowest point on the planned route of blind dissection was determined. The average value of the narrowest point on the planned route of blind dissection was 8.7+/-2.3mm (range 2-15mm). The ideal angle of dissection being 0 degrees was found in 93% of cases. In 7% we found the angle of 5 degrees toward the right border of inferior vena cava to be the better choice. Our results show that liver hanging maneuver is a safe procedure. With the dissection in the proposed route the risk of disrupting short subhepatic veins is low (7%).

Characteristics of vertigo and the affected vestibular nerve systems in idiopathic bilateral vestibulopathy.

PubMed

Fujimoto, Chisato; Kinoshita, Makoto; Kamogashira, Teru; Egami, Naoya; Sugasawa, Keiko; Yamasoba, Tatsuya; Iwasaki, Shinichi

2016-01-01

Vertigo attacks in IBV patients involving both the superior and inferior vestibular nerve systems were significantly more severe than vertigo attacks in patients with selective involvement of the inferior vestibular nerve system alone. To investigate the relationship between the frequency and duration of vertigo and the affected vestibular nerve system in idiopathic bilateral vestibulopathy (IBV). This study categorized 44 IBV patients into the following three sub-groups according to the affected vestibular nerve system: superior, inferior, and mixed type. These patients were also categorized into the following three sub-groups according to their clinical time course: progressive type showing no episodes of vertigo, sequential type showing recurrent vertigo attacks and single-attack type showing a single episode of vertigo. Ten, 11 and 23 patients were classified as the superior, the inferior, and the mixed type, respectively. Seventeen, 23, and four patients were classified as the progressive, the sequential, and the single-attack type, respectively. For the patients having one or more vertigo attacks, the duration of the vertigo attack was longer than 24 h in 69% of the mixed type, and the duration of vertigo in the mixed type was significantly longer than that in the inferior type (p < 0.05).

[Functional recordings of human nasal inferior turbinates -- the device design].

PubMed

Mikulewicz, W; Galasiński, J

1993-01-01

There is prototype of device presented. It is used in order to record a simultaneous capacitance and resistance vessels functions, of human inferior turbinate. Present results indicate usefulness of device in clinical trials.

Diplopia after inferior alveolar nerve block: case report and related physiology.

PubMed

You, Tae Min

2015-06-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.

Diplopia after inferior alveolar nerve block: case report and related physiology

PubMed Central

2015-01-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management. PMID:28879264

Successful Percutaneous Retrieval of an Inferior Vena Cava Filter Migrating to the Right Ventricle in a Bariatric Patient

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

Veerapong, Jula; Wahlgren, Carl Magnus, E-mail: carl.wahlgren@karolinska.s; Jolly, Neeraj

The use of an inferior vena cava filter has an important role in the management of patients who are at high risk for development of pulmonary embolism. Migration is a rare but known complication of inferior vena cava filter placement. We herein describe a case of a prophylactic retrievable vena cava filter migrating to the right ventricle in a bariatric patient. The filter was retrieved percutaneously by transjugular approach and the patient did well postoperatively. A review of the current literature is given.

The Isolated Perfused Rat Liver and its use in the Study of Chemical Kinetics: Quality and Performance Parameters

DTIC Science & Technology

1999-04-01

atrium , the inferior vena cava was closed with a silk ligature and the liver was carefully excised. 2.4 Liver...withdraw needle. 5.5.10 Secure tip of cannula with ligature and connect medium at lowest flow rate (5 mL/min). 5.5.11 Cut inferior vena cava below the...heart. 5.5.14 Cannulate the superior vena cava via an incision in the right atrium , secure with ligature. 5.5.15 Close ligature around inferior vena cava

The course and the anatomo-functional relationships of the optic radiation: a combined study with ‘post mortem’ dissections and ‘in vivo’ direct electrical mapping

PubMed Central

Sarubbo, Silvio; De Benedictis, Alessandro; Milani, Paola; Paradiso, Beatrice; Barbareschi, Mattia; Rozzanigo, Umbero; Colarusso, Enzo; Tugnoli, Valeria; Farneti, Marco; Granieri, Enrico; Duffau, Hugues; Chioffi, Franco

2015-01-01

Even if different dissection, tractographic and connectivity studies provided pure anatomical evidences about the optic radiations (ORs), descriptions of both the anatomical structure and the anatomo-functional relationships of the ORs with the adjacent bundles were not reported. We propose a detailed anatomical and functional study with ‘post mortem’ dissections and ‘in vivo’ direct electrical stimulation (DES) of the OR, demonstrating also the relationships with the adjacent eloquent bundles in a neurosurgical ‘connectomic’ perspective. Six human hemispheres (three left, three right) were dissected after a modified Klingler's preparation. The anatomy of the white matter was analysed according to systematic and topographical surgical perspectives. The anatomical results were correlated to the functional responses collected during three resections of tumours guided by cortico-subcortical DES during awake procedures. We identified two groups of fibres forming the OR. The superior component runs along the lateral wall of the occipital horn, the trigone and the supero-medial wall of the temporal horn. The inferior component covers inferiorly the occipital horn and the trigone, the lateral wall of the temporal horn and arches antero-medially to form the Meyer's Loop. The inferior fronto-occipital fascicle (IFOF) covers completely the superior OR along its entire course, as confirmed by the subcortical DES. The inferior longitudinal fascicle runs in a postero-anterior and inferior direction, covering the superior OR posteriorly and the inferior OR anteriorly. The IFOF identification allows the preservation of the superior OR in the anterior temporal resection, avoiding post-operative complete hemianopia. The identification of the superior OR during the posterior temporal, inferior parietal and occipital resections leads to the preservation of the IFOF and of the eloquent functions it subserves. The accurate knowledge of the OR course and the relationships with the adjacent bundles is crucial to optimize quality of resection and functional outcome. PMID:25402811

Significance of radiological variables studied on orthopantamogram to pridict post-operative inferior alveoler nerve paresthesia after third molar extraction.

PubMed

Pathak, Sachin; Mishra, Nitin; Rastogi, Madhur Kant; Sharma, Shalini

2014-05-01

Removal of impacted third molar is a procedure that is often associated with post-operative complications. The rate of complications is somewhat high because of its proximity to the vital structures. Inferior alveolar nerve paresthesia is one of the common complications of impacted their molar surgery. This is due to intimate relationship between roots of mandibular third molar and inferior alveolar canal. To access the proximity of inferior alveolar canal to third molar many diagnostic methods are suggested but in conventional radiography orthopantamogram is considered as the best. There are many findings onorthopantamogram that are suggestive of close proximity of nerve to the canal. In this study authors reviewed seven radiographic findings related to proximity of roots to the inferior alveolar nerve as seen on orthopantamogram and try to find a relationship between these radiographic variables and presence of post-operative paresthesia. The study containd 100 impacted third molars need to be removed. Presence of radiographic findings on orthopantamogram were noted and analyzed, to find a relationship with occurrence of post-operative inferior alveolar nerve paresthesia. This study comprises of 100 impacted third molar teeth indicated for extraction. Cases were randomly selected from the patients, needs to undergo extraction of impacted mandibular third molar. After extraction cases were evaluated for occurrence of inferior alveolar nerve paresthesia. Stastical Analyisis: Data was transferred to SPss 21 software for frequency calculation, and two tailed p-values were obtained betweens these variables and post-operative paresthesia, by applying Fischer's exact test (GRAPH PAD SOFTWARE). Out of seven, four radiological findings that are grooving of roots, hooked roots, bifid roots and obliteration of white line are significantly related to post-operative paresthesia while bending of canal, narrow canal and darkening of tooth roots over the canal are not significantly associated with post-operative morbidity of facial nerve.

Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis.

PubMed

Visa, Laura; Jiménez-Fonseca, Paula; Martínez, Elena Asensio; Hernández, Raquel; Custodio, Ana; Garrido, Manuel; Viudez, Antonio; Buxo, Elvira; Echavarria, Ignacio; Cano, Juana María; Macias, Ismael; Mangas, Montserrat; de Castro, Eva Martínez; García, Teresa; Manceñido, Felipe Álvarez; Montes, Ana Fernández; Azkarate, Aitor; Longo, Federico; Serrano, Asunción Díaz; López, Carlos; Hurtado, Alicia; Cerdá, Paula; Serrano, Raquel; Gil-Negrete, Aitziber; Carnicero, Alfonso Martín; Pimentel, Paola; Ramchandani, Avinash; Carmona-Bayonas, Alberto

2018-05-01

Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs.<70years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. 33% (n=489) of the cases analyzed were ≥70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3-4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91-1.14), P (non inferiority)=0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87-1.08), P(non-inferiority)=0.001. In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects. Copyright © 2017 Elsevier Inc. All rights reserved.

The history of the human female inferiority ideas in evolutionary biology.

PubMed

Bergman, Gerald

2002-01-01

A review of the prominent late 19th-century biological writings reveals that a major plank of early evolution theory was the belief that women were intellectually and physically inferior to men. Female inferiority was a logical conclusion of the Darwinian world view because males were believed to be exposed to far greater selective pressures than females, especially in war, competition for mates, food and clothing. Conversely, women were protected from selection by norms that required adult males provide for and protect women and children. Darwinists taught that as a result of this protection, natural selection operated far more actively on males than on females, producing male superiority in virtually all intellectual and skill areas. As a result, males became "more evolved" than women. The women inferiority doctrine is an excellent example of the fact that armchair logic often has been more important in building Darwinism than fossil and other empirical evidence.

Intravenous leiomyomatosis of the uterus with extension to the right heart

PubMed Central

2011-01-01

A 42-year-old woman admitted with debilitation and engorgement both lower extremities. Transthoracic two-dimensional echocardiography, abdominal ultrasound and computerized tomography revealed a lobulated pelvic mass, a mass within right internal iliac vein, both common iliac vein, as well as the inferior vena cava, extending into the right atrium. In addition, echocardiography and abdominal ultrasound showed the tumor of right atrium and inferior vena cave has no stalk and has well-demarcated borders with the wall of right atrium and inferior vena cave. Hence, the presumptive diagnosis of IVL was made by echocardiography and abdominal ultrasound and the presumptive diagnosis of sarcoma with invasion in right internal iliac vein, both common iliac vein, the inferior vena cava, as well as the right atrium was made by multi-detector-row computerized tomography. The patient underwent a one-stage combined multidisciplinary thoraco-abdominal operation under general anaesthetic. Subsequently the pathologic report confirmed IVL. PMID:21943238

Early Clinical Features of Pseudoexfoliation Syndrome in Anterior Segment and Gonioscopy Examination.

PubMed

Gür Güngör, Sirel; Bayer, Atilla; Akman, Ahmet; Asena, Leyla

2017-01-01

To determine the early signs of pseudoexfoliation (PEX) in fellow eyes of cases with unilateral PEX. Fellow eyes of 34 cases with unilateral PEX were evaluated by slit-lamp and gonioscopy. Findings associated with PEX were recorded. Mean age was 67.8±8.1 years (range 55-86 years). Twenty-five patients (73.5%) had pigmentation in the inferior angle and 23 patients (67.6%) had Sampaolesi's line located on the inferior angle in fellow eyes. The other most common findings were loss of peripupillary ruff in 10 patients (29.4%) and pigment dispersion following pupil dilation in 14 patients (41.1%). Pigmentation in the inferior angle and Sampaolesi's line on the inferior angle seem to be the most common early findings associated with PEX. Special attention should be paid to these findings in cases with ocular hypertension for proper management.

The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

PubMed

El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

2008-01-01

This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

El aprendizaje significativo en las ciencias al participar en proyectos de investigacion cientifica

NASA Astrophysics Data System (ADS)

Mora Polanco, Miguelena

La ciencia es el eje fundamental a traves del cual se desarrollan las habilidades necesarias para el pensar cientifico que va a la busqueda del conocimiento cientifico. La intencion de este estudio fue indagar en el tema de investigacion cientifica desde el punto de vista de los participantes en los siguientes aspectos relacionados con la experiencia de investigacion cientifica: a) conceptos, b) proceso, c) destrezas y d) disposicion. Tambien se analizaron: a) las perspectivas del metodo cientifico, b) la estrategia de ensenanza, c) la cultura cientifica y d) la exposicion del proyecto investigativo en la Feria Cientifica; como parte del aprendizaje significativo de la ciencias de los participantes. Esta investigacion cualitativa propuso como diseno el estudio de caso. Los aspectos relacionados a la experiencia de participar en proyecto de investigacion cientifica son el fenomeno o caso bajo estudio. En el estudio participaron cinco (5) estudiantes egresados de escuela publica o privada que cursaban hasta el tercer ano de estudios universitarios, conducentes a un bachillerato en educacion secundaria en ciencias o en ciencias naturales. Las tecnicas utilizadas para recopilar los datos fueron: analisis de documentos del DEPR, revision de artefactos y entrevistas profundas. Para el analisis de los datos de las entrevistas se utilizo el modelo de Wolcott (1994). Del analisis de documentos del DEPR se identificaron areas a mejorar en las guias de las cartas circulares con relacion a la investigacion escolar y la feria cientifica. El analisis de los artefactos proveyo evidencia de como los internados, simposios e investigaciones fomentan el que los estudiantes se superen en el aspecto cognitivo, se conviertan en creadores del conocimiento, al hacer suyo los conceptos para poder explicarlos al publico. De las entrevistas los participantes manifestaron que la experiencia de investigacion fue una de aprendizaje significativo que los marco para toda la vida y les expandio su curiosidad de modo que lo aplican en su vida. La experiencia los ayudo en el entendimiento y la aplicacion de conceptos, procesos y destrezas relacionados con la ciencia. Finalmente, los participantes proveyeron las estrategias didacticas que desde su perspectiva facilitan la ensenanza-aprendizaje de la ciencia.

[Measurement of intrafraction displacement of the mediastinal metastatic lymph nodes of non-small cell lung cancer based on four-dimensional computed tomography (4D-CT)].

PubMed

Wang, Su-zhen; Li, Jian-bin; Zhang, Ying-jie; Li, Feng-xiang; Wang, Wei; Liu, Tong-hai

2012-09-01

To measure the intrafraction displacement of the mediastinal metastatic lymph nodes of non-small cell lung cancer (NSCLC) based on four-dimensional computed tomography (4D-CT), and to provide the basis for the internal margin of metastatic mediastinal lymph nodes. Twenty-four NSCLC patients with mediastinal metastatic lymph nodes confirmed by contrast enhanced CT (short axis diameter ≥ 1 cm) were included in this study. 4D-CT simulation was carried out during free breathing and 10 image sets were acquired. The mediastinal metastatic lymph nodes and the dome of ipsilateral diaphragma were separately delineated on the CT images of 10 phases of breath cycle, and the lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal station. Then the displacements of the lymph nodes in the left-right, anterior-posterior, superior-inferior directions and the 3-dimensional vector were measured. The differences of displacement in three directions for the same group of metastatic lymph nodes and in the same direction for different groups of metastatic lymph nodes were compared. The correlation between the displacement of ipsilateral diaphragma and mediastinal lymph nodes was analyzed in superior-inferior direction. The displacements in left-right, anterior-posterior and superior-inferior directions were (2.24 ± 1.55) mm, (1.87 ± 0.92) mm and (3.28 ± 2.59) mm for the total (53) mediastinal lymph nodes, respectively. The vectors were (4.70 ± 2.66) mm, (3.87 ± 2.45) mm, (4.97 ± 2.75) mm and (5.23 ± 2.67) mm for the total, upper, middle and lower mediastinal lymph nodes, respectively. For the upper mediastinal lymph nodes, the displacements in left-right, anterior-posterior and superior-inferior directions showed no significant difference between each other (P > 0.05). For the middle mediastinal lymph nodes, the displacements merely in anterior-posterior and superior-inferior directions showed significant difference (P = 0.005), while the displacements were not significantly different in the left-right and anterior-posterior, left-right and superior-inferior directions (P > 0.05). The displacements of the total and the lower mediastinal lymph nodes in left-right and superior-inferior, or anterior-posterior and superior-inferior directions were significantly different (P < 0.05), but was not significantly different in left-right and anterior-posterior directions (P > 0.05). The displacements of different group of mediastinal lymph nodes in a single direction or vector showed no significant difference (P > 0.05). In the superior-inferior direction, the correlation between the displacements of ipsilateral diaphragma and mediastinal lymph nodes were not statistically significant (P > 0.05). During free breathing, the differences between the intrafractional displacement of mediastinal metastatic lymph nodes in the same direction and its station were not statistically significant. The displacements of the total mediastinal metastatic lymph nodes in the superior-inferior direction were greater than that in the left-right and anterior-posterior directions, especially for the middle and lower mediastinal metastatic lymph nodes. There was no significant correlation between the displacements of ipsilateral diaphragma and the mediastinal metastatic lymph nodes in the superior-inferior direction, so it was unreasonable to estimate and predict the displacement of mediastinal metastatic lymph nodes by the displacement of ipsilateral diaphragma.

The clinical evaluation of the CADence device in the acoustic detection of coronary artery disease.

PubMed

Thomas, Joseph L; Ridner, Michael; Cole, Jason H; Chambers, Jeffrey W; Bokhari, Sabahat; Yannopoulos, Demetris; Kern, Morton; Wilson, Robert F; Budoff, Matthew J

2018-06-23

The noninvasive detection of turbulent coronary flow may enable diagnosis of significant coronary artery disease (CAD) using novel sensor and analytic technology. Eligible patients (n = 1013) with chest pain and CAD risk factors undergoing nuclear stress testing were studied using the CADence (AUM Cardiovascular Inc., Northfield MN) acoustic detection (AD) system. The trial was designed to demonstrate non-inferiority of AD for diagnostic accuracy in detecting significant CAD as compared to an objective performance criteria (sensitivity 83% and specificity 80%, with 15% non-inferiority margins) for nuclear stress testing. AD analysis was blinded to clinical, core lab-adjudicated angiographic, and nuclear data. The presence of significant CAD was determined by computed tomographic (CCTA) or invasive angiography. A total of 1013 subjects without prior coronary revascularization or Q-wave myocardial infarction were enrolled. Primary analysis was performed on subjects with complete angiographic and AD data (n = 763) including 111 subjects (15%) with severe CAD based on CCTA (n = 34) and invasive angiography (n = 77). The sensitivity and specificity of AD were 78% (p = 0.012 for non-inferiority) and 35% (p < 0.001 for failure to demonstrate non-inferiority), respectively. AD results had a high 91% negative predictive value for the presence of significant CAD. AD testing failed to demonstrate non-inferior diagnostic accuracy as compared to the historical performance of a nuclear stress OPC due to low specificity. AD sensitivity was non-inferior in detecting significant CAD with a high negative predictive value supporting a potential value in excluding CAD.

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection.

PubMed

Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi

2008-01-01

Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection

PubMed Central

Taghavi Zenouz, Ali; Ebrahimi, Hooman; Mahdipour, Masoumeh; Pourshahidi, Sara; Amini, Parisa; Vatankhah, Mahdi

2008-01-01

Background and aims Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Materials and methods Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. Results 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). Conclusion According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance. PMID:23285329

Heart block and cardiac embolization of fractured inferior vena cava filter.

PubMed

Abudayyeh, Islam; Takruri, Yessar; Weiner, Justin B

2016-01-01

A 66-year-old man underwent a placement of an inferior vena cava filter before a gastric surgery 9 years prior, presented to the emergency room with a complete atrioventricular block. Chest x-ray and transthoracic echocardiogram showed struts migrating to right ventricle with tricuspid regurgitation. Cardiothoracic surgery was consulted and declined an open surgical intervention due to the location of the embolized fragments and the patient's overall condition. It was also felt that the fragments had migrated chronically and were adhered to the cardiac structures. The patient underwent a dual-chamber permanent pacemaker implantation. Post-implant fluoroscopy showed no displacement of the inferior vena cava filter struts due to the pacemaker leads indicating that the filter fracture had likely been a chronic process. This case highlights a rare combination of complications related to inferior vena cava filter fractures and the importance of assessing for such fractures in chronic placements. Inferior vena cava filter placement for a duration greater than 1 month can be associated with filter fractures and strut migration which may lead to, although rare, serious or fatal complications such as complete atrioventricular conduction system disruption and valvular damage including significant tricuspid regurgitation. Assessing for inferior vena cava filter fractures in chronic filter placement is important to avoid such complications. When possible, retrieval of the filter should be considered in all patients outside the acute setting in order to avoid filter-related complications. Filter retrieval rates remain low even when a retrievable filter is in place and the patient no longer has a contraindication to anticoagulation.

The impact of top-down spatial attention on laterality and hemispheric asymmetry in the human parietal cortex

PubMed Central

Jeong, Su Keun; Xu, Yaoda

2016-01-01

The human parietal cortex exhibits a preference to contralaterally presented visual stimuli (i.e., laterality) as well as an asymmetry between the two hemispheres with the left parietal cortex showing greater laterality than the right. Using visual short-term memory and perceptual tasks and varying target location predictability, this study examined whether hemispheric laterality and asymmetry are fixed characteristics of the human parietal cortex or whether they are dynamic and modulated by the deployment of top-down attention to the target present hemifield. Two parietal regions were examined here that have previously been shown to be involved in visual object individuation and identification and are located in the inferior and superior intraparietal sulcus (IPS), respectively. Across three experiments, significant laterality was found in both parietal regions regardless of attentional modulation with laterality being greater in the inferior than superior IPS, consistent with their roles in object individuation and identification, respectively. Although the deployment of top-down attention had no effect on the superior IPS, it significantly increased laterality in the inferior IPS. The deployment of top-down spatial attention can thus amplify the strength of laterality in the inferior IPS. Hemispheric asymmetry, on the other hand, was absent in both brain regions and only emerged in the inferior but not the superior IPS with the deployment of top-down attention. Interestingly, the strength of hemispheric asymmetry significantly correlated with the strength of laterality in the inferior IPS. Hemispheric asymmetry thus seems to only emerge when there is a sufficient amount of laterality present in a brain region. PMID:27494544

The impact of top-down spatial attention on laterality and hemispheric asymmetry in the human parietal cortex.

PubMed

Jeong, Su Keun; Xu, Yaoda

2016-08-01

The human parietal cortex exhibits a preference to contralaterally presented visual stimuli (i.e., laterality) as well as an asymmetry between the two hemispheres with the left parietal cortex showing greater laterality than the right. Using visual short-term memory and perceptual tasks and varying target location predictability, this study examined whether hemispheric laterality and asymmetry are fixed characteristics of the human parietal cortex or whether they are dynamic and modulated by the deployment of top-down attention to the target present hemifield. Two parietal regions were examined here that have previously been shown to be involved in visual object individuation and identification and are located in the inferior and superior intraparietal sulcus (IPS), respectively. Across three experiments, significant laterality was found in both parietal regions regardless of attentional modulation with laterality being greater in the inferior than superior IPS, consistent with their roles in object individuation and identification, respectively. Although the deployment of top-down attention had no effect on the superior IPS, it significantly increased laterality in the inferior IPS. The deployment of top-down spatial attention can thus amplify the strength of laterality in the inferior IPS. Hemispheric asymmetry, on the other hand, was absent in both brain regions and only emerged in the inferior but not the superior IPS with the deployment of top-down attention. Interestingly, the strength of hemispheric asymmetry significantly correlated with the strength of laterality in the inferior IPS. Hemispheric asymmetry thus seems to only emerge when there is a sufficient amount of laterality present in a brain region.

The effect of isolated labrum resection on shoulder stability.

PubMed

Pouliart, Nicole; Gagey, Olivier

2006-03-01

The present study was initiated to determine whether glenohumeral instability and dislocation can result from isolated lesions of the glenoid labrum in an arthroscopic cadaver model. Adjacent combinations of four zones of the labrum (superior, anterosuperior, anteroinferior and inferior) were sequentially removed with a motorised shaver, taking great care to leave the capsule intact in 24 cadaver shoulders. Stability was tested before and after inserting the scope and after each resection step. Inferior stability was examined by performing an inferior drawer test. Anterior stability was evaluated with an anteroposterior drawer test in 0 degrees of abduction and with a load-and-shift test in external rotation and 90 degrees abduction. Labral resection of all four zones maximally resulted in a grade 1 inferior instability (<10 mm inferior translation). When two adjacent labral zones were resected, a grade 2 anterior drawer (>10 mm anterior but no medial translation) was seen in 17% of the specimens. This was seen in one more specimen after the addition of a third zone. There were no differences in the stability of the load-and-shift test after any amount of labral resection. Total labral debridement increased inferior and anterior translation, but did not allow the humeral head to dislocate. The degree of stability in the cocked-arm position, which is the most prone to dislocation, is not altered. In patients, isolated labral tears, that is, without evidence of capsuloligamentous damage, can probably be safely debrided without risking glenohumeral instability to the point of dislocation. Nevertheless, anterior translation may significantly increase when two or more zones are resected.

Extralaryngeal division of the recurrent laryngeal nerve: a new description for the inferior laryngeal nerve.

PubMed

Yalcin, Bulent; Tunali, Selcuk; Ozan, Hasan

2008-05-01

Extralaryngeal division of the recurrent laryngeal nerve was contradictory in the literature. We aimed to investigate extralaryngeal division of the nerve, and also propose a new description for the inferior laryngeal nerve. Sixty specimens (120 sides) were examined for this project, including 41 men and 19 women cadavers between the ages of 40 and 89 years at death. In one right side, terminal segment of the nerve gave off many small branches surrounding the inferior thyroid artery then reaching the larynx, trachea, thyroid gland and esophagus. In eight sides, terminal segment of the nerve had no extralaryngeal division and entered the larynx as a single trunk. In 110 sides, the nerve had extralaryngeal division. One hundred and three nerves had two laryngeal and one to three extralaryngeal branches. Two types were described in this group. In type I (66 nerves), both branches arose from the same level of nerve. Type I had two subtypes: type Ia, the origin of the branches was just below the inferior constrictor muscle; type Ib, the origin of the branches was 15-35 mm below the muscle. In type II (37 nerves), the laryngeal branches arose just 3-5 mm above the extralaryngeal branches. We observed that the laryngeal and extralaryngeal branches arose generally from the same point of the recurrent laryngeal nerve. The inferior laryngeal nerve is thus very short, or even nonexistent. Therefore, we suggest that if the term "superior laryngeal nerve" is a given, standard, and accepted term, then the term "inferior laryngeal nerve" should also be accepted instead of the term "recurrent laryngeal nerve."

Inferior Oblique Overaction: Anterior Transposition Versus Myectomy.

PubMed

Rajavi, Zhale; Feizi, Mohadeseh; Behradfar, Narges; Yaseri, Mehdi; Sayanjali, Shima; Motevaseli, Tahmine; Sabbaghi, Hamideh; Faghihi, Mohammad

2017-07-01

To compare the efficacy of inferior oblique myectomy and anterior transposition for correcting inferior oblique overaction (IOOA). This retrospective study was conducted on 56 patients with IOOA who had either myectomy or anterior transposition of the inferior oblique muscle from 2010 to 2015. The authors compared preoperative and postoperative inferior oblique muscle function grading (-4 to +4) as the main outcome measure and vertical and horizontal deviation, dissociated vertical deviation (DVD), and A- and V-pattern between the two surgical groups as secondary outcomes. A total of 99 eyes of 56 patients with a mean age of 5.9 ± 6.5 years were included (47 eyes in the myectomy group and 52 eyes in the anterior transposition group). There were no differences in preoperative best corrected visual acuity, amblyopia, spherical equivalent, and primary versus secondary IOOA between the two groups. Both surgical procedures were effective in reducing IOOA and satisfactory results were similar between the two groups: 61.7% and 67.3% in the myectomy and anterior transposition groups, respectively (P = .56). After adjustment for the preoperative DVD, there was no statistically significant difference between the two groups postoperatively. The preoperative hypertropia was 6 to 14 and 6 to 18 prism diopters (PD) in the myectomy and anterior transposition groups, respectively. After surgery, no patient had a vertical deviation greater than 5 PD. Both the inferior oblique myectomy and anterior transposition procedures are effective in reducing IOOA with similar satisfactory results. DVD and hypertropia were also corrected similarly by these two surgical procedures. [J Pediatr Ophthalmol Strabismus. 2017;54(4):232-237.]. Copyright 2017, SLACK Incorporated.

Inferiority is compex

NASA Astrophysics Data System (ADS)

Wade, Jess

2017-07-01

In Inferior: How Science Got Women Wrong and the New Research That's Rewriting the Story, author Angela Saini puts forward the idea that bad science has been used to endorse the cultural prejudice that women are both biologically and psychologically second rate to men.

Methods of defining the non-inferiority margin in randomized, double-blind controlled trials: a systematic review.

PubMed

Althunian, Turki A; de Boer, Anthonius; Klungel, Olaf H; Insani, Widya N; Groenwold, Rolf H H

2017-03-07

There is no consensus on the preferred method for defining the non-inferiority margin in non-inferiority trials, and previous studies showed that the rationale for its choice is often not reported. This study investigated how the non-inferiority margin is defined in the published literature, and whether its reporting has changed over time. A systematic PubMed search was conducted for all published randomized, double-blind, non-inferiority trials from January 1, 1966, to February 6, 2015. The primary outcome was the number of margins that were defined by methods other than the historical evidence of the active comparator. This was evaluated for a time trend. We also assessed the under-reporting of the methods of defining the margin as a secondary outcome, and whether this changed over time. Both outcomes were analyzed using a Poisson log-linear model. Predictors for better reporting of the methods, and the use of the fixed-margin method (one of the historical evidence methods) were also analyzed using logistic regression. Two hundred seventy-three articles were included, which account for 273 non-inferiority margins. There was no statistically significant difference in the number of margins that were defined by other methods compared to those defined based on the historical evidence (ratio 2.17, 95% CI 0.86 to 5.82, p = 0.11), and this did not change over time. The number of margins for which methods were unreported was similar to those with reported methods (ratio 1.35, 95% CI 0.76 to 2.43, p = 0.31), with no change over time. The method of defining the margin was less often reported in journals with low-impact factors compared to journals with high-impact factors (OR 0.20; 95% CI 0.10 to 0.37, p < 0.0001). The publication of the FDA draft guidance in 2010 was associated with increased reporting of the fixed-margin method (after versus before 2010) (OR 3.54; 95% CI 1.12 to 13.35, p = 0.04). Non-inferiority margins are not commonly defined based on the historical evidence of the active comparator, and they are poorly reported. Authors, reviewers, and editors need to take notice of reporting this critical information to allow for better judgment of non-inferiority trials.

Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial.

PubMed

Hwang, Rita; Bruning, Jared; Morris, Norman R; Mandrusiak, Allison; Russell, Trevor

2017-04-01

Is a 12-week, home-based telerehabilitation program conducted in small groups non-inferior to a traditional centre-based program in terms of the change in 6-minute walk distance? Is the telerehabilitation program also non-inferior to a centre-based program in terms of functional capacity, muscle strength, quality of life, urinary incontinence, patient satisfaction, attendance rates, and adverse events? Randomised, parallel, non-inferiority trial with concealed allocation, intention-to-treat analysis and assessor blinding. Patients with stable chronic heart failure (including heart failure with reduced or preserved ejection fraction) were recruited from two tertiary hospitals in Brisbane, Australia. The experimental group received a 12-week, real-time exercise and education intervention delivered into the participant's home twice weekly, using online videoconferencing software. The control group received a traditional hospital outpatient-based program of the same duration and frequency. Both groups received similar exercise prescription. Participants were assessed by independent assessors at baseline (Week 0), at the end of the intervention (Week 12) and at follow-up (Week 24). The primary outcome was a between-group comparison of the change in 6-minute walk distance, with a non-inferiority margin of 28m. Secondary outcomes included other functional measures, quality of life, patient satisfaction, program attendance rates and adverse events. In 53 participants (mean age 67 years, 75% males), there were no significant between-group differences on 6-minute walk distance gains, with a mean difference of 15m (95% CI -28 to 59) at Week 12. The confidence intervals were within the predetermined non-inferiority range. The secondary outcomes indicated that the experimental intervention was at least as effective as traditional rehabilitation. Significantly higher attendance rates were observed in the telerehabilitation group. Telerehabilitation was not inferior to a hospital outpatient-based rehabilitation program in patients with chronic heart failure. Telerehabilitation appears to be an appropriate alternative because it promotes greater attendance at the rehabilitation sessions. ACTRN12613000390785. [Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T (2017) Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. Journal of Physiotherapy 63: 101-107]. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Protocol for Removal of Third Molar Root Tips from the Inferior Alveolar Canal-Crossing the line.

PubMed

Punga, Rohit; Keswani, Kiran

2014-12-01

The safe removal of third molars involved with the inferior alveolar canal (IAC) has been an area of concern since long. Many times we hesitate for the removal of third molars, fearing injury to the inferior alveolar nerve. The authors here describe a simple technique which can be used to remove third molars showing evidence of proximity to IAC on presurgical radiographic evaluation, as well as those root tips which, during removal, accidentally enter the IAC space. A step-by-step protocol is presented along with necessary precautions during the operative procedure.

Intraosseous Hemangioma of the Inferior Turbinate

PubMed Central

Takeda, Kazuya; Takenaka, Yukinori; Hashimoto, Michiko

2010-01-01

The nasal cavity harbors an enormous variety of neoplasms, including epithelial and mesenchymal tumors. Hemangioma is an infrequent mesenchymal tumor of the nasal cavity, mostly arising in the mucosa and rarely in the bones. We describe the case of a 73-year-old woman who was referred to our hospital with a tumor in her left nasal cavity. The tumor originated from the left inferior turbinate. Histological examination subsequent to complete excision revealed that the tumor was an intraosseous cavernous hemangioma. To our knowledge, this is the second case of intraosseous hemangioma of the inferior turbinate reported in the English literature. PMID:20300428

Compression of the Inferior Vena Cava by the Right Iliac Artery: A Rare Variant of May-Thurner Syndrome

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

Fretz, V.; Binkert, C. A., E-mail: Christoph.Binkert@ksw.c

May-Thurner syndrome is known as compression of the left common iliac vein by the right common iliac artery. We describe a case of an atypical compression of the inferior vena cava by the right common iliac artery secondary to a high aortic bifurcation. Despite an extensive collateral network, there was a significant venous gradient between the iliac veins and the inferior vena cava above the compression. After stenting the venous pressure gradient disappeared. Follow-up 4 months later revealed a good clinical response with a patent stent.

Relationship between auditory thresholds, central spontaneous activity and hair cell loss after acoustic trauma

PubMed Central

Mulders, W.H.A.M.; Ding, D.; Salvi, R.; Robertson, D.

2011-01-01

Acoustic trauma caused by exposure to a very loud sound increases spontaneous activity in central auditory structures such as the inferior colliculus. This hyperactivity has been suggested as a neural substrate for tinnitus, a phantom hearing sensation. In previous studies we have described a tentative link between the frequency region of hearing impairment and the corresponding tonotopic regions in the inferior colliculus showing hyperactivity. In this study we further investigated the relationship between cochlear compound action potential threshold loss, cochlear outer and inner hair cell loss and central hyperactivity in inferior colliculus of guinea pigs. Two weeks after a 10 kHz pure tone acoustic trauma, a tight relationship was demonstrated between the frequency region of compound action potential threshold loss and frequency regions in the inferior colliculus showing hyperactivity. Extending the duration of the acoustic trauma from 1 to 2 h did not result in significant increases in final cochlear threshold loss, but did result in a further increase of spontaneous firing rates in the inferior colliculus. Interestingly, hair cell loss was not present in the frequency regions where elevated cochlear thresholds and central hyperactivity were measured, suggesting that subtle changes in hair cell or primary afferent neural function are sufficient for central hyperactivity to be triggered and maintained. PMID:21491427

Temporal order processing of syllables in the left parietal lobe.

PubMed

Moser, Dana; Baker, Julie M; Sanchez, Carmen E; Rorden, Chris; Fridriksson, Julius

2009-10-07

Speech processing requires the temporal parsing of syllable order. Individuals suffering from posterior left hemisphere brain injury often exhibit temporal processing deficits as well as language deficits. Although the right posterior inferior parietal lobe has been implicated in temporal order judgments (TOJs) of visual information, there is limited evidence to support the role of the left inferior parietal lobe (IPL) in processing syllable order. The purpose of this study was to examine whether the left inferior parietal lobe is recruited during temporal order judgments of speech stimuli. Functional magnetic resonance imaging data were collected on 14 normal participants while they completed the following forced-choice tasks: (1) syllable order of multisyllabic pseudowords, (2) syllable identification of single syllables, and (3) gender identification of both multisyllabic and monosyllabic speech stimuli. Results revealed increased neural recruitment in the left inferior parietal lobe when participants made judgments about syllable order compared with both syllable identification and gender identification. These findings suggest that the left inferior parietal lobe plays an important role in processing syllable order and support the hypothesized role of this region as an interface between auditory speech and the articulatory code. Furthermore, a breakdown in this interface may explain some components of the speech deficits observed after posterior damage to the left hemisphere.

Temporal Order Processing of Syllables in the Left Parietal Lobe

PubMed Central

Baker, Julie M.; Sanchez, Carmen E.; Rorden, Chris; Fridriksson, Julius

2009-01-01

Speech processing requires the temporal parsing of syllable order. Individuals suffering from posterior left hemisphere brain injury often exhibit temporal processing deficits as well as language deficits. Although the right posterior inferior parietal lobe has been implicated in temporal order judgments (TOJs) of visual information, there is limited evidence to support the role of the left inferior parietal lobe (IPL) in processing syllable order. The purpose of this study was to examine whether the left inferior parietal lobe is recruited during temporal order judgments of speech stimuli. Functional magnetic resonance imaging data were collected on 14 normal participants while they completed the following forced-choice tasks: (1) syllable order of multisyllabic pseudowords, (2) syllable identification of single syllables, and (3) gender identification of both multisyllabic and monosyllabic speech stimuli. Results revealed increased neural recruitment in the left inferior parietal lobe when participants made judgments about syllable order compared with both syllable identification and gender identification. These findings suggest that the left inferior parietal lobe plays an important role in processing syllable order and support the hypothesized role of this region as an interface between auditory speech and the articulatory code. Furthermore, a breakdown in this interface may explain some components of the speech deficits observed after posterior damage to the left hemisphere. PMID:19812331

Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature

PubMed Central

Cervera-Espert*, Juan; Pérez-Martínez*, Sara; Cervera-Ballester, Juan; Penarrocha-Oltra, David

2016-01-01

Background Coronectomy is an alternative to complete removal of an impacted mandibular third molar. Most authors have recommended coronectomy to prevent damage to the inferior alveolar nerve during surgical extraction of lower third molars. The present study offers a systematic review and metaanalysis of the coronectomy technique. Material and Methods A systematic review and meta-analysis was performed based on a PubMed and Cochrane databases search for articles published from 2014 and involving coronectomy of mandibular third molars located near the inferior alveolar nerve canal, with a minimum of 10 cases and a minimum follow-up period of 6 months. After application of the inclusion and exclusion criteria, a total of 12 articles were included in the study. Results and Discussion Coronectomy results in significantly lesser loss of sensitivity of the inferior alveolar nerve and prevents the occurrence of dry socket. No statistically significant differences were observed in the incidence of pain and infection between coronectomy and complete surgical extraction. After coronectomy, the remaining tooth fragment migrates an average of 2 mm within two years. Conclusions Coronectomy is indicated when the mandibular third molar is in contact with the inferior alveolar nerve and complete removal of the tooth may cause nerve damage. Key words:Coronectomy, included third molar, inferior alveolar nerve injury. PMID:27031064

Inferior fronto-temporo-occipital connectivity: a missing link between maltreated girls and neglectful mothers

PubMed Central

León, Inmaculada; Góngora, Daylin; Hernández-Cabrera, Juan A.; Byrne, Sonia; Bobes, María A.

2016-01-01

The neurobiological alterations resulting from adverse childhood experiences that subsequently may lead to neglectful mothering are poorly understood. Maternal neglect of an infant’s basic needs is the most prevalent type of child maltreatment. We tested white matter alterations in neglectful mothers, the majority of whom had also suffered maltreatment in their childhood, and compared them to a matched control group. The two groups were discriminated by a structural brain connectivity pattern comprising inferior fronto-temporo-occipital connectivity, which constitutes a major portion of the face-processing network and was indexed by fewer streamlines in neglectful mothers. Mediation and regression analyses showed that fewer streamlines in the right inferior longitudinal fasciculus tract (ILF-R) predicted a poorer quality of mother–child emotional availability observed during cooperative play and that effect depended on the respective interactions with left and right inferior fronto-occipital fasciculi (IFO-R/L), with no significant impact of psychopathological and cognitive conditions. Volume alteration in ILF-R but not in IFO-L modulated the impact of having been maltreated on emotional availability. The findings suggest the altered inferior fronto-temporal-occipital connectivity, affecting emotional visual processing, as a possible common neurological substrate linking a history of childhood maltreatment with maternal neglect. PMID:27342834

Inferior alveolar nerve injury after mandibular third molar extraction: a literature review.

PubMed

Sarikov, Rafael; Juodzbalys, Gintaras

2014-01-01

The purpose of this study was to systematically review the comprehensive overview of literature data about injury to the inferior alveolar nerve after lower third molar extraction to discover the prevalence of injury, the risk factors, recovery rates, and alternative methods of treatment. Literature was selected through a search of PubMed electronic databases. Articles from January 2009 to June 2014 were searched. English language articles with a minimum of 6 months patient follow-up and injury analysis by patient's reporting, radiographic, and neurosensory testing were selected. In total, 84 literature sources were reviewed, and 14 of the most relevant articles that are suitable to the criteria were selected. Articles were analyzed on men and women. The influence of lower third molar extraction (especially impacted) on the inferior alveolar nerve was clearly seen. The incidence of injury to the inferior alveolar nerve after lower third molar extraction was about 0.35 - 8.4%. The injury of the inferior alveolar nerve can be predicted by various radiological signs. There are few risk factors that may increase the risk of injury to the nerve such as patients over the age of 24 years old, with horizontal impactions, and extraction by trainee surgeons. Recovery is preferable and permanent injury is very rare.

Efficacy of an asynchronous electronic curriculum in emergency medicine education in the United States.

PubMed

Wray, Alisa; Bennett, Kathryn; Boysen-Osborn, Megan; Wiechmann, Warren; Toohey, Shannon

2017-01-01

The aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum. The study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference. Using a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was -3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points. Replacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.

The phonatory deviation diagram: a novel objective measurement of vocal function.

PubMed

Madazio, Glaucya; Leão, Sylvia; Behlau, Mara

2011-01-01

To identify the discriminative characteristics of the phonatory deviation diagram (PDD) in rough, breathy and tense voices. One hundred and ninety-six samples of normal and dysphonic voices from adults were submitted to perceptual auditory evaluation, focusing on the predominant vocal quality and the degree of deviation. Acoustic analysis was performed with the VoxMetria (CTS Informatica). Significant differences were observed between the dysphonic and normal groups (p < 0.001), and also between the breathy and rough samples (p = 0.044) and the breathy and tense samples (p < 0.001). All normal voices were positioned in the inferior left quadrant, 45% of the rough voices in the inferior right quadrant, 52.6% of the breathy voices in the superior right quadrant and 54.3% of the tense voices in the inferior left quadrant of the PDD. In the inferior left quadrant, 93.8% of voices with no deviation were located and 72.7% of voices with mild deviation; voices with moderate deviation were distributed in the inferior and superior right quadrants, the latter ones containing the most deviant voices and 80% of voices with severe deviation. The PDD was able to discriminate normal from dysphonic voices, and the distribution was related to the type and degree of voice alteration. Copyright © 2011 S. Karger AG, Basel.

Clinical trial: the treatment of gastro-oesophageal reflux disease in primary care--prospective randomized comparison of rabeprazole 20 mg with esomeprazole 20 and 40 mg.

PubMed

Eggleston, A; Katelaris, P H; Nandurkar, S; Thorpe, P; Holtmann, G

2009-05-01

A trial of empirical PPI therapy is usual practice for most patients with symptoms of gastro-oesophageal reflux disease (GERD) in primary care. To determine if the 4-week efficacy of rabeprazole 20 mg for resolving heartburn and regurgitation symptoms is non-inferior to esomeprazole 40 mg or 20 mg. In all, 1392 patients were randomized to rabeprazole 20 mg, esomeprazole 20 mg or 40 mg once daily. Patients, doctors and assessors were blinded. Symptom resolution data were collected on days 0-7 and day-28 using the Patient Assessment of Upper Gastrointestinal Disorders Symptom Severity Index with a shortened version used on days 8-27. Rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete resolution of regurgitation and satisfactory resolution of heartburn and regurgitation. For complete heartburn resolution, the efficacy of rabeprazole 20 mg and esomeprazole 40 mg was statistically indistinguishable, although the non-inferiority test was inconclusive. Rabeprazole 20 mg was non-inferior to esomeprazole 20 mg for all outcomes. In uninvestigated GERD patients, rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete and satisfactory relief of regurgitation and satisfactory relief of heartburn, and not different for complete resolution of heartburn.

Bayesian approach for assessing non-inferiority in a three-arm trial with pre-specified margin.

PubMed

Ghosh, Samiran; Ghosh, Santu; Tiwari, Ram C

2016-02-28

Non-inferiority trials are becoming increasingly popular for comparative effectiveness research. However, inclusion of the placebo arm, whenever possible, gives rise to a three-arm trial which has lesser burdensome assumptions than a standard two-arm non-inferiority trial. Most of the past developments in a three-arm trial consider defining a pre-specified fraction of unknown effect size of reference drug, that is, without directly specifying a fixed non-inferiority margin. However, in some recent developments, a more direct approach is being considered with pre-specified fixed margin albeit in the frequentist setup. Bayesian paradigm provides a natural path to integrate historical and current trials' information via sequential learning. In this paper, we propose a Bayesian approach for simultaneous testing of non-inferiority and assay sensitivity in a three-arm trial with normal responses. For the experimental arm, in absence of historical information, non-informative priors are assumed under two situations, namely when (i) variance is known and (ii) variance is unknown. A Bayesian decision criteria is derived and compared with the frequentist method using simulation studies. Finally, several published clinical trial examples are reanalyzed to demonstrate the benefit of the proposed procedure. Copyright © 2015 John Wiley & Sons, Ltd.

Preparación de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional*

PubMed Central

Al-rousan, Tala M.; Rubenstein, Linda M.; Wallace, Robert B.

2015-01-01

Objetivos. Nos propusimos determinar el grado de preparación frente a los desastres naturales de los adultos mayores en los Estados Unidos y evaluar los factores que pueden afectar negativamente la salud y la seguridad durante este tipo de incidentes. Métodos. Obtuvimos una muestra de adultos de 50 años en adelante (n = 1 304) de la encuesta del 2010 del Estudio de la Salud y la Jubilación (HRS por su sigla en inglés). La encuesta recogió datos sobre las características demográficas generales, el estado de discapacidad o las limitaciones funcionales, y también sobre factores y comportamientos relacionados con la preparación frente a los desastres. Calculamos una puntuación global de preparación mediante indicadores individuales a fin de evaluar el grado de preparación general. Resultados. La media de la edad de los participantes (n = 1 304) fue de 70 años (desviación estándar [DE] = 9,3). Solo 34,3% informaron que habían participado en un programa formativo o que habían leído materiales sobre la preparación para los desastres. Casi 15% indicaron que usaban dispositivos médicos eléctricos que podían correr riesgo de no funcionar si se interrumpiera el suministro eléctrico. La puntuación de preparación indicó que la edad más avanzada, la discapacidad física y el menor nivel de escolaridad y de ingresos se asociaban independiente y significativamente a un grado de preparación general inferior. Conclusiones. A pesar de la mayor vulnerabilidad ante los desastres y del número cada vez mayor de adultos mayores en los Estados Unidos, muchos de los problemas sustanciales que encontramos son remediables y requieren atención en los sectores de la sociedad dedicados a la atención clínica, a la salud pública y al manejo de situaciones de emergencia.

Neurobiología de la impulsividad y los trastornos de la conducta alimentaria*

PubMed Central

Orozco-Cabal, Luis Felipe; Herin, David

2009-01-01

Resumen Introducción La impulsividad es un rasgo de personalidad multidimensional relacionado con el control del comportamiento y las emociones. Está presente de manera diversa en los trastornos de la conducta alimentaria, particularmente, en la bulimia nerviosa (BN). Aunque la relación entre la impulsividad y BN ha sido objeto de numerosas investigaciones, en la actualidad se desconocen los sustratos neurobiológicos de esta relación. Objetivos Discutir críticamente la evidencia que sugiere que las alteraciones en los sistemas neuronales relacio-nados con las funciones ejecutivas, con la formación de preferencias y con la regulación de los estados emocionales sirven como base para el rasgo de personalidad impulsiva, así como su estado en subgrupos de pacientes con BN. Métodos Búsqueda selectiva de la literatura relevante. Resultados y conclusiones Esta discusión ilustra la complejidad de la relación entre la impulsividad y BN, donde la impulsividad actúa como un factor de vulnerabilidad que puede sensibilizar al sujeto con BN a estados emocionales negativos, durante los cuales modifica el impacto de estímulos internos y externos sobre el comportamiento y su regulación, favoreciendo así patrones de comportamiento maladaptativos e inflexibles. PMID:19838321

Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus: a pilot study.

PubMed

Mattioli, Flavia; Ambrosi, Claudia; Mascaro, Lorella; Scarpazza, Cristina; Pasquali, Patrizia; Frugoni, Marina; Magoni, Mauro; Biagi, Laura; Gasparotti, Roberto

2014-02-01

Early poststroke aphasia rehabilitation effects and their functional MRI (fMRI) correlates were investigated in a pilot, controlled longitudinal study. Twelve patients with mild/moderate aphasia (8 Broca, 3 anomic, and 1 Wernicke) were randomly assigned to daily language rehabilitation for 2 weeks (starting 2.2 [mean] days poststroke) or no rehabilitation. The Aachen Aphasia Test and fMRI recorded during an auditory comprehension task were performed at 3 time intervals: mean 2.2 (T1), 16.2 (T2), and 190 (T3) days poststroke. Groups did not differ in terms of age, education, aphasia severity, lesions volume, baseline fMRI activations, and in task performance during fMRI across examinations. Rehabilitated patients significantly improved in naming and written language tasks (P<0.05) compared with no rehabilitation group both at T2 and T3. Functional activity at T1 was reduced in language-related cortical areas (right and left inferior frontal gyrus and middle temporal gyrus, right inferior parietal lobule and superior temporal gyrus) in patients compared with controls. T2 and T3 follow-ups revealed a cortical activation increase, with significantly greater activation in the left hemisphere areas in rehabilitated patients at T2 and T3, and a time×treatment effect at T2 in the left inferior Broca area after rehabilitation. Left inferior frontal gyrus activation at T2 significantly correlated with naming improvement. Early poststroke aphasia treatment is useful, has durable effects, and may lead to early enhanced recruitment of brain areas, particularly the left inferior frontal gyrus, which persists in the chronic phase.

Reduced Inferior and Orbital Frontal Thickness in Adolescent Bulimia Nervosa Persists Over Two-Year Follow-Up.

PubMed

Cyr, Marilyn; Kopala-Sibley, Daniel C; Lee, Seonjoo; Chen, Chen; Stefan, Mihaela; Fontaine, Martine; Terranova, Kate; Berner, Laura A; Marsh, Rachel

2017-10-01

Cross-sectional data suggest functional and anatomical disturbances in inferior and orbital frontal regions in bulimia nervosa (BN). Using longitudinal data, we investigated whether reduced cortical thickness (CT) in these regions arises early and persists over adolescence in BN, independent of symptom remission, and whether CT reductions are markers of BN symptoms. A total of 33 adolescent females with BN symptoms (BN or other specified feeding or eating disorder) and 28 healthy adolescents participated in this study. Anatomical magnetic resonance imaging and clinical data were acquired at 3 time points within 2-year intervals over adolescence, with 31% average attrition between assessments. Using a region-of-interest approach, we assessed group differences in CT at baseline and over time, and tested whether between- and within-subject variations in CT were associated with the frequency of BN symptoms. Reduced CT in the right inferior frontal gyrus persisted over adolescence in BN compared to healthy adolescents, even in those who achieved full or partial remission. Within the BN group, between-subject variations in CT in the inferior and orbital frontal regions were inversely associated with specific BN symptoms, suggesting, on average over time, greater CT reductions in individuals with more frequent BN symptoms. Reduced CT in inferior frontal regions may contribute to illness persistence into adulthood. Reductions in the thickness of the inferior and orbital frontal regions may be markers of specific BN symptoms. Because our sample size precluded correcting for multiple comparisons, these findings should be replicated in a larger sample. Future study of functional changes in associated fronto-striatal circuits could identify potential circuit-based intervention targets. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

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.

Randomized, non-inferiority trial comparing a nitric oxide releasing solution with a macrolide antibiotic for control of bovine respiratory disease in beef feedlot calves at high-risk of developing respiratory tract disease.

PubMed

Crepieux, T; Miller, C; Regev-Shoshani, G; Schaefer, A; Dorin, C; Alexander, T; Timsit, E

2016-04-01

Nitric oxide, a molecule produced in most mammalian cells, has bactericidal and virucidal properties. Nasal instillation of a nitric oxide releasing solution (NORS) on arrival at the feedlot was recently reported as non-inferior to a parenteral injection of a macrolide antibiotic, tilmicosin, for control of bovine respiratory disease (BRD) in cattle at low-to-moderate risk of developing BRD. The objective of this study was to evaluate whether NORS was non-inferior to tilmicosin for control of BRD in cattle at high-risk of developing BRD (the target population for many BRD control programs). High-risk Angus-cross heifers (n=840) were randomly allocated to 2 treatment groups on arrival at a feedlot and received either NORS or tilmicosin for BRD control. Non-inferiority was assessed by calculating the difference in prevalence of heifers diagnosed with BRD during the first 40 d after arrival between NORS and tilmicosin treatment groups. The non-inferiority margin (δ) was set at 8.5%. Thirty-six and 19% of heifers were diagnosed with BRD in the NORS and tilmicosin groups, respectively. Because the lower bound of the 2-sided 95% confidence interval (CI) of the difference in BRD prevalence between the 2 treatment groups (17%; 95% CI=11-23%) was higher than δ, an inferiority of NORS was concluded. Although on-arrival nasal administration of NORS can be viewed as a more rational control strategy than parental injection of antibiotics, further research is needed to improve NORS efficacy before it can be recommended to prevent BRD in high-risk cattle. Copyright © 2016 Elsevier Ltd. All rights reserved.

Particle radiotherapy, a novel external radiation therapy, versus liver resection for hepatocellular carcinoma accompanied with inferior vena cava tumor thrombus: A matched-pair analysis.

PubMed

Komatsu, Shohei; Kido, Masahiro; Asari, Sadaki; Toyama, Hirochika; Ajiki, Tetsuo; Demizu, Yusuke; Terashima, Kazuki; Okimoto, Tomoaki; Sasaki, Ryohei; Fukumoto, Takumi

2017-12-01

Hepatocellular carcinoma accompanied with inferior vena cava tumor thrombus carries a dismal prognosis, and the feasibility of local treatment has remained controversial. The present study aimed to compare the outcomes of particle radiotherapy and liver resection in patients with hepatocellular carcinoma with inferior vena cava tumor thrombus. Thirty-one and 19 patients, respectively, underwent particle radiotherapy and liver resection for hepatocellular carcinoma with inferior vena cava tumor thrombus. A matched-pair analysis was undertaken to compare the short- and long-term outcomes according to tumor stage determined using the tumor-node-metastasis classification. Both stages IIIB and IV (IVA and IVB) patients were well-matched for 12 factors, including treatment policy and patient and tumor characteristics. The median survival time of matched patients with stage IIIB tumors in the particle radiotherapy group was greater than that in the liver resection group (748 vs 272 days, P = .029), whereas no significant difference was observed in the median survival times of patients with stage IV tumors (239 vs 311 days, respectively). There were significantly fewer treatment-related complications of grade 3 or greater in the particle radiotherapy group (0%) than in the liver resection group (26%). Particle radiotherapy is potentially preferable in hepatocellular carcinoma patients with stage IIIB inferior vena cava tumor thrombus and at least equal in efficiency to liver resection in those with stage IV disease, while causing significantly fewer complications. Considering the relatively high survival and low invasiveness of particle radiotherapy when compared to liver resection, this approach may represent a novel treatment modality for hepatocellular carcinoma with inferior vena cava tumor thrombus. Copyright © 2017 Elsevier Inc. All rights reserved.

Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts.

PubMed

Marroig, Bruno; Favorito, Luciano Alves; Fortes, Marco A; Sampaio, Francisco J B

2015-12-01

The aim of this study was to analyze the anatomy of the inferior pole collecting system and the mid-renal-zone classification in human endocasts applied to flexible ureteroscopy. 170 three-dimensional polyester resin endocasts of the kidney collecting system were obtained from 85 adult cadavers. We divided the endocasts into four groups: A1--kidney midzone (KM), drained by minor calices (mc) that are dependent on the superior or the inferior caliceal groups; A2--KM drained by crossed calices; B1--KM drained by a major caliceal group independent of both the superior and inferior groups; and B2--KM drained by mc entering directly into the renal pelvis. We studied the number of calices, the angle between the lower infundibulum and renal pelvis and the angle between the lower infundibulum and the inferior mc (LIICA). Means were statistically compared using ANOVA and the unpaired T test (p < 0.05). We found 57 (33.53 %) endocasts of group A1; 23 (13.53 %) of group A2; 59 (34.71 %) of group B1; and 31 (18.23 %) of group B2. The inferior pole was drained by four or more calices in 84 cases (49.41 %), distributed into groups as follows: A1 = 35 cases (41.67 %); A2 = 18 (21.43 %); B1 = 22 (26.19 %); and B2 = 9 (10.71 %). Perpendicular mc were observed in 15 cases (8.82 %). We did not observe statistical differences between the LIICA in the groups studied. Collector systems with kidney midzone drained by minor calices that are dependent on the superior or on the inferior caliceal groups presented at least two restrictive anatomical features. The mid-renal-zone classification was predictive of anatomical risk factors for lower pole ureteroscopy difficulties.

Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts.

PubMed

Croome, Kris P; Wall, William; Chandok, Natasha; Beck, Gavin; Marotta, Paul; Hernandez-Alejandro, Roberto

2013-11-01

The impact of ischemia/reperfusion injury in the setting of transplantation for hepatocellular carcinoma (HCC) has not been thoroughly investigated. The present study examined data from the Scientific Registry of Transplant Recipients for all recipients of deceased donor liver transplants performed between January 1, 1995 and October 31, 2011. In a multivariate Cox analysis, significant predictors of patient survival included the following: HCC diagnosis (P < 0.01), donation after cardiac death (DCD) allograft (P < 0.001), hepatitis C virus-positive status (P < 0.01), recipient age (P < 0.01), donor age (P < 0.001), Model for End-Stage Liver Disease score (P < 0.001), recipient race, and an alpha-fetoprotein level > 400 ng/mL at the time of transplantation. In order to test whether the decreased survival seen for HCC recipients of DCD grafts was more than would be expected because of the inferior nature of DCD grafts and the diagnosis of HCC, a DCD allograft/HCC diagnosis interaction term was created to look for potentiation of effect. In a multivariate analysis adjusted for all other covariates, this interaction term was statistically significant (P = 0.049) and confirmed that there was potentiation of inferior survival with the use of DCD allografts in recipients with HCC. In conclusion, patient survival and graft survival were inferior for HCC recipients of DCD allografts versus recipients of donation after brain death allografts. This potentiation of effect of inferior survival remained even after adjustments for the inherent inferiority observed in DCD allografts as well as other known risk factors. It is hypothesized that this difference could reflect an increased rate of recurrence of HCC. © 2013 American Association for the Study of Liver Diseases.

Surgical anatomy of the radial nerve in the deltopectoral approach for revision shoulder arthroplasty and periprosthetic fracture fixation: a cadaveric study.

PubMed

Fu, Michael C; Hendel, Michael D; Chen, Xiang; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

2017-12-01

Radial nerve injury is a rare but clinically significant complication of revision shoulder arthroplasty and fixation of native and periprosthetic proximal humeral fractures. Understanding of the anatomic relationship between the radial nerve as it enters the humeral spiral groove and anterior shoulder landmarks in a deltopectoral approach is necessary to avoid iatrogenic radial nerve injury. Eight forequarter cadaveric specimens were dissected through a deltopectoral approach. Distances between the radial nerve entry into the proximal spiral groove and the coracoid process, distal lesser tuberosity/inferior subscapularis insertion, superior latissimus insertion, and inferior latissimus insertion were measured. Means, standard deviations, and ranges were determined for each distance. The radial nerve entry into the proximal spiral groove averaged 133.1 mm (range, 110.3-153.0 mm) from the coracoid process, 101.9 mm (range, 76.5-124.3 mm) from the distal lesser tuberosity/inferior subscapularis insertion, 81.0 mm (range, 63.4-101.5 mm) from the superior latissimus insertion, and 39.6 mm (range, 25.5-55.4 mm) from the inferior latissimus insertion. The proximal spiral groove was distal to the inferior latissimus insertion in all specimens. The risk of iatrogenic injury to the radial nerve at the spiral groove may be minimized through proper identification and protection or avoidance of circumferential fixation. However, if encircling fixation with cerclage cables is necessary, instrumentation proximal to the inferior edge of the latissimus dorsi insertion may reduce the risk of radial nerve injury. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

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

Ohri, Nitin; Rapkin, Bruce D.; Guha, Chandan

Purpose: To examine associations between radiation therapy (RT) noncompliance and clinical outcomes. Methods and Materials: We reviewed all patients who completed courses of external beam RT with curative intent in our department from the years 2007 to 2012 for cancers of the head and neck, breast, lung, cervix, uterus, or rectum. Patients who missed 2 or more scheduled RT appointments (excluding planned treatment breaks) were deemed noncompliant. Univariate, multivariable, and propensity-matched analyses were performed to examine associations between RT noncompliance and clinical outcomes. Results: Of 1227 patients, 266 (21.7%) were noncompliant. With median follow-up of 50.9 months, 108 recurrences (8.8%) and 228more » deaths (18.6%) occurred. In univariate analyses, RT noncompliance was associated with increased recurrence risk (5-year cumulative incidence 16% vs 7%, P<.001), inferior recurrence-free survival (5-year actuarial rate 63% vs 79%, P<.001), and inferior overall survival (5-year actuarial rate 72% vs 83%, P<.001). In multivariable analyses that were adjusted for disease site and stage, comorbidity score, gender, ethnicity, race, and socioeconomic status (SES), RT noncompliance was associated with inferior recurrence, recurrence-free survival, and overall survival rates. Propensity score–matched models yielded results nearly identical to those seen in univariate analyses. Low SES was associated with RT noncompliance and was associated with inferior clinical outcomes in univariate analyses, but SES was not associated with inferior outcomes in multivariable models. Conclusion: For cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have been observed linking SES and clinical outcomes.« less

Telephone cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a randomized controlled non-inferiority trial.

PubMed

Turner, Cynthia M; Mataix-Cols, David; Lovell, Karina; Krebs, Georgina; Lang, Katie; Byford, Sarah; Heyman, Isobel

2014-12-01

Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT. Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up. Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received. TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information-Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Telephone Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Non-inferiority Trial

PubMed Central

Turner, Cynthia M.; Mataix-Cols, David; Lovell, Karina; Krebs, Georgina; Lang, Katie; Byford, Sarah; Heyman, Isobel

2014-01-01

Objective Many adolescents with obsessive-compulsive disorder (OCD) do not have access to evidence-based treatment. A randomized controlled non-inferiority trial was conducted in a specialist OCD clinic to evaluate the effectiveness of telephone cognitive-behavioral therapy (TCBT) for adolescents with OCD compared to standard clinic-based, face-to-face CBT. Method Seventy-two adolescents, aged 11 through 18 years with primary OCD, and their parents were randomized to receive specialist TCBT or CBT. The intervention provided differed only in the method of treatment delivery. All participants received up to 14 sessions of CBT, incorporating exposure with response prevention (E/RP), provided by experienced therapists. The primary outcome measure was the Children’s Yale–Brown Obsessive-Compulsive Scale (CY-BOCS). Blind assessor ratings were obtained at midtreatment, posttreatment, 3-month, 6-month, and 12-month follow-up. Results Intent-to-treat analyses indicated that TCBT was not inferior to face-to-face CBT at posttreatment, 3-month, and 6-month follow-up. At 12-month follow-up, there were no significant between-group differences on the CY-BOCS, but the confidence intervals exceeded the non-inferiority threshold. All secondary measures confirmed non-inferiority at all assessment points. Improvements made during treatment were maintained through to 12-month follow-up. Participants in each condition reported high levels of satisfaction with the intervention received. Conclusion TCBT is an effective treatment and is not inferior to standard clinic-based CBT, at least in the midterm. This approach provides a means of making a specialized treatment more accessible to many adolescents with OCD. Clinical trial registration information–Evaluation of telephone-administered cognitive-behaviour therapy (CBT) for young people with obsessive-compulsive disorder (OCD); http://www.controlled-trials.com; ISRCTN27070832. PMID:25457928

Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication.

PubMed

Kang, Sang-Hoon; Won, Yu-Jin

2017-12-01

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery.

7 CFR 29.6027 - Nested.

Code of Federal Regulations, 2012 CFR

2012-01-01

... INSPECTION Standards Definitions § 29.6027 Nested. Any tobacco which has been loaded, packed, or arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior tobacco, any of...

7 CFR 29.6027 - Nested.

Code of Federal Regulations, 2013 CFR

2013-01-01

... INSPECTION Standards Definitions § 29.6027 Nested. Any tobacco which has been loaded, packed, or arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior tobacco, any of...

7 CFR 29.6027 - Nested.

Code of Federal Regulations, 2014 CFR

2014-01-01

... INSPECTION Standards Definitions § 29.6027 Nested. Any tobacco which has been loaded, packed, or arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior tobacco, any of...

7 CFR 29.6027 - Nested.

Code of Federal Regulations, 2011 CFR

2011-01-01

... INSPECTION Standards Definitions § 29.6027 Nested. Any tobacco which has been loaded, packed, or arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior tobacco, any of...

The anatomic basis of lingual nerve trauma associated with inferior alveolar block injections.

PubMed

Morris, Christopher D; Rasmussen, Jared; Throckmorton, Gaylord S; Finn, Richard

2010-11-01

This study describes the anatomic variability in the position of the lingual nerve in the pterygomandibular space, the location of the inferior alveolar nerve block injection. Simulated standard landmark-based inferior alveolar nerve blocks were administered to 44 fixed sagitally bisected cadaver heads. Measurements were made of the diameter of the nerves and distances between the needle and selected anatomic landmarks and the nerves. Of 44 simulated injections, 42 (95.5%) passed lateral to the lingual nerve, 7 (16%) passed within 0.1 mm of the nerve, and 2 (4.5%) penetrated the nerve. The position of the lingual nerve relative to bony landmarks within the interpterygoid fascia was highly variable. Variation in the position of the lingual nerve is an important contributor to lingual nerve trauma during inferior alveolar block injections. This factor should be an important part of preoperative informed consent. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The Effect of 2 Injection Speeds on Local Anesthetic Discomfort During Inferior Alveolar Nerve Blocks.

PubMed

de Souza Melo, Marcelo Rodrigo; Sabey, Mark Jon Santana; Lima, Carla Juliane; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

2015-01-01

This randomized double-blind crossover trial investigated the discomfort associated with 2 injection speeds, low (60 seconds) and slow (100 seconds), during inferior alveolar nerve block by using 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine. Three phases were considered: (a) mucosa perforation, (b) needle insertion, and (c) solution injection. Thirty-two healthy adult volunteers needing bilateral inferior alveolar nerve blocks at least 1 week apart were enrolled in the present study. The anesthetic procedure discomfort was recorded by volunteers on a 10-cm visual analog scale in each phase for both injection speeds. Comparison between the 2 anesthesia speeds in each phase was performed by paired t test. Results showed no statistically significant difference between injection speeds regarding perforation (P = .1016), needle placement (P = .0584), or speed injection (P = .1806). The discomfort in all phases was considered low. We concluded that the 2 injection speeds tested did not affect the volunteers' pain perception during inferior alveolar nerve blocks.

TVT-O vs. TVT for the treatment of SUI: a non-inferiority study.

PubMed

Yang, Xiang; Jiang, Min; Chen, Xinliang; Tong, Xiaowen; Li, Huaifang; Qiu, Jin; Shao, Lingyun

2012-01-01

This study aimed to prospectively compare, in terms of efficacy and safety, the tension-free vaginal tape (TVT) and the transobturator vaginal tape inside-out (TVT-O) procedure for stress urinary incontinence. A cough stress test was applied to the objective outcomes, while urinary incontinence-specific quality of life questionnaire was applied to the subjective outcomes. A test for non-inferiority was carried out for detecting the success rate between the two groups. The objective success rates were found to be 95.4% (62/65) in the TVT group and 96.4% (108/112) in the TVT-O group. No significant difference was found between these two groups in the success rate by non-inferiority test (P < 0.0005), with significant improvement in quality of life and no significant difference in patient satisfaction rates in the two groups (P > 0.05). In the study, the TVT-O procedure could be defined to be identical to the TVT approach in success rate by non-inferiority test.

Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature

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

Flood, Karen, E-mail: karenrogers@doctors.org.uk; Nicholson, Anthony A.

2013-06-15

Purpose. To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods, Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results. Outcome data collected between 3 months and 4 yearsmore » (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.« less

Activation in the Right Inferior Parietal Lobule Reflects the Representation of Musical Structure beyond Simple Pitch Discrimination.

PubMed

Royal, Isabelle; Vuvan, Dominique T; Zendel, Benjamin Rich; Robitaille, Nicolas; Schönwiesner, Marc; Peretz, Isabelle

2016-01-01

Pitch discrimination tasks typically engage the superior temporal gyrus and the right inferior frontal gyrus. It is currently unclear whether these regions are equally involved in the processing of incongruous notes in melodies, which requires the representation of musical structure (tonality) in addition to pitch discrimination. To this aim, 14 participants completed two tasks while undergoing functional magnetic resonance imaging, one in which they had to identify a pitch change in a series of non-melodic repeating tones and a second in which they had to identify an incongruous note in a tonal melody. In both tasks, the deviants activated the right superior temporal gyrus. A contrast between deviants in the melodic task and deviants in the non-melodic task (melodic > non-melodic) revealed additional activity in the right inferior parietal lobule. Activation in the inferior parietal lobule likely represents processes related to the maintenance of tonal pitch structure in working memory during pitch discrimination.

Activation in the Right Inferior Parietal Lobule Reflects the Representation of Musical Structure beyond Simple Pitch Discrimination

PubMed Central

Royal, Isabelle; Vuvan, Dominique T.; Zendel, Benjamin Rich; Robitaille, Nicolas; Schönwiesner, Marc; Peretz, Isabelle

2016-01-01

Pitch discrimination tasks typically engage the superior temporal gyrus and the right inferior frontal gyrus. It is currently unclear whether these regions are equally involved in the processing of incongruous notes in melodies, which requires the representation of musical structure (tonality) in addition to pitch discrimination. To this aim, 14 participants completed two tasks while undergoing functional magnetic resonance imaging, one in which they had to identify a pitch change in a series of non-melodic repeating tones and a second in which they had to identify an incongruous note in a tonal melody. In both tasks, the deviants activated the right superior temporal gyrus. A contrast between deviants in the melodic task and deviants in the non-melodic task (melodic > non-melodic) revealed additional activity in the right inferior parietal lobule. Activation in the inferior parietal lobule likely represents processes related to the maintenance of tonal pitch structure in working memory during pitch discrimination. PMID:27195523

A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In person versus home-based telehealth.

PubMed

Acierno, Ron; Knapp, Rebecca; Tuerk, Peter; Gilmore, Amanda K; Lejuez, Carl; Ruggiero, Kenneth; Muzzy, Wendy; Egede, Leonard; Hernandez-Tejada, Melba A; Foa, Edna B

2017-02-01

This is the first randomized controlled trial to evaluate non-inferiority of Prolonged Exposure (PE) delivered via home-based telehealth (HBT) compared to standard in-person (IP) PE. One-hundred thirty two Veterans recruited from a Southeastern Veterans Affairs Medical Center and affiliated University who met criteria for posttraumatic stress disorder (PTSD) were randomized to receive PE via HBT or PE via IP. Results indicated that PE-HBT was non-inferior to PE-IP in terms of reducing PTSD scores at post-treatment, 3 and 6 month follow-up. However, non-inferiority hypotheses for depression were only supported at 6 month follow-up. HBT has great potential to reduce patient burden associated with receiving treatment in terms of travel time, travel cost, lost work, and stigma without sacrificing efficacy. These findings indicate that telehealth treatment delivered directly into patients' homes may dramatically increase the reach of this evidence-based therapy for PTSD without diminishing effectiveness. Published by Elsevier Ltd.

Accuracy of un-supervised versus provider-supervised self-administered HIV testing in Uganda: A randomized implementation trial.

PubMed

Asiimwe, Stephen; Oloya, James; Song, Xiao; Whalen, Christopher C

2014-12-01

Unsupervised HIV self-testing (HST) has potential to increase knowledge of HIV status; however, its accuracy is unknown. To estimate the accuracy of unsupervised HST in field settings in Uganda, we performed a non-blinded, randomized controlled, non-inferiority trial of unsupervised compared with supervised HST among selected high HIV risk fisherfolk (22.1 % HIV Prevalence) in three fishing villages in Uganda between July and September 2013. The study enrolled 246 participants and randomized them in a 1:1 ratio to unsupervised HST or provider-supervised HST. In an intent-to-treat analysis, the HST sensitivity was 90 % in the unsupervised arm and 100 % among the provider-supervised, yielding a difference 0f -10 % (90 % CI -21, 1 %); non-inferiority was not shown. In a per protocol analysis, the difference in sensitivity was -5.6 % (90 % CI -14.4, 3.3 %) and did show non-inferiority. We conclude that unsupervised HST is feasible in rural Africa and may be non-inferior to provider-supervised HST.

A rare congenital extrahepatic portosystemic shunt affecting the inferior mesenteric vein, inferior vena cava, and left ovarian vein.

PubMed

Takeuchi, Hajime; Takeda, Yoko; Takahashi, Miyo; Hayashi, Shogo; Fukuzawa, Yoshitaka; Nakano, Takashi

2014-09-01

To observe a case of congenital extrahepatic portosystemic shunt and discuss it from the embryological and clinical viewpoints. An 85-year-old female cadaver was employed for a dissection course at Aichi Medical University in 2009. There was no evidence of liver cirrhosis macroscopically or microscopically. A portosystemic shunt was observed that involved communication between the inferior mesenteric vein, inferior vena cava (IVC), and left ovarian vein by a single Y-shaped shunt vessel. To the best of our knowledge, this is the first reported case of the above-mentioned three veins being connected by a single Y-shaped shunt vessel. Considering the other venous diameters, the shunt appeared to flow into the splenic vein and IVC. It cannot be denied that this shunt may have led to hepatic encephalopathy, although the shunt effect may have been minimal. Embryological development of IVC appears to occur close to the plexus of anastomosing vitelline veins, forming the portal vein.

ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas.

PubMed

De Gennaro, Luisa; Brunetti, Natale Daniele; Ruggiero, Massimo; Rutigliano, David; Locuratolo, Nicola; Di Biase, Matteo; Caldarola, Pasquale

2017-10-01

Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.

Treatment of Superior Vena Cava (SVC) Syndrome and Inferior Vena Cava (IVC) Thrombosis in a Patient with Colorectal Cancer: Combination of SVC Stenting and IVC Filter Placement to Palliate Symptoms and Pave the Way for Port Implantation

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

Sauter, Alexander; Triller, Juergen; Schmidt, Felix

Thrombosis of the inferior vena cava is a life-threatening complication in cancer patients leading to pulmonary embolism. These patients can also be affected by superior vena cava syndrome causing dyspnea followed by trunk or extremity swelling. We report the case of a 61-year-old female suffering from an extended colorectal tumor who became affected by both of the mentioned complications. Due to thrombus formation within the right vena jugularis interna, thrombosis of the inferior vena cava, and superior vena cava syndrome, a combined interventional procedure via a left jugular access with stenting of the superior vena cava and filter placement intomore » the inferior vena cava was performed As a consequence, relief of the patient's symptoms, prevention of pulmonary embolism, and paving of the way for further venous chemotherapy were achieved.« less

Inferior ST-Elevation Acute Myocardial Infarction or an Inferior-Lead Brugada-like Electrocardiogram Pattern Associated With the Use of Pregabalin and Quetiapine?

PubMed

Brunetti, Natale D; Ieva, Riccardo; Correale, Michele; Cuculo, Andrea; Santoro, Francesco; Guaricci, Andrea I; De Gennaro, Luisa; Gaglione, Antonio; Di Biase, Matteo

2016-01-01

The Brugada electrocardiogram pattern is characterized by coved-type ST-elevation (>2 mm) in the right precordial leads. We report the case of a 62-year-old man, with bipolar disorder, admitted to the emergency department because of dyspnea and chest discomfort. The patient was on treatment with pregabalin and quetiapine. Unexpectedly, electrocardiogram at admission showed diffuse ST-elevation, more evident in inferior leads, where a Brugada-like pattern was present. The patient underwent coronary angiography with a diagnosis of suspected acute coronary syndrome. Coronary angiography, however, showed mild coronary artery disease not requiring coronary angioplasty. Echocardiography did not reveal left ventricular dysfunction or pericardial effusion. Troponin levels remained normal over serial controls. Eventually, chest radiography showed lung opacities and consolidation suggestive for pneumonia. To the best of our knowledge, this is one of the first cases showing a transient Brugada-like electrocardiogram pattern in inferior leads, probably amplified by the administration of pregabalin and quetiapine.

Mapping interference resolution across task domains: A shared control process in left inferior frontal gyrus

PubMed Central

Nelson, James K.; Reuter-Lorenz, Patricia A.; Persson, Jonas; Sylvester, Ching-Yune C.; Jonides, John

2009-01-01

Work in functional neuroimaging has mapped interference resolution processing onto left inferior frontal regions for both verbal working memory and a variety of semantic processing tasks. The proximity of the identified regions from these different tasks suggests the existence of a common, domain-general interference resolution mechanism. The current research specifically tests this idea in a within-subject design using fMRI to assess the activation associated with variable selection requirements in a semantic retrieval task (verb generation) and a verbal working memory task with a trial-specific proactive interference manipulation (recent-probes). High interference trials on both tasks were associated with activity in the midventrolateral region of the left inferior frontal gyrus, and the regions activated in each task strongly overlapped. The results indicate that an elemental component of executive control associated with interference resolution during retrieval from working memory and from semantic memory can be mapped to a common portion of the left inferior frontal gyrus. PMID:19111526

Genetic Factors and Orofacial Motor Learning Selectively Influence Variability in Central Sulcus Morphology in Chimpanzees (Pan troglodytes)

PubMed Central

Autrey, Michelle; Mahovetz, Lindsay; Pope, Sarah; Mareno, Mary Catherine; Schapiro, Steven J.

2017-01-01

Captive chimpanzees (Pan troglodytes) have been shown to learn the use of novel attention-getting (AG) sounds to capture the attention of humans as a means of requesting or drawing their attention to a desired object or food. There are significant individual differences in the use of AG sounds by chimpanzees and, here, we examined whether changes in cortical organization of the central sulcus (CS) were associated with AG sound production. MRI scans were collected from 240 chimpanzees, including 122 that reliably produced AG sounds and 118 that did not. For each subject, the depth of CS was quantified along the superior–inferior plane with specific interest in the inferior portion corresponding to the region of the motor cortex where the mouth and orofacial movements are controlled. Results indicated that CS depth in the inferior, but not superior, portion was significantly greater in chimpanzees that reliably produced AG sounds compared with those who did not. Quantitative genetic analyses indicated that overall CS surface area and depth were significantly heritable, particularly in the superior regions, but less so in the inferior and central portions. Further, heritability in CS depth was altered as a function of acquisition of AG sounds. The collective results suggest that learning to produce AG sounds resulted in region-specific cortical reorganization within the inferior portion of the CS, a finding previously undocumented in chimpanzees or any nonhuman primate. SIGNIFICANCE STATEMENT Recent studies in chimpanzees (Pan troglodytes) have shown that some can learn to produce novel sounds by configuring different orofacial movement patterns and these sounds are used in communicatively relevant contexts. Here, we examined the neuromorphological correlates in the production of these sounds in chimpanzees. We show that chimpanzees that have learned to produce these sounds show significant differences in central sulcus (CS) morphology, particularly in the inferior region. We further show that overall CS morphology and regions within the superior portion are significantly heritable, whereas central and inferior portions of the CS are not. The collective findings suggest chimpanzees exhibit cortical plasticity in regions of the brain that were central to the emergence of speech functions in humans. PMID:28473646

Retinal nerve fiber layer analysis with scanning laser polarimetry and RTVue-OCT in patients of retinitis pigmentosa.

PubMed

Xue, Kang; Wang, Min; Chen, Junyi; Huang, Xin; Xu, Gezhi

2013-01-01

To measure the thickness of the retinal nerve fiber layer (RNFL) of patients with retinitis pigmentosa (RP) and that of normal controls by scanning laser polarimetry with enhanced corneal compensation (GDxECC) and RTVue-optical coherence tomography (OCT). Fifty-two eyes of 26 patients were included. All patients underwent complete ophthalmological examinations and testing with GDxECC. Twenty-eight of 52 eyes of RP patients underwent RTVue-OCT measurements. A group of 50 eyes of 25 normal subjects (controls) was also included. GDxECC measured RNFL thickness in the peripapillary area in all subjects as well as temporal-superior-nasal-inferior-temporal (TSNIT) parameters, including TSNIT means, superior and inferior region means, TSNIT standard deviation (SD), inter-eye symmetry and nerve fiber indicator (NFI). RTVue-OCT measured the mean, superior, inferior, temporal and nasal quadrant RNFL thickness. In RP patients and controls, TSNIT means by GDxECC were, respectively, 65.00 ± 7.35 and 55.32 ± 5.20. Mean superior quadrant thicknesses were 80.56 ± 10.93 and 69.54 ± 7.45. Mean inferior thicknesses were 80.58 ± 9.34 and 69.12 ± 7.78. SDs were 27.92 ± 5.21 and 28.23 ± 4.01. Inter-eye symmetries were 0.82 ± 0.17 and 0.87 ± 0.09. NFIs were 9.74 ± 8.73 and 16.81 ± 8.13. The differences between mean TSNIT, mean superior and mean inferior quadrant thicknesses and NFIs were statistically significant (p < 0.001). In RTVue-OCT measurements, the differences between mean, superior, inferior and temporal quadrant RNFL thicknesses were statistically significant (p = 0.0322, 0.0213, 0.0387, 0.0005). The RNFL measured by GDxECC was significantly thicker in RP patients than in controls. RNFL thickness measured by RTVue-OCT was significantly greater in RP patients than in controls in the superior, inferior and temporal regions. This contribution provides information on RNFL thickness and discusses the mechanism underlying this phenomenon. Copyright © 2012 S. Karger AG, Basel.

Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block.

PubMed

Ribeiro, Leandro; Ramalho, Sara; Gerós, Sandra; Ferreira, Edite Coimbra; Faria e Almeida, António; Condé, Artur

2014-06-01

Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block. Copyright © 2014 Elsevier Inc. All rights reserved.

Reconstruction of a total avulsion of the hepatic veins and the suprahepatic inferior vena cava secondary to blunt thoracoabdominal trauma.

PubMed

Kaemmerer, Daniel; Daffner, Wolfgang; Niwa, Martin; Kuntze, Thomas; Hommann, Merten

2011-02-01

Blunt injury to the inferior vena cava is a rare but dramatic event having a high mortality up to 80%. The mortality increases after total avulsion especially in combination with secondary intra-abdominal injuries. We report on a 15-year-old boy who sustained a blunt trauma with a total, partially covered avulsion of the hepatic veins and the suprahepatic inferior vena cava. We treated the patient under internal bypassing of the retrohepatic vena cava by using the heart-lung machine and reconstructed the hepatic veins and suprahepatic vena cava with a conduit made of pericard.

Mirror neuron system: basic findings and clinical applications.

PubMed

Iacoboni, Marco; Mazziotta, John C

2007-09-01

In primates, ventral premotor and rostral inferior parietal neurons fire during the execution of hand and mouth actions. Some cells (called mirror neurons) also fire when hand and mouth actions are just observed. Mirror neurons provide a simple neural mechanism for understanding the actions of others. In humans, posterior inferior frontal and rostral inferior parietal areas have mirror properties. These human areas are relevant to imitative learning and social behavior. Indeed, the socially isolating condition of autism is associated with a deficit in mirror neuron areas. Strategies inspired by mirror neuron research recently have been used in the treatment of autism and in motor rehabilitation after stroke.

Maximizing Nephron Mass in Horseshoe Kidney Transplantation Using Inferior Epigastric Artery: Case Report.

PubMed

Elec, Florin-Ioan; Zaharie, Andreea; Vintilă, Ionuţ-Lucian; Ghervan, Liviu

2018-06-06

Due to the progressive shortage of donors, kidneys with congenital anomalies are considered for transplantation. We report a successful transplantation of a split horseshoe kidney from a deceased donor by using the inferior epigastric artery with an end-to-end anastomosis, supplying the isthmus. Thus, we preserved as much as possible the functional parenchyma for a good long-term outcome. The learning point is that the use of the right inferior epigastric artery seems to be a good solution to perfuse the lower artery in order to avoid its ligation, thus reducing the nephron mass of the graft. © 2018 S. Karger AG, Basel.

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

PubMed

Lee, Hyung; Baik, Seung Kug

2004-09-15

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

Abdominal wall phlebitis due to Prevotella bivia following renal transplantation in a patient with an occluded inferior vena cava.

PubMed

Janssen, S; van Donselaar-van der Pant, K A M I; van der Weerd, N C; Develter, W; Bemelman, F J; Grobusch, M P; Idu, M M; Ten Berge, I J M

2013-02-01

Pre-existing occlusion of the inferior vena cava may complicate renal transplantation. Suppurative abdominal wall phlebitis following renal transplantation was diagnosed in a patient with pre-existing thrombosis of the inferior vena cava of unknown cause. The phlebitis developed in the subcutaneous collateral veins of the abdominal wall contra-laterally to the renal transplant. Cultures from abdominal wall micro-abscesses yielded Prevotella bivia as the causative agent. This complication has not been described before in the context of renal transplantation. The pathogenesis and management of this serious complication are discussed in this paper.

7 CFR 29.3533 - Nested.

Code of Federal Regulations, 2013 CFR

2013-01-01

... INSPECTION Standards Official Standard Grades for Dark Air-Cured Tobacco (u.s. Types 35, 36, 37 and Foreign... arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes: (a) Any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior...

7 CFR 29.3533 - Nested.

Code of Federal Regulations, 2012 CFR

2012-01-01

... INSPECTION Standards Official Standard Grades for Dark Air-Cured Tobacco (u.s. Types 35, 36, 37 and Foreign... arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes: (a) Any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior...

7 CFR 29.3533 - Nested.

Code of Federal Regulations, 2011 CFR

2011-01-01

... INSPECTION Standards Official Standard Grades for Dark Air-Cured Tobacco (u.s. Types 35, 36, 37 and Foreign... arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes: (a) Any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior...

7 CFR 29.3533 - Nested.

Code of Federal Regulations, 2014 CFR

2014-01-01

... INSPECTION Standards Official Standard Grades for Dark Air-Cured Tobacco (u.s. Types 35, 36, 37 and Foreign... arranged to conceal foreign matter or tobacco of inferior grade, quality, or condition. Nested includes: (a) Any lot of tobacco which contains foreign matter or damaged, injured, tangled, or other inferior...

Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication

PubMed Central

2017-01-01

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery. PMID:29349355

ULTRASOUND MEASUREMENTS AND OBJECTIVE FORCES OF GLENOHUMERAL TRANSLATIONS DURING SHOULDER ACCESSORY PASSIVE MOTION TESTING IN HEALTHY INDIVIDUALS

PubMed Central

Worst, Haley; Decarreau, Ryan; Davies, George

2016-01-01

Background Clinical examination of caspuloligamentous structures of the glenohumeral joint has historically been subjective in nature, as demonstrated by limited intra-rater and inter-rater reproducibility. Musculoskeletal diagnostic ultrasound was utilized to develop a clinically objective measurement technique for glenohumeral inferior and posterolateral translation. Purpose The purpose of this study was to measure the accessory passive force required to achieve end range glenohumeral posterolateral and inferior accessory translation, as well as, to quantify the amount of translation of the glenohumeral joint caused by the applied force. Study Design Cross-sectional descriptive correlational study Methods Twenty-five asymptomatic subjects between the ages of 18 and 30 were recruited via convenience sampling. Posterolateral and inferior shoulder accessory passive translation was assessed and measured using a GE LOGIQe ultrasound, while concurrently using a hand held dynamometer to quantify the passive force applied during assessment. Normative values for force and translation were described as means and standard deviations. Results Mean values for posterolateral translation were 6.5 +/− 4.0 mm on the right shoulder and 6.3 +/− 3.5 mm on the left with an associated mean force of 127.1 +/− 55.6 N and 114.4 +/− 50.7 N, respectively. Mean values for inferior translation were 4.8 +/− 1.7 mm on the right shoulder and 5.4 +/− 1.8 mm on the left with an associated mean force of 84.5 +/− 30.5 N and 76.1 +/− 30.1 N, respectively. There was a significant association between inferior translation and inferior force (r = .51). No significant association was found between posterolateral translation and posterolateral force. Significant differences were found between dominant and non-dominant shoulders for posterolateral translation, posterolateral force to produce translation, and inferior translation values. Conclusions Force data in the posterolateral and inferior direction is consistent with previously reported data for passive accessory motion testing at the shoulder. The results of this study provide data for glenohumeral translations and actual forces applied. Musculoskeletal diagnostic ultrasound can be a clinically relevant way to objectively measure the translation of the glenohumeral joint for assessing accessory passive motion joint translation while performing mobilizations or passive structure testing. This study provides a basis for comparison for healthy shoulder joints. Level of Evidence 2b PMID:27757287

Strength of Temporal White Matter Pathways Predicts Semantic Learning.

PubMed

Ripollés, Pablo; Biel, Davina; Peñaloza, Claudia; Kaufmann, Jörn; Marco-Pallarés, Josep; Noesselt, Toemme; Rodríguez-Fornells, Antoni

2017-11-15

Learning the associations between words and meanings is a fundamental human ability. Although the language network is cortically well defined, the role of the white matter pathways supporting novel word-to-meaning mappings remains unclear. Here, by using contextual and cross-situational word learning, we tested whether learning the meaning of a new word is related to the integrity of the language-related white matter pathways in 40 adults (18 women). The arcuate, uncinate, inferior-fronto-occipital and inferior-longitudinal fasciculi were virtually dissected using manual and automatic deterministic fiber tracking. Critically, the automatic method allowed assessing the white matter microstructure along the tract. Results demonstrate that the microstructural properties of the left inferior-longitudinal fasciculus predict contextual learning, whereas the left uncinate was associated with cross-situational learning. In addition, we identified regions of special importance within these pathways: the posterior middle temporal gyrus, thought to serve as a lexical interface and specifically related to contextual learning; the anterior temporal lobe, known to be an amodal hub for semantic processing and related to cross-situational learning; and the white matter near the hippocampus, a structure fundamental for the initial stages of new-word learning and, remarkably, related to both types of word learning. No significant associations were found for the inferior-fronto-occipital fasciculus or the arcuate. While previous results suggest that learning new phonological word forms is mediated by the arcuate fasciculus, these findings show that the temporal pathways are the crucial neural substrate supporting one of the most striking human abilities: our capacity to identify correct associations between words and meanings under referential indeterminacy. SIGNIFICANCE STATEMENT The language-processing network is cortically (i.e., gray matter) well defined. However, the role of the white matter pathways that support novel word learning within this network remains unclear. In this work, we dissected language-related (arcuate, uncinate, inferior-fronto-occipital, and inferior-longitudinal) fasciculi using manual and automatic tracking. We found the left inferior-longitudinal fasciculus to be predictive of word-learning success in two word-to-meaning tasks: contextual and cross-situational learning paradigms. The left uncinate was predictive of cross-situational word learning. No significant correlations were found for the arcuate or the inferior-fronto-occipital fasciculus. While previous results showed that learning new phonological word forms is supported by the arcuate fasciculus, these findings demonstrate that learning new word-to-meaning associations is mainly dependent on temporal white matter pathways. Copyright © 2017 the authors 0270-6474/17/3711102-13$15.00/0.

Magnetic resonance imaging evaluation of adjacent segments after cervical disc arthroplasty: magnet strength and its effect on image quality. Clinical article.

PubMed

Antosh, Ivan J; DeVine, John G; Carpenter, Clyde T; Woebkenberg, Brian J; Yoest, Stephen M

2010-12-01

Disc arthroplasty is an alternative to fusion following anterior discectomy when treating either cervical radiculopathy or myelopathy. Its theoretical benefits include preservation of the motion segment and the potential prevention of adjacent-segment degeneration. There is a paucity of data regarding the ability to use MR imaging to evaluate the adjacent segments. The purpose of this study was for the authors to introduce open MR imaging as an alternative method in imaging adjacent segments following cervical disc arthroplasty using a Co-Cr implant and to report their preliminary results using this technique. Postoperative cervical MR images were obtained in the first 16 patients in whom the porous coated motion (PCM-V) cervical arthroplasty system was used to treat a single level between C-3 and C-7. Imaging was performed in all 16 patients with a closed 1.5-T unit, and in the final 6 patients it was also performed with an open 0.2-T unit. All images were evaluated by an independent radiologist observer for the ability to visualize the superior endplate, disc space, and inferior endplate at the superior and inferior adjacent levels. Utilizing the 1.5-T magnet to assess the superior adjacent level, the superior endplate, disc space, and inferior endplate could each be visualized less than 50% of the time on sagittal T1- and sagittal and axial T2-weighted images. Similarly, the inferior adjacent level structures were adequately visualized less than 50% of the time, with the exception of slightly improved visualization of the inferior endplate on T1-weighted images (56%). Axial images allowed worse visualization than sagittal images at both the superior and inferior adjacent levels. Utilizing the 0.2-T magnet to assess the superior and inferior adjacent levels, the superior endplate, disc space, and inferior endplate were adequately visualized in 100% of images. Based on the results of this case series, it appears that the strength of the magnet affects the artifact from the Co-Cr endplates. The open 0.2-T MR imaging unit reduces artifact at adjacent levels after cervical disc arthroplasty without a significant reduction in the image quality. Magnetic resonance imaging can be used to evaluate the adjacent segments after disc arthroplasty if magnet strength is addressed, providing another means to assess the long-term efficacy of this novel treatment.

Safety and Tolerance Evaluation of Milk Fat Globule Membrane-Enriched Infant Formulas: A Randomized Controlled Multicenter Non-Inferiority Trial in Healthy Term Infants

PubMed Central

Billeaud, Claude; Puccio, Giuseppe; Saliba, Elie; Guillois, Bernard; Vaysse, Carole; Pecquet, Sophie; Steenhout, Philippe

2014-01-01

OBJECTIVE This multicenter non-inferiority study evaluated the safety of infant formulas enriched with bovine milk fat globule membrane (MFGM) fractions. METHODS Healthy, full-term infants (n = 119) age ≤14 days were randomized to standard infant formula (control), standard formula enriched with a lipid-rich MFGM fraction (MFGM-L), or standard formula enriched with a protein-rich MFGM fraction (MFGM-P). Primary outcome was mean weight gain per day from enrollment to age 4 months (non-inferiority margin: −3.0 g/day). Secondary (length, head circumference, tolerability, morbidity, adverse events) and exploratory (phospholipids, metabolic markers, immune markers) outcomes were also evaluated. RESULTS Weight gain was non-inferior in the MFGM-L and MFGM-P groups compared with the control group. Among secondary and exploratory outcomes, few between-group differences were observed. Formula tolerance rates were high (>94%) in all groups. Adverse event and morbidity rates were similar across groups except for a higher rate of eczema in the MFGM-P group (13.9% vs control [3.5%], MFGM-L [1.4%]). CONCLUSION Both MFGM-enriched formulas met the primary safety endpoint of non-inferiority in weight gain and were generally well tolerated, although a higher rate of eczema was observed in the MFGM-P group. PMID:25452707

Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial.

PubMed

Aggarwal, Vivek; Singla, Mamta; Kabi, Debipada

2010-03-01

Anesthetic efficacy of inferior alveolar nerve block decreases in patients with irreversible pulpitis. It was hypothesized that premedication with nonsteroidal anti-inflammatory drugs might improve the success rates in patients with inflamed pulps. Sixty-nine adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. The patients were divided into 3 groups on a random basis and were randomly given 1 of the 3 drugs including ibuprofen, ketorolac, and placebo 1 hour before anesthesia. All patients received standard inferior alveolar nerve block of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of initial inferior alveolar nerve block. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as none or mild pain. Statistical analysis with nonparametric chi2 tests showed that placebo gave 29% success rate. Premedication with ibuprofen gave 27%, and premedication with ketorolac gave 39% success rate. There was no significant difference between the 3 groups. Preoperative administration of ibuprofen or ketorolac has no significant effect on success rate of inferior alveolar nerve block in patients with irreversible pulpitis. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

PubMed

Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis.

PubMed

Hamerschmidt, Rodrigo; Hamerschmidt, Rogério; Moreira, Ana Tereza Ramos; Tenório, Sérgio Bernardo; Timi, Jorge Rufno Ribas

2016-01-01

Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

The extent of inferior displacement of the mastoid tegmen is related to the severity of congenital aural atresia.

PubMed

Ju, Young-Ho; Park, Euyhyun; Park, Sangheon; Jung, Kwangjin; Lee, Kijeong; Im, Gi Jung

2014-03-01

The extent of inferior displacement of the mastoid tegmen is related to the severity of congenital aural atresia (CAA). To analyze anatomic variations observed on high-resolution temporal bone computed tomography (TBCT) in patients with CAA, the extent of inferior displacement of the mastoid tegmen and the size of the incudo-stapedial (IS) joint angle were compared with surgical parameters for atresiaplasty, such as Jahrsdoerfer score and hearing acuity. Sixty-one patients with unilateral CAA underwent high-resolution TBCT and hearing tests. We evaluated TBCTs in terms of Jahrsdoerfer criteria and analyzed the relationships among the inferior displacement of the mastoid tegmen, size of the IS joint angle, hearing acuity, and the Jahrsdoerfer score on the atretic side. IS joint angle on the atretic side was found to be 120.6 ± 11°, which was significantly greater than the corresponding value of 103.4 ± 5.4° on the normal side. Cholesteatoma occurred significantly more often in CAA patients with narrow external auditory canals (EACs) (9/27; 33.3%), compared with CAA patients with no EAC opening (2/34; 5.9%). There was a significant relation between the extent of inferior displacement of the mastoid tegmen (28.9% in the atretic side and 17.3% in the normal side) and the Jahrsdoerfer score (p < 0.0001).

A periodic network of neurochemical modules in the inferior colliculus.

PubMed

Chernock, Michelle L; Larue, David T; Winer, Jeffery A

2004-02-01

A new organization has been found in shell nuclei of rat inferior colliculus. Chemically specific modules with a periodic distribution fill about half of layer 2 of external cortex and dorsal cortex. Modules contain clusters of small glutamic acid decarboxylase-positive neurons and large boutons at higher density than in other inferior colliculus subdivisions. The modules are also present in tissue stained for parvalbumin, cytochrome oxidase, nicotinamide adenine dinucleotide phosphate-diaphorase, and acetylcholinesterase. Six to seven bilaterally symmetrical modules extend from the caudal extremity of the external cortex of the inferior colliculus to its rostral pole. Modules are from approximately 800 to 2200 microm long and have areas between 5000 and 40,000 microm2. Modules alternate with immunonegative regions. Similar modules are found in inbred and outbred strains of rat, and in both males and females. They are absent in mouse, squirrel, cat, bat, macaque monkey, and barn owl. Modules are immunonegative for glycine, calbindin, serotonin, and choline acetyltransferase. The auditory cortex and ipsi- and contralateral inferior colliculi project to the external cortex. Somatic sensory influences from the dorsal column nuclei and spinal trigeminal nucleus are the primary ascending sensory input to the external cortex; ascending auditory input to layer 2 is sparse. If the immunopositive modular neurons receive this input, the external cortex could participate in spatial orientation and somatic motor control through its intrinsic and extrinsic projections.

'Bone map' for a safe placement of miniscrews generated by computed tomography.

PubMed

Hernández, L C; Montoto, G; Puente Rodríguez, M; Galbán, L; Martínez, V

2008-06-01

The aim of this manuscript is to provide a bone map that can be used as a general guide to determine the areas where miniscrews can be safely anchored. Twenty-one computed tomographies (CTs) of maxilla and mandible were taken by the imaging centre ORTOSCAN and two measures were taken: --first, the interradicular space in the mesiodistal plane of the maxillary and mandible teeth with slices taken at 3, 6, and 9 mm from the alveolar crest, in the palatine and vestibular slices, --second, the interradicular space in the vestibular-lingual direction. We can see that the greatest amount of mesiodistal bone is between the first and second inferior molars on the vestibular side and between the second and first inferior molars on the lingual side, whereas the least amount of bone on the mesiodistal plane is between the inferior incisors on the vestibular side. To determine the length of the miniscrew, we must take into account that the greatest amount of vestibular-lingual bone is between the first and second inferior molar, whereas the least amount is between the central and lateral inferior incisors. Mesiodistal values in vestibular are those that must be considered when inserting the microscrew so as not to damage the dental tissue. Mesiodistal measurements taken in palatal-lingual do not present problems when inserting microscrews.

Factors associated with developing a fear of falling in subjects with primary open-angle glaucoma.

PubMed

Adachi, Sayaka; Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

2018-02-13

To investigate the relationship between clinical risk factors, including visual field (VF) defects and visual acuity, and a fear of falling, among patients with primary open-angle glaucoma (POAG). All participants answered the following question at a baseline ophthalmic examination: Are you afraid of falling? The same question was then answered every 12 months for 3 years. A binocular integrated visual field was calculated by merging a patient's monocular Humphrey field analyzer VFs, using the 'best sensitivity' method. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral VFs were calculated. The relationship between these mean VF measurements, and various clinical factors, against patients' baseline fear of falling and future fear of falling was analyzed using multiple logistic regression. Among 392 POAG subjects, 342 patients (87.2%) responded to the fear of falling question at least twice in the 3 years study period. The optimal regression model for patients' baseline fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. The optimal regression equation for future fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. Defects in the inferior peripheral VF area are significantly related to the development of a fear of falling.

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

PubMed Central

Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note

PubMed Central

2017-01-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics. PMID:28879340

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note.

PubMed

Won, Yu-Jin; Kang, Sang-Hoon

2017-06-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics.

Inferior Colliculus Lesions Impair Eyeblink Conditioning in Rats

ERIC Educational Resources Information Center

Freeman, John H.; Halverson, Hunter E.; Hubbard, Erin M.

2007-01-01

The neural plasticity necessary for acquisition and retention of eyeblink conditioning has been localized to the cerebellum. However, the sources of sensory input to the cerebellum that are necessary for establishing learning-related plasticity have not been identified completely. The inferior colliculus may be a source of sensory input to the…

A Materialist Theory of Women's Status.

ERIC Educational Resources Information Center

Flax, Jane

The paper examines three factors--reproduction, production, and psychodynamics--which contribute to maintaining an inferior image of women in a capitalistic society. It also offers suggestions for changing these social structures so that they will not relegate women to inferior social status. In a capitalistic society production is based on…

Unidentified retained inferior vena cava myxoma detected by intra-operative trans-oesophageal echocardiography.

PubMed

Vohra, H A; Phillips, N J; Nel, L; Diprose, P; Ohri, S K

2010-06-01

We report a unilateral right atrial familial myxoma with a multicentric nature discovered during cardiac surgery. After the patient was weaned off cardiopulmonary bypass, an inferior vena cava myxoma was discovered with intra-operative trans-oesophageal echocardiogram (TOE) which had been missed preoperatively and during surgery.

Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

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

Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br; Santos, Aline Cristine Barbosa; Tannuri, Uenis

We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge ofmore » the stent.« less

Predicting Growth in Word Level Reading Skills in Children With Developmental Dyslexia Using an Object Rhyming Functional Neuroimaging Task.

PubMed

Farris, Emily A; Ring, Jeremiah; Black, Jeffrey; Lyon, G Reid; Odegard, Timothy N

2016-04-01

An object rhyming task that does not require text reading and is suitable for younger children was used to predict gains in word level reading skills following an intensive 2-year reading intervention for children with developmental dyslexia. The task evoked activation in bilateral inferior frontal regions. Growth in untimed pseudoword reading was associated with increased pre-intervention activation of the left inferior frontal gyrus, and growth in timed word reading was associated with pre-intervention activation of the left and right inferior frontal gyri. These analyses help identify pre-intervention factors that facilitate reading skill improvements in children with developmental dyslexia.

Four impacted fourth molars in a young patient: a case report

PubMed Central

CLEMENTINI, M.; OTTRIA, L.; PANDOLFI, C.; AGRESTINI, C.; BARLATTANI, A.

2013-01-01

Summary The occurrence of supernumerary teeth is a relatively uncommon dental anomaly and it’s rare for patients to have impacted fourth molars in all quadrant. Aim of this work is to describe the presence of bilateral fourth molars in the maxilla and the mandible in a young male patient aged 22 years came to our hospital with acute pericoronal infection around unerupted third inferior molars. Routine radiographic examination revealed impacted inferior third molars but also unerupted bilateral upper and inferior fourth molars. The acute infection was treated by local measures and the patient was subsequently admitted for removal of third and fourth impacted upper and lower molars under general anesthesia. PMID:23741604

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

PubMed

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

2018-01-01

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

75 FR 9228 - Draft Guidance for Industry on Non-Inferiority Clinical Trials; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... guidance provides sponsors and review staff in the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) with the agency's interpretation of the underlying principles involved in the use of non-inferiority (NI) study designs to provide evidence of the effectiveness...

Abnormal connection of the inferior vena cava to the left atrium with double outlet right ventricle and heterotaxia: a case report.

PubMed

Günal, N; Bilgiç, A; Lenk, M K; Yurdakul, Y; Sarigül, A; Ispir, S

1996-03-01

A 4-year-old boy with abnormal connection of the inferior vena cava to the left atrium and double outlet right ventricle and right atrial isomerism is presented. The anomalies were detected by echocardiography and angiography, and later verified through surgical intervention.

Inferior Frontal Sensitivity to Common Speech Sounds Is Amplified by Increasing Word Intelligibility

ERIC Educational Resources Information Center

Vaden, Kenneth I., Jr.; Kuchinsky, Stefanie E.; Keren, Noam I.; Harris, Kelly C.; Ahlstrom, Jayne B.; Dubno, Judy R.; Eckert, Mark A.

2011-01-01

The left inferior frontal gyrus (LIFG) exhibits increased responsiveness when people listen to words composed of speech sounds that frequently co-occur in the English language (Vaden, Piquado, & Hickok, 2011), termed high phonotactic frequency (Vitevitch & Luce, 1998). The current experiment aimed to further characterize the relation of…

The Underrepresentation of African American Female Students in STEM Fields: Implications for Classroom Teachers

ERIC Educational Resources Information Center

Farinde, Abiola A.; Lewis, Chance W.

2012-01-01

African American women are underrepresented in STEM (science, technology, engineering and math) fields (Catsambis, 1994). The socialization and "under-education" of African American female students engenders ideas of inferiority, while the presence of an inferior race, sex and class, in one body, may produce an ideology of mediocrity.…

The Premise of Black Inferiority: An Enduring Obstacle Fifty Years Post-"Brown"

ERIC Educational Resources Information Center

O'Connor, Carla

2006-01-01

Gloria Ladson-Billings explains in her chapter that, in part, the promise of "Brown v. Board of Education" has not been realized because it was premised on black inferiority. She elaborates that "instead of addressing the underlying pathology of the defendant--White supremacy"--the evidence, case, and accordant ruling…

Scimitar sign with normal pulmonary venous drainage and anomalous inferior vena cava.

PubMed Central

Herer, B; Jaubert, F; Delaisements, C; Huchon, G; Chretien, J

1988-01-01

A case of the scimitar sign due to an anomaly of the right sided pulmonary vein with normal drainage into the left atrium was associated with an azygos continuation of the inferior vena cava. Digital subtraction angiography allows the identification of these rare congenital vascular malformations. Images PMID:3175980

Inferior Vena Cava Filters: Current and Future Concepts.

PubMed

Kaufman, John Andrew

2018-01-01

The inferior vena cava filter clinical environment is notable for the degree of controversy, uncertainty, and fear associated with these devices by both physicians and the public. This article reviews some of the more important current issues with these devices as well as emerging and future trends. Copyright © 2017 Elsevier Inc. All rights reserved.

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

PubMed Central

2016-01-01

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar. PMID:26877992

[Parietal Cortices and Body Information].

PubMed

Naito, Eiichi; Amemiya, Kaoru; Morita, Tomoyo

2016-11-01

Proprioceptive signals originating from skeletal muscles and joints contribute to the formation of both the human body schema and the body image. In this chapter, we introduce various types of bodily illusions that are elicited by proprioceptive inputs, and we discuss distinct functions implemented by different parietal cortices. First, we illustrate the primary importance of the motor network in the processing of proprioceptive (kinesthetic) signals originating from muscle spindles. Next, we argue that the right inferior parietal cortex, in concert with the inferior frontal cortex (both regions connected by the inferior branch of the superior longitudinal fasciculus-SLF III), may be involved in the conscious experience of body image. Further, we hypothesize other functions of distinct parietal regions: the association between internal hand motor representation with external object representation in the left inferior parietal cortex, visuo-kinesthetic processing in the bilateral posterior parietal cortices, and the integration of somatic signals from different body parts in the higher-order somatosensory parietal cortices. Our results indicate that a distinct parietal region, in concert with its anatomically and functionally connected frontal regions, probably plays specialized roles in the processing of body-related information.

Resection of giant right atrial lymphoma using vacuum-assisted cardiopulmonary bypass without snaring the inferior vena cava.

PubMed

Shin, Hankei; Mori, Mitsuharu; Matayoshi, Toru; Suzuki, Ryo; Yozu, Ryohei

2004-08-01

A 53-year-old man sustained hemodynamic collapse due to a huge right atrial tumor and was transferred to our hospital and underwent a life-saving emergency operation. The tumor arose from the inferolateral wall of the right atrium, occupying almost the whole right atrial cavity and obstructing not only the inflow of the right ventricle but also the orifice of the inferior vena cava. Venous cannulation via the right atrial wall and placing a snare around the inferior vena cava were impossible. With a cardiopulmonary bypass using vacuum-assisted venous drainage, the tumor was successfully resected and the tricuspid valve was replaced with a bioprosthetic valve without snaring the inferior vena cava. Postoperative histological examination demonstrated the tumor to be a large B-cell non-Hodgkin type malignant lymphoma. When the tumor is large and it is difficult to establish total cardiopulmonary bypass, the vacuum-assisted cardiopulmonary bypass is a useful option. This can achieve a bloodless operative field and is not blocked by the incoming air, due to the venous drainage being continually pressure-regulated.

Comparable cortical activation with inferior performance in women during a novel cognitive inhibition task.

PubMed

Halari, R; Kumari, V

2005-03-07

Men are hypothesised to perform better than women at tasks requiring cognitive inhibition. The present study applied whole-brain functional magnetic resonance imaging to investigate the neural correlates of cognitive inhibition using a novel task, requiring detection of numbers decreasing in numerical order, in relation to sex. The study involved 19 young healthy subjects (9 men, 10 women). Behavioural sex differences favouring men were found on the inhibition, but not on the automatization (i.e. detection of numbers increasing in numerical order), condition of the task. Significant areas of activation associated with cognitive inhibition included the right inferior prefrontal and bilateral dorsolateral prefrontal cortices, left inferior and superior parietal lobes, and bilateral temporal regions across men and women. No brain region was significantly differently activated in men and women. Our findings demonstrate that (a) cognitive inhibition is dependent on intact processes within frontal and parietal regions, and (b) women show inferior cognitive inhibition despite of comparable activation to men in relevant regions. Equated behavioural performance may elicit sex differences in brain activation.

Iatrogenic Diversion of Inferior Vena Cava into Left Atrium after Surgery for a Rare Combination of Congenital Heart Diseases

PubMed Central

Sabzi, Feridoun

2016-01-01

Atrial septal defect (ASD) is a common congenital anomaly that has low surgical mortality and morbidity. We report a very rare case of a low-lying ASD, combined with the drainage of the inferior vena cava and the left superior vena cava into the left atrium. This combination was associated with an unroofed coronary sinus. We also describe an iatrogenic surgical diversion of the inferior vena cava into the left atrium with its complication. The patient presented with moderate cyanosis and was referred for elective ASD repair. He underwent surgical repair of the ASD after transthoracic echocardiography. Early postoperative right-to-left shunting with cyanosis and hypoxia was associated with abdominal complications. Surgical re-exploration revealed the diversion of the inferior vena cava into the left atrium, which was repaired with a pericardial patch. Peptic ulcer perforation was repaired after abdominal laparotomy. The patient had an uneventful recovery and was discharged home on the 17th postoperative day. One-year follow-up revealed no recurrence of cyanosis or residual ASD on echocardiography. PMID:27928261

Physiologic bases for anterior ST segment depression in patients with acute inferior wall myocardial infarction.

PubMed

Mirvis, D M

1988-11-01

Patients with acute inferior myocardial infarction commonly have ST segment depression in the anterior precordial leads. This may reflect either reciprocal changes from the inferior ST elevation or primary ST depression from additional anterior subendocardial ischemia. From a biophysical perspective reciprocal changes should be uniformly anticipated from basic dipole theory. Detection will vary with the size, location, orientation, and electrical intensity of the lesion and with the ECG lead system deployed to register the anterior changes. Alternatively, acute occlusion of the right coronary artery may produce ischemia in the anterior left ventricular wall supplied by a stenotic anterior descending coronary artery. Anterior ischemia may result from the abnormal hemodynamics or the reduced collateral flow produced by acute right coronary artery occlusion. Thus both mechanisms are based on sound physiologic principles. A review of the clinical literature suggests that such patients represent a heterogeneous group. In some instances coexistent anterior ischemia is present, whereas in others the anterior ST depression is the passive reflection of inferior ST elevation augmented in many cases by a large infarct size or more extensive posterobasal or septal involvement.

[Surgical treatment of inferior pole comminuted fractures of patella with new type tension band].

PubMed

Sun, B; Zhang, Z S; Zhou, F; Tian, Y; Ji, H Q; Guo, Y; Lv, Y; Yang, Z W

2015-04-18

To study the effectiveness of inferior pole fracture of patella treating by the new tension band. From Dec. 2011 to Dec. 2013, 21 patients with inferior pole fracture of patella were treated with the new tension band which consisted of cannulated screw, titanium cable and shims. There were 21 patients[10 males, 11 females, the average age was 54 years(21 to 79)],of whom,all were "fell on knees". The average operation time was 89 min (57-197 min),the follow-up visits were done from 7-31 months (average 18 months), the bone healing time was from 8-12 weeks (average 10.5 weeks). The post operation assessment was done by Bostman score, from 20-30 (average 27),10 excellent,and 11 good. No complication occurred. The new tension band is the effective treatment for inferior pole fracture of patella. The internal fixation is reliable, it is simple to operate, and patients can take exercises as early as possible. Therefore, the new tension band has a better clinical value.

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

PubMed

Claffey, Elizabeth; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2004-08-01

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Evening hyperphagia and food motivation: a preliminary study of neural mechanisms.

PubMed

Lundgren, Jennifer D; Patrician, Trisha M; Breslin, Florence J; Martin, Laura E; Donnelly, Joseph E; Savage, Cary R

2013-12-01

Evening hyperphagia (EH; consumption of ≥25% of total daily calories after the evening meal) is a circadian delay in the pattern of daily food intake and is a core criterion of night eating syndrome (Allison et al., 2010). This preliminary study examined the brain response to food cues using functional magnetic resonance imaging (fMRI) in seven obese adults with EH compared to seven obese adults without EH. When contrasting food to non-food and blurry baseline images pre-meal, groups differed in brain activation in the inferior frontal gyrus, precentral gyrus, cingulate gyrus, superior temporal gyrus and cerebellum. At post meal, groups differed in brain activation in the fusiform gyrus, inferior frontal gyrus, inferior parietal lobule and the cerebellum. Significant interactions between time (pre-meal, post-meal) and group (EH, control) when contrasting food to non-food images were also noted in the inferior frontal gyrus and the superior temporal gyrus. Further research is necessary to replicate these findings and determine if they have a mechanistic role in the development of circadian delayed eating behavior in obese adults with EH. © 2013.

[Clinical analysis of patients with lower extremity deep venous thrombosis complicated with inferior vena cava thrombus].

PubMed

Dong, Dian-ning; Wu, Xue-jun; Zhang, Shi-yi; Zhong, Zhen-yue; Jin, Xing

2013-06-04

To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences. The clinical characteristics, diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively. All of them were of proximal DVT. There were phlegmasia cerulea dolens (n = 3), pulmonary embolism (n = 3) and completely occlusion of IVC (n = 5). Clinical manifestations were severe. Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases. Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases. The effective rate of thrombolysis for fresh IVC thrombus was 100%. Among 5 cases with Cockett Syndrome, 3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein. And 17 IVCFs were retrieved successfully within 3 weeks. IVC thrombus disappeared completely in 15 cases. Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT. And CDT is recommended for symptomatic occlusive IVC thrombus.

Intraosseous repair of the inferior alveolar nerve in rats: an experimental model.

PubMed

Curtis, N J; Trickett, R I; Owen, E; Lanzetta, M

1998-08-01

A reliable method of exposure of the inferior alveolar nerve in Wistar rats has been developed, to allow intraosseous repair with two microsurgical techniques under halothane inhalational anaesthesia. The microsuturing technique involves anastomosis with 10-0 nylon sutures; a laser-weld technique uses an albumin-based solder containing indocyanine green, plus an infrared (810 nm wavelength) diode laser Seven animals had left inferior alveolar nerve repairs performed with the microsuture and laser-weld techniques. Controls were provided by unoperated nerves in the repaired cases. Histochemical analysis was performed utilizing neuron counts and horseradish peroxidase tracer (HRP) uptake in the mandibular division of the trigeminal ganglion, following sacrifice and staining of frozen sections with cresyl violet and diaminobenzidene. The results of this analysis showed similar mean neuron counts and mean HRP uptake by neurons for the unoperated controls and both microsuture and laser-weld groups. This new technique of intraosseous exposure of the inferior alveolar nerve in rats is described. It allows reliable and reproducible microsurgical repairs using both microsuture and laser-weld techniques.

Inferior alveolar nerve canal and branches detected with dental cone beam computed tomography in lower third molar region.

PubMed

Yamada, Takahisa; Ishihama, Kohji; Yasuda, Kouichi; Hasumi-Nakayama, Yoko; Ito, Kana; Yamaoka, Minoru; Furusawa, Kiyofumi

2011-05-01

To evaluate the course of the inferior alveolar nerve and its branches, the detectable branches were investigated with dental cone beam computed tomography (CBCT). Patients in whom the lower third molar (M3) and inferior alveolar nerve canal showed overlapping in the initial panoramic image were included. One hundred twelve impacted lower M3s were extracted after examination with dental CBCT. The detection ratio, the course of the branches, and their relation with the M3 were retrospectively investigated. One hundred fifty-five branches were observed in 106 cases (94.6%, 106/112) around the M3. Most branches coursed under the M3 (55.5%, 86/155), and 85 branches (54.8%, 85/155) were in contact with the M3. The inferior alveolar nerve canal and branch(es) were mostly in contact with the M3 (57.5%, 61/106). Dental CBCT can detect most tubular structures representing branches in the impacted lower M3 region. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Inferiorly based buccinator myomucosal island flap in oral and pharyngeal reconstruction. Four techniques to increase its application

PubMed Central

Rahpeyma, Amin; khajehahmadi, Saeedeh

2015-01-01

Introduction Reconstruction of oral and pharyngeal defects after pathologic resections with the same tissue is an optimal and ideal target. Islanded variety of inferiorly pedicled facial artery musculomucosal flap, in which facial artery and vein are skeletonized (referred to as inferiorly based BUMIF), is suitable for reconstruction of medium-sized mucosal defects. Presentation of cases In this article, with four cases, modifications of this flap are demonstrated in reconstruction of large intraoral and oropharyngeal defects and coverage of alveolar ridge in the mandible. Discussion In some situations, there is a need for more mucosal paddle, longer vascular pedicle and more adaptation to the recipient bed. Conclusion Relocating Stensen’s duct increases the mucosal paddle with cranial extension of superior limit while differential incision of the mucosa and buccinator muscle in mandibular vestibule extend the lower limit of this flap. Bone suture is a good complementary technique when this flap is used for coverage of mandibular alveolar ridge. Inferiorly based BUMIF with added length is indicated for oropharyngeal and contralateral mouth floor reconstructions. PMID:26218177

Creativity and the default network: A functional connectivity analysis of the creative brain at rest☆

PubMed Central

Beaty, Roger E.; Benedek, Mathias; Wilkins, Robin W.; Jauk, Emanuel; Fink, Andreas; Silvia, Paul J.; Hodges, Donald A.; Koschutnig, Karl; Neubauer, Aljoscha C.

2014-01-01

The present research used resting-state functional magnetic resonance imaging (fMRI) to examine whether the ability to generate creative ideas corresponds to differences in the intrinsic organization of functional networks in the brain. We examined the functional connectivity between regions commonly implicated in neuroimaging studies of divergent thinking, including the inferior prefrontal cortex and the core hubs of the default network. Participants were prescreened on a battery of divergent thinking tests and assigned to high- and low-creative groups based on task performance. Seed-based functional connectivity analysis revealed greater connectivity between the left inferior frontal gyrus (IFG) and the entire default mode network in the high-creative group. The right IFG also showed greater functional connectivity with bilateral inferior parietal cortex and the left dorsolateral prefrontal cortex in the high-creative group. The results suggest that the ability to generate creative ideas is characterized by increased functional connectivity between the inferior prefrontal cortex and the default network, pointing to a greater cooperation between brain regions associated with cognitive control and low-level imaginative processes. PMID:25245940

A contemporary view of atrioventricular nodal physiology.

PubMed

Markowitz, Steven M; Lerman, Bruce B

2018-06-16

In delaying transmission of the cardiac impulse from the atria to the ventricles, the atrioventricular (AV) node serves a critical function in augmenting ventricular filling during diastole and limiting the ventricular response during atrial tachyarrhythmias. The complex structure of the nodal region, however, also provides the substrate for reentrant rhythms. Recent discoveries have elucidated the cellular basis and anatomical determinants of slow conduction in the node. Based on analysis of gap junction proteins, distinct structural components of the AV node have been defined, including the compact node, right and left inferior nodal extensions, the lower nodal bundle, and transitional tissue. Emerging evidence supports the role of the inferior nodal extensions in mediating slow pathway conduction. The most common form of reentry involving the node, slow-fast AV nodal reentrant tachycardia (AVNRT), utilizes the inferior nodal extensions for anterograde slow pathway conduction; the structures responsible for retrograde fast pathway activation in the superior septum are less well defined and likely heterogeneous. Atypical forms of AVNRT arise from circuits that activate at least one of the inferior extensions in the retrograde direction.

Liver hanging maneuver for right hemiliver in situ donation--anatomical considerations.

PubMed

Trotovsek, B; Gadzijev, E M; Ravnik, D; Hribernik, M

2006-01-01

An anatomical study was carried out to evaluate the safety of the liver hanging maneuver for the right hemiliver in living donor and in situ splitting transplantation. During this procedure a 4-6 cm blind dissection is performed between the inferior vena cava and the liver. Short subhepatic veins entering the inferior vena cava from segments 1 and 9 could be torn with consequent hemorrhage. One hundred corrosive casts of livers were evaluated to establish the position and diameter of short subhepatic veins and the inferior right hepatic vein. The average distance from the right border of the inferior vena cava to the opening of segment 1 veins was 16.7+/-3.4 mm and to the entrance of segment 9 veins was 5.0+/-0.5 mm. The width of the narrowest point on the route of blind dissection was determined, with the average value being 8.7+/-2.3 mm (range 2-15 mm). The results show that the liver hanging maneuver is a safe procedure. A proposed route of dissection minimizes the risk of disrupting short subhepatic veins (7%).

Does the reduction of inferior turbinate affect lower airway functions?

PubMed

Unsal, Ozlem; Ozkahraman, Mehtap; Ozkarafakili, Mufide Arzu; Akpinar, Meltem; Korkut, Arzu Yasemin; Kurt Dizdar, Senem; Uslu Coskun, Berna

2017-11-06

Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Compensatory brain activation in children with attention deficit/hyperactivity disorder during a simplified Go/No-go task.

PubMed

Ma, Jun; Lei, Du; Jin, Xingming; Du, Xiaoxia; Jiang, Fan; Li, Fei; Zhang, Yiwen; Shen, Xiaoming

2012-05-01

Given that a number of recent studies have shown attenuated brain activation in prefrontal regions in children with ADHD, it has been recognized as a disorder in executive function. However, fewer studies have focused exclusively on the compensatory brain activation in ADHD. The present study objective was to investigate the compensatory brain activation patterns during response inhibition (RI) processing in ADHD children. In this study, 15 ADHD children and 15 sex-, age-, and IQ-matched control children were scanned with a 3-T MRI equipment while performing a simplified letter Go/No-go task. The results showed more brain activation in the ADHD group compared with the control group, whereas the accuracy and reaction time of behavioral performance were the same. Children with ADHD did not activate the normal RI brain circuits, which are thought to be predominantly located in the right middle/inferior frontal gyrus (BA46/44), right inferior parietal regions (BA40), and pre-SMA(BA6), but instead, activated brain regions, such as the left inferior frontal cortex, the right inferior temporal cortex, the right precentral gyrus, the left postcentral gyrus, the inferior occipital cortex, the middle occipital cortex, the right calcarine, the right hippocampus, the right midbrain, and the cerebellum. Our conclusion is that children with ADHD tend to compensatorily use more posterior and diffusive brain regions to sustain normal RI function. © Springer-Verlag 2011

Cytoarchitectural and functional abnormalities of the inferior colliculus in sudden unexplained perinatal death.

PubMed

Lavezzi, Anna M; Pusiol, Teresa; Matturri, Luigi

2015-02-01

The inferior colliculus is a mesencephalic structure endowed with serotonergic fibers that plays an important role in the processing of acoustic information. The implication of the neuromodulator serotonin also in the aetiology of sudden unexplained fetal and infant death syndromes and the demonstration in these pathologies of developmental alterations of the superior olivary complex (SOC), a group of pontine nuclei likewise involved in hearing, prompted us to investigate whether the inferior colliculus may somehow contribute to the pathogenetic mechanism of unexplained perinatal death. Therefore, we performed in a wide set of fetuses and infants, aged from 33 gestational weeks to 7 postnatal months and died of both known and unknown cause, an in-depth anatomopathological analysis of the brainstem, particularly of the midbrain. Peculiar neuroanatomical and functional abnormalities of the inferior colliculus, such as hypoplasia/structural disarrangement and immunonegativity or poor positivity of serotonin, were exclusively found in sudden death victims, and not in controls. In addition, these alterations were frequently related to dysgenesis of connected structures, precisely the raphé nuclei and the superior olivary complex, and to nicotine absorption in pregnancy. We propose, on the basis of these results, the involvement of the inferior colliculus in more important functions than those related to hearing, as breathing and, more extensively, all the vital activities, and then in pathological conditions underlying a sudden death in vulnerable periods of the autonomic nervous system development, particularly associated to harmful risk factors as cigarette smoking.

MR imaging evaluation of inferior olivary nuclei: comparison of postoperative subjects with and without posterior fossa syndrome.

PubMed

Patay, Z; Enterkin, J; Harreld, J H; Yuan, Y; Löbel, U; Rumboldt, Z; Khan, R; Boop, F

2014-04-01

Posterior fossa syndrome is a severe postoperative complication occurring in up to 29% of children undergoing posterior fossa tumor resection; it is most likely caused by bilateral damage to the proximal efferent cerebellar pathways, whose fibers contribute to the Guillain-Mollaret triangle. When the triangle is disrupted, hypertrophic olivary degeneration develops. We hypothesized that MR imaging patterns of inferior olivary nucleus changes reflect patterns of damage to the proximal efferent cerebellar pathways and show association with clinical findings, in particular the presence or absence of posterior fossa syndrome. We performed blinded, randomized longitudinal MR imaging analyses of the inferior olivary nuclei of 12 children with and 12 without posterior fossa syndrome after surgery for midline intraventricular tumor in the posterior fossa. The Fisher exact test was performed to investigate the association between posterior fossa syndrome and hypertrophic olivary degeneration on MR imaging. The sensitivity and specificity of MR imaging findings of bilateral hypertrophic olivary degeneration for posterior fossa syndrome were measured. Of the 12 patients with posterior fossa syndrome, 9 had bilateral inferior olivary nucleus abnormalities. The 12 patients without posterior fossa syndrome had either unilateral or no inferior olivary nucleus abnormalities. The association of posterior fossa syndrome and hypertrophic olivary degeneration was statistically significant (P < .0001). Hypertrophic olivary degeneration may be a surrogate imaging indicator for damage to the contralateral proximal efferent cerebellar pathway. In the appropriate clinical setting, bilateral hypertrophic olivary degeneration may be a sensitive and specific indicator of posterior fossa syndrome.

Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

PubMed

Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

2017-01-01

The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effects of sexual reproduction of the inferior competitor Brachionus calyciflorus on its fitness against Brachionus angularis

NASA Astrophysics Data System (ADS)

Li, Chen; Niu, Cuijuan

2015-03-01

Sexual reproduction adversely affects the population growth of cyclic parthenogenetic animals. The density-dependent sexual reproduction of a superior competitor could mediate the coexistence. However, the cost of sex may make the inferior competitor more vulnerable. To investigate the effect of sexual reproduction on the inferior competitor, we experimentally paired the competition of one Brachionus angularis clone against three Brachionus calyciflorus clones. One of the B. calyciflorus clones showed a low propensity for sexual reproduction, while the other two showed high propensities. The results show that all B. calyciflorus clones were excluded in the competition for resources at low food level. The increased food level promoted the competition persistence, but the clones did not show a clear pattern. Both the cumulative population density and resting egg production increased with the food level. The cumulative population density decreased with the mixis investment, while the resting egg production increased with the mixis investment. A trade-off between the population growth and sexual reproduction was observed in this research. The results indicate that although higher mixis investment resulted in a lower population density, it would not determinately accelerate the exclusion process of the inferior competitor. On the contrary, higher mixis investment promoted resting egg production before being excluded and thus promised a long-term benefit. In conclusion, our results suggest that mixis investment, to some extent, favored the excluded inferior competitor under fierce competition or some other adverse conditions.

CaV3.1 is a tremor rhythm pacemaker in the inferior olive

PubMed Central

Park, Young-Gyun; Park, Hye-Yeon; Lee, C. Justin; Choi, Soonwook; Jo, Seonmi; Choi, Hansol; Kim, Yang-Hann; Shin, Hee-Sup; Llinas, Rodolfo R.; Kim, Daesoo

2010-01-01

The rhythmic motor pathway activation by pacemaker neurons or circuits in the brain has been proposed as the mechanism for the timing of motor coordination, and the abnormal potentiation of this mechanism may lead to a pathological tremor. Here, we show that the potentiation of CaV3.1 T-type Ca2+ channels in the inferior olive contributes to the onset of the tremor in a pharmacological model of essential tremor. After administration of harmaline, 4- to 10-Hz synchronous neuronal activities arose from the IO and then propagated to cerebellar motor circuits in wild-type mice, but those rhythmic activities were absent in mice lacking CaV3.1 gene. Intracellular recordings in brain-stem slices revealed that the CaV3.1-deficient inferior olive neurons lacked the subthreshold oscillation of membrane potentials and failed to trigger 4- to 10-Hz rhythmic burst discharges in the presence of harmaline. In addition, the selective knockdown of CaV3.1 gene in the inferior olive by shRNA efficiently suppressed the harmaline-induced tremor in wild-type mice. A mathematical model constructed based on data obtained from patch-clamping experiments indicated that harmaline could efficiently potentiate CaV3.1 channels by changing voltage-dependent responsiveness in the hyperpolarizing direction. Thus, CaV3.1 is a molecular pacemaker substrate for intrinsic neuronal oscillations of inferior olive neurons, and the potentiation of this mechanism can be considered as a pathological cause of essential tremor. PMID:20498062

Multimodality language mapping in patients with left-hemispheric language dominance on Wada test

PubMed Central

Kojima, Katsuaki; Brown, Erik C.; Rothermel, Robert; Carlson, Alanna; Matsuzaki, Naoyuki; Shah, Aashit; Atkinson, Marie; Mittal, Sandeep; Fuerst, Darren; Sood, Sandeep; Asano, Eishi

2012-01-01

Objective We determined the utility of electrocorticography (ECoG) and stimulation for detecting language-related sites in patients with left-hemispheric language-dominance on Wada test. Methods We studied 13 epileptic patients who underwent language mapping using event-related gamma-oscillations on ECoG and stimulation via subdural electrodes. Sites showing significant gamma-augmentation during an auditory-naming task were defined as language-related ECoG sites. Sites at which stimulation resulted in auditory perceptual changes, failure to verbalize a correct answer, or sensorimotor symptoms involving the mouth were defined as language-related stimulation sites. We determined how frequently these methods revealed language-related sites in the superior-temporal, inferior-frontal, dorsolateral-premotor, and inferior-Rolandic regions. Results Language-related sites in the superior-temporal and inferior-frontal gyri were detected by ECoG more frequently than stimulation (p < 0.05), while those in the dorsolateral-premotor and inferior-Rolandic regions were detected by both methods equally. Stimulation of language-related ECoG sites, compared to the others, more frequently elicited language symptoms (p < 0.00001). One patient developed dysphasia requiring in-patient speech therapy following resection of the dorsolateral-premotor and inferior-Rolandic regions containing language-related ECoG sites not otherwise detected by stimulation. Conclusions Language-related gamma-oscillations may serve as an alternative biomarker of underlying language function in patients with left-hemispheric language-dominance. Significance Measurement of language-related gamma-oscillations is warranted in presurgical evaluation of epileptic patients. PMID:22503906

Adult Wilms tumor with inferior vena cava thrombus and distal deep vein thrombosis - a case report and literature review.

PubMed

Ratajczyk, Krzysztof; Czekaj, Adrian; Rogala, Joanna; Kowal, Pawel

2018-02-23

Adult Wilms tumor (WT, nephroblastoma) is a rare, but well-described renal neoplasm. Although inferior vena cava tumor thrombosis is present in up to 10% of Wilms tumors in childhood, only few cases of this clinical manifestation in adults have been reported. To the best of our knowledge, this is the first case of adult WT infiltrating into inferior vena cava (IVC) with concomitant distal deep vein thrombosis. A 28-year-old male patient with gross hematuria and right flank pain was diagnosed with right kidney tumor penetrating to IVC. Preoperatively, acute distal thrombosis in inferior vena cava and lower extremities veins occurred. Right radical nephrectomy with tumor thrombectomy via cavotomy was performed. In order to prevent pulmonary embolism, IVC was ligated below left renal vein level. Histopathological examination revealed a triphasic nephroblastoma without anaplastic features. Postoperatively, patient was diagnosed with metastatic liver disease, which was treated with two lines of chemotherapy followed by radiotherapy with achievement of complete response. Adult WT occurs usually in young patients, under 40 years of age. Neoadjuvant chemotherapy proved to be effective in children, resulting with tumor shrinkage and venous tumor thrombus regression. Therefore, percutaneous biopsy should be always considered in young patients presenting with renal tumor invading venous system. IVC ligation is a safe treatment option in the event of complete inferior vena cava occlusion due to distal thrombosis concomitant to tumor thrombus, provided collateral venous pathways are well-developed.

Notes on testing non-inferiority under the partial verification design with a confirmatory procedure limited to screen positives.

PubMed

Lui, Kung-Jong

2012-05-01

When a new test with fewer invasions or less expenses to administer than the traditional test is developed, we may be interested in testing whether the former is non-inferior to the latter with respect to test accuracy. We define non-inferiority via both the odds ratio (OR) of correctly identifying a case and the OR of correctly identifying a non-case between two tests under comparison. We focus our discussion on testing the non-inferiority of a new screening test to a traditional screening test when a confirmatory procedure is performed only on patients with screen positives. On the basis of well-established methods for paired-sample data, we derive an asymptotic test procedure and an exact test procedure with respect to the two ORs defined here. Using Monte Carlo simulation, we evaluate the performance of these test procedures in a variety of situations. We note that the test procedures proposed here can also be applicable if we are interested in testing non-inferiority with respect to the ratio of sensitivities and the ratio of specificities. We discuss interval estimation of these ORs and sample size calculation based on the asymptotic test procedure considered here. We use the data taken from a study of the prostate-specific-antigen (PSA) test and the digital rectal examination (DRE) test to illustrate the practical use of these test procedures, interval estimators and sample size calculation formula. Copyright © 2012 Elsevier Inc. All rights reserved.

A novel method for quantifying the amount of trabecular meshwork pigment in glaucomatous and nonglaucomatous eyes.

PubMed

Kinori, Michael; Hostovsky, Avner; Skaat, Alon; Schwartsman, Jonathan; Melamed, Shlomo

2014-01-01

To assess the use of a computerized program for evaluating the amount of trabecular meshwork (TM) pigmentation in normal (control), primary open-angle glaucoma (POAG), and pseudoexfoliation glaucoma/pigmentary dispersion glaucoma (PXFG/PDG) patients. All included patients were from the Goldschleger Eye Institute glaucoma clinic. After signing an informed consent, each patient's anterior chamber angle was photographed using a single photo-slit under the same conditions. Only one eye per patient was photographed. The superior TM and the inferior TM were documented. Then, the degree of "blackness" (representing melanin pigment) was assessed using the ImageJ program. Of the 43 eyes photographed, 8 were excluded because of low-quality images. Of the remaining 35 patients, 14 were normal, 10 had POAG, and 11 had PXFG/PDG. The amount of pigment was the same in the control and the POAG patients whether the inferior TM (P=0.24), superior TM (P=0.58), or the sum inferior TM+superior TM (P=0.85) was measured. The pigment level was significantly higher in the PXFG/PDG group than in the control group (inferior TM, P<0.01; superior TM, P=0.047; sum, P<0.01). The difference between the inferior and the superior TM pigment levels was found to be statistically insignificant in all the groups (normal, P=0.86; POAG, P=0.10; PXFG/PDG, P=0.22). The use of ImageJ software might play a role in the quantification of pigment evaluation of the TM.

Cytoarchitectural and Functional Abnormalities of the Inferior Colliculus in Sudden Unexplained Perinatal Death

PubMed Central

Lavezzi, Anna M.; Pusiol, Teresa; Matturri, Luigi

2015-01-01

Abstract The inferior colliculus is a mesencephalic structure endowed with serotonergic fibers that plays an important role in the processing of acoustic information. The implication of the neuromodulator serotonin also in the aetiology of sudden unexplained fetal and infant death syndromes and the demonstration in these pathologies of developmental alterations of the superior olivary complex (SOC), a group of pontine nuclei likewise involved in hearing, prompted us to investigate whether the inferior colliculus may somehow contribute to the pathogenetic mechanism of unexplained perinatal death. Therefore, we performed in a wide set of fetuses and infants, aged from 33 gestational weeks to 7 postnatal months and died of both known and unknown cause, an in-depth anatomopathological analysis of the brainstem, particularly of the midbrain. Peculiar neuroanatomical and functional abnormalities of the inferior colliculus, such as hypoplasia/structural disarrangement and immunonegativity or poor positivity of serotonin, were exclusively found in sudden death victims, and not in controls. In addition, these alterations were frequently related to dysgenesis of connected structures, precisely the raphé nuclei and the superior olivary complex, and to nicotine absorption in pregnancy. We propose, on the basis of these results, the involvement of the inferior colliculus in more important functions than those related to hearing, as breathing and, more extensively, all the vital activities, and then in pathological conditions underlying a sudden death in vulnerable periods of the autonomic nervous system development, particularly associated to harmful risk factors as cigarette smoking. PMID:25674737

Incidence and factors related to delirium in an intensive care unit.

PubMed

Mori, Satomi; Takeda, Juliana Rumy Tsuchihashi; Carrara, Fernanda Souza Angotti; Cohrs, Cibelli Rizzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

2016-01-01

To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics. Identificar a incidência de delirium, comparar as características demográficas e clínicas dos pacientes com e sem delirium e verificar os fatores relacionados ao delirium em pacientes internados em Unidade de Terapia Intensiva (UTI). Coorte prospectiva, cuja amostra foi constituída de pacientes internados em UTI de um hospital universitário. Variáveis demográficas, clínicas e da avaliação com o Confusion Assessment Method for Intensive Care Unit para identificação de delirium foram processadas para análise univariada, e regressão logística para identificar fatores relacionados à ocorrência do delirium. Do total de 149 pacientes da amostra, 69 (46,3%) apresentaram delirium durante a internação na UTI, observando-se que a média da idade, o índice de gravidade e o tempo de permanência nas UTI foram estatisticamente maiores. Os fatores relacionados ao delirium foram: idade, midazolam, morfina e propofol. Os resultados mostraram elevada incidência de delirium na UTI e sua ocorrência associada às idades mais avançadas e o uso de sedativos e analgésicos, ressaltando-se a importância da atuação do enfermeiro na prevenção e identificação precoce do quadro nos pacientes com essas características.

Maintenance treatment for opioid dependence with slow-release oral morphine: a randomized cross-over, non-inferiority study versus methadone

PubMed Central

Beck, Thilo; Haasen, Christian; Verthein, Uwe; Walcher, Stephan; Schuler, Christoph; Backmund, Markus; Ruckes, Christian; Reimer, Jens

2014-01-01

Aims To compare the efficacy of slow-release oral morphine (SROM) and methadone as maintenance medication for opioid dependence in patients previously treated with methadone. Design Prospective, multiple-dose, open label, randomized, non-inferiority, cross-over study over two 11-week periods. Methadone treatment was switched to SROM with flexible dosing and vice versa according to period and sequence of treatment. Setting Fourteen out-patient addiction treatment centres in Switzerland and Germany. Participants Adults with opioid dependence in methadone maintenance programmes (dose ≥50 mg/day) for ≥26 weeks. Measurements The efficacy end-point was the proportion of heroin-positive urine samples per patient and period of treatment. Each week, two urine samples were collected, randomly selected and analysed for 6-monoacetyl-morphine and 6-acetylcodeine. Non-inferiority was concluded if the two-sided 95% confidence interval (CI) in the difference of proportions of positive urine samples was below the predefined boundary of 10%. Findings One hundred and fifty-seven patients fulfilled criteria to form the per protocol population. The proportion of heroin-positive urine samples under SROM treatment (0.20) was non-inferior to the proportion under methadone treatment (0.15) (least-squares mean difference 0.05; 95% CI = 0.02, 0.08; P > 0.01). The 95% CI fell within the 10% non-inferiority margin, confirming the non-inferiority of SROM to methadone. A dose-dependent effect was shown for SROM (i.e. decreasing proportions of heroin-positive urine samples with increasing SROM doses). Retention in treatment showed no significant differences between treatments (period 1/period 2: SROM: 88.7%/82.1%, methadone: 91.1%/88.0%; period 1: P = 0.50, period 2: P = 0.19). Overall, safety outcomes were similar between the two groups. Conclusions Slow-release oral morphine appears to be at least as effective as methadone in treating people with opioid use disorder. PMID:24304412

Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o'clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes.

PubMed

Imhoff, Andreas B; Ansah, Patrick; Tischer, Thomas; Reiter, Christoph; Bartl, Christoph; Hench, Maximilian; Spang, Jeffrey T; Vogt, Stephan

2010-09-01

Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization. There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization. Cohort Study; Level of evidence, 3. Between 1996 and 2000, 221 patients were treated with arthroscopic stabilization for anterior-inferior shoulder dislocation. Of these 221 consecutive patients, 190 (140 male, 50 female) with an average age of 28.0 years (range, 14.4-59.2 years) were available for follow-up (average follow-up, 37.4 +/- 15.8 months). Fixation methods were FASTak (n = 138), Suretac (n = 28), or Panalok (n = 24) anchors. Concomitant SLAP lesions were seen in 38 of 190 cases (20%). Redislocation rates varied between anchor systems (FASTak, 6.5%; Suretac, 25%; Panalok, 16.8%). Superior labral anterior posterior lesions, when treated, did not influence clinical outcomes or redislocation rate. A concomitant rotator cuff tear did not influence redislocation rate. Postoperative outcomes (Rowe score, Constant score, American Shoulder and Elbow Surgeons [ASES] shoulder index, 12-item questionnaire) in patients with a partial tear were also not altered. On the other hand, the redislocation rate correlated with patient age and number of prior dislocations. Return to sports at preinjury level was possible in 80% of cases. Arthroscopic repair of anterior-inferior instability using the 5:30-o'clock portal is dependent on anchor type and can show good to excellent results. Because of several coinjuries in anterior-inferior instability, an arthroscopic approach may be required to identify and treat such lesions.

Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to compare strategies to optimize antibiotic use.

PubMed

Schweitzer, V A; van Smeden, M; Postma, D F; Oosterheert, J J; Bonten, M J M; van Werkhoven, C H

2017-12-01

The Response Adjusted for Days of Antibiotic Risk (RADAR) statistic was proposed to improve the efficiency of trials comparing antibiotic stewardship strategies to optimize antibiotic use. We studied the behaviour of RADAR in a non-inferiority trial in which a β-lactam monotherapy strategy (n = 656) was non-inferior to fluoroquinolone monotherapy (n = 888) for patients with moderately severe community-acquired pneumonia. Patients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the β-lactam group had a more favourable ranking than the fluoroquinolone group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the β-lactam group and performed the RADAR and non-inferiority analysis. The RADAR of the β-lactam group compared with the fluoroquinolone group was 60.3% (95% CI 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favour of β-lactam. Sample sizes for RADAR were 38% (250/653) and 89% (580/653) of the non-inferiority sample size calculation, using five or eight clinical outcome categories, respectively. With simulated mortality rates, loss of non-inferiority of the β-lactam group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the β-lactam group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively. RADAR favoured β-lactam over fluoroquinolone therapy for community-acquired pneumonia. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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

Shen, S; Kim, R; Benhabib, S

Purpose: HDR brachytherapy using interstitial needle template for cervical cancer is commonly delivered in 4-5 fractions. Routine verification of needle positions before each fraction is often based on radiographic imaging of implanted fiducial markers. The current study evaluated interfractional displacement of implanted fiducial markers using CT images. Methods: 9 sequential patients with cervical interstitial needle implants were evaluated. The superior and inferior borders of the target volumes were defined by fiducial markers in planning CT. The implant position was verified with kV orthogonal images before each fraction. A second CT was acquired prior 3rd fraction (one or 2 days postmore » planning CT). Distances from inferior and superior fiducial markers to pubic symphysis plane (perpendicular to vaginal obtulator)were measured. Distance from needle tip of a reference needle (next to the inferior marker) to the pubic symphysis plane was also determined. The difference in fiducial marker distance or needle tip distance between planning CT and CT prior 3rd fraction were measured to assess markers migration and needle displacement. Results: The mean inferior marker displacement was 4.5 mm and ranged 0.9 to 11.3 mm. The mean superior marker displacement was 2.7 mm and ranged 0 to 10.4 mm. There was a good association between inferior and superior marker displacement (r=0.95). Mean averaged inferior and superior marker displacement was 3.3 mm and ranged from 0.1 to 10.9 mm, with a standard deviation of 3.2 mm. The mean needle displacement was 5.6 mm and ranged 0.2 to 15.6 mm. Needle displacements were reduced (p<0.05) after adjusting according to needle-to-fiducials distance. Conclusion: There were small fiducial marker displacements between HDR fractions. Our study suggests a target margin of 9.7 mm to cover interfractional marker displacements (in 95% cases) for pretreatment verification based on radiographic imaging.« less

Survey of Nerve Fiber Layer Thickness in Anisometropic and Strabismic Amblyopia.

PubMed

Soltani Moghaddam, Reza; Medghalchi, Abdolreza; Alizadeh, Yousef

2017-01-01

. To investigate the effect of anisometropic and strabismic amblyopia on the nerve fiber layer thickness. This cross-sectional study was done on 54 amblyopic subjects, equally in both strabismic and anisometropic groups. The thickness otonerve fiber layer measured in superior, inferior, nasal, temporal quadrants and as a whole in both eyes of both groups. The means of thickness were compared in amblyopic and sound eyes. In strabismus group, the average nerve fiber layer thickness of the sound eye , in superior, inferior, nasal and temporal quadrants and as a whole were 113.23±14, 117.37±25, 68.96±6, 69.55±14 and 93.40±8 microns respectively. In amblyopic eyes of the same group, these measurements were 103.11±18, 67.74±11, and 69.59±16 and 89.59±12 microns in superior, inferior, nasal, temporal quadrants and as whole respectively. In anisometropic groups, the sound eye measurements were as 130.96±22, 129.07±29, 80.62±12, and 83.88±20 and 107.7±13 microns in superior, inferior, nasal and temporal quadrants and as a whole orderly. In amblyopic eyes of this group the mean thicknesses were 115.63±29, 133.15±25, 78.8±15, 80.2±16 and 109.17±21 microns in superior, inferior, nasal, temporal quadrants and as a whole respectively. Statistically, there were no significant differences between amblyopic and sound eyes (P>0.5). Our study did not support any significant change in a nerve fiber layer thickness of amblyopic patients; however, decreased thickness in superior and nasal quadrants of strabismic amblyopia and except inferior quadrant and as a whole. These measurements may be a clue for management and prognosis of amblyopia in old age.

Connectional Modularity of Top-Down and Bottom-Up Multimodal Inputs to the Lateral Cortex of the Mouse Inferior Colliculus

PubMed Central

Lesicko, Alexandria M.H.; Hristova, Teodora S.; Maigler, Kathleen C.

2016-01-01

The lateral cortex of the inferior colliculus receives information from both auditory and somatosensory structures and is thought to play a role in multisensory integration. Previous studies in the rat have shown that this nucleus contains a series of distinct anatomical modules that stain for GAD-67 as well as other neurochemical markers. In the present study, we sought to better characterize these modules in the mouse inferior colliculus and determine whether the connectivity of other neural structures with the lateral cortex is spatially related to the distribution of these neurochemical modules. Staining for GAD-67 and other markers revealed a single modular network throughout the rostrocaudal extent of the mouse lateral cortex. Somatosensory inputs from the somatosensory cortex and dorsal column nuclei were found to terminate almost exclusively within these modular zones. However, projections from the auditory cortex and central nucleus of the inferior colliculus formed patches that interdigitate with the GAD-67-positive modules. These results suggest that the lateral cortex of the mouse inferior colliculus exhibits connectional as well as neurochemical modularity and may contain multiple segregated processing streams. This finding is discussed in the context of other brain structures in which neuroanatomical and connectional modularity have functional consequences. SIGNIFICANCE STATEMENT Many brain regions contain subnuclear microarchitectures, such as the matrix-striosome organization of the basal ganglia or the patch-interpatch organization of the visual cortex, that shed light on circuit complexities. In the present study, we demonstrate the presence of one such micro-organization in the rodent inferior colliculus. While this structure is typically viewed as an auditory integration center, its lateral cortex appears to be involved in multisensory operations and receives input from somatosensory brain regions. We show here that the lateral cortex can be further subdivided into multiple processing streams: modular regions, which are targeted by somatosensory inputs, and extramodular zones that receive auditory information. PMID:27798184

Cephalometrically assessing the validity of superior, middle and inferior tragus points on ala-tragus line while establishing the occlusal plane in edentulous patient

PubMed Central

Thombare, Ram

2013-01-01

PURPOSE The purpose of this study was to decide the most appropriate point on tragus to be used as a reference point at time of marking ala tragus line while establishing occlusal plane. MATERIALS AND METHODS The data was collected in two groups of subjects: 1) Dentulous 2) Edentulous group having sample size of 30 for each group with equal gender distribution (15 males, 15 females each). Downs analysis was used for base value. Lateral cephalographs were taken for all selected subjects. Three points were marked on tragus as Superior (S), Middle (M), and Inferior (I) and were joined with ala (A) of the nose to form ala-tragus lines. The angle formed by each line (SA plane, MA plane, IA plane) with Frankfort Horizontal (FH) plane was measured by using custom made device and modified protractor in all dentulous and edentulous subjects. Also, in dentulous subjects angle between Frankfort Horizontal plane and natural occlusal plane was measured. The measurements obtained were subjected to the following statistical tests; descriptive analysis, Student's unpaired t-test and Pearson's correlation coefficient. RESULTS The results demonstrated, the mean angle COO (cant of occlusal plane) as 9.76°, inferior point on tragus had given the mean angular value of IFH [Angle between IA plane (plane formed by joining inferior point-I on tragus and ala of nose- A) and FH plane) as 10.40° and 10.56° in dentulous and edentulous subjects respectively which was the closest value to the angle COO and was comparable with the values of angle COO value in Downs analysis. Angulations of ala-tragus line marked from inferior point with occlusal plane in dentulous subject had given the smallest value 2.46° which showed that this ala-tragus line was nearly parallel to occlusal plane. CONCLUSION The inferior point marked on tragus is the most appropriate point for marking ala-tragus line. PMID:23508068

The arcuate nucleus of the C57BL/6J mouse hindbrain is a displaced part of the inferior olive.

PubMed

Fu, Yu Hong; Watson, Charles

2012-01-01

The arcuate nucleus is a prominent cell group in the human hindbrain, characterized by its position on the pial surface of the pyramid. It is considered to be a precerebellar nucleus and has been implicated in the pathology of several disorders of respiration. An arcuate nucleus has not been convincingly demonstrated in other mammals, but we have found a similarly positioned nucleus in the C57BL/6J mouse. The mouse arcuate nucleus consists of a variable group of neurons lying on the pial surface of the pyramid. The nucleus is continuous with the ventrolateral part of the principal nucleus of the inferior olive and both groups are calbindin positive. At first we thought that this mouse nucleus was homologous with the human arcuate nucleus, but we have discovered that the neurons of the human nucleus are calbindin negative, and are therefore not olivary in nature. We have compared the mouse arcuate neurons with those of the inferior olive in terms of molecular markers and cerebellar projection. The neurons of the arcuate nucleus and of the inferior olive share three major characteristics: they both contain neurons utilizing glutamate, serotonin or acetylcholine as neurotransmitters; they both project to the contralateral cerebellum, and they both express a number of genes not present in the major mossy fiber issuing precerebellar nuclei. Most importantly, both cell groups express calbindin in an area of the ventral hindbrain almost completely devoid of calbindin-positive cells. We conclude that the neurons of the hindbrain mouse arcuate nucleus are a displaced part of the inferior olive, possibly separated by the caudal growth of the pyramidal tract during development. The arcuate nucleus reported in the C57BL/6J mouse can therefore be regarded as a subgroup of the rostral inferior olive, closely allied with the ventral tier of the principal nucleus. Copyright © 2012 S. Karger AG, Basel.

Intraoperative ketorolac dose of 15mg versus the standard 30mg on early postoperative pain after spine surgery: A randomized, blinded, non-inferiority trial.

PubMed

Duttchen, Kaylene M; Lo, Andy; Walker, Andrew; McLuckie, Duncan; De Guzman, Cecilia; Roman-Smith, Helen; Davis, Melinda

2017-09-01

The primary aim of this study is to show the non-inferiority of 15mg intraoperative dose of ketorolac as compared to the standard 30mg ketorolac by looking at the visual analog scale pain (VAS) scores 4h after an adult spine surgery. The study design is a prospective randomized non-inferiority clinical trial looking at non-inferiority of intraoperative 15mg ketorolac from the standard 30mg dose. Quaternary care center. 50 adult (18-65years of age) undergoing lumbar decompression spine surgery. Group A received a single intraoperative dose of 15mg ketorolac at the end of surgery and group B received single intraoperative dose of 30mg ketorolac. The primary outcome was the visual analog scale (VAS) pain scores 4h after an adult spine surgery. Secondary measures were morphine usage in the first 8 and 24h postoperatively, numeric rating scores (NRS) up to 24h, sedation, nausea, vomiting, respiratory depression, pruritus and bleeding complications. Intention to treat analysis showed a mean increase in 4h VAS pain score of 7.9mm (95% CI: -4.5mm to 20.4mm) in patients administered 15mg ketorolac. This difference was neither statistically (P=0.207) nor clinically significant (<18mm on VAS scale). A similar increase in the 15mg group was noted through a per protocol analysis, 6.9mm (95% CI: -6.6mm to 20.5mm, P=0.307) greater in the 15mg group. Non-inferiority of 15mg was not confirmed. No significant difference was found in secondary endpoints. Ketorolac 30mg intravenous was not superior to 15mg intravenous for post-operative pain management after spine surgery. However, 15mg failed to meet the pre-specified criteria for non-inferiority to the 30mg dose. Copyright © 2017 Elsevier Inc. All rights reserved.

Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation.

PubMed

Fumimoto, Tomoko; Ueyama, Takeshi; Shimizu, Akihiko; Yoshiga, Yasuhiro; Ono, Makoto; Kato, Takayoshi; Ishiguchi, Hironori; Okamura, Takayuki; Yamada, Jutaro; Yano, Masafumi

2017-09-01

There is little information about the relationship between J waves and the occurrence of ventricular fibrillation (VF) in patients with vasospastic angina (VSA). The present study aimed to assess the incidence of J waves and the occurrence of VF in patients with VSA. The subjects consisted of 62 patients with VSA diagnosed by acetylcholine provocation tests in our institution from 2002 to 2014. We investigated the VF events, prevalence of J waves, and relationship between the VF events and J waves. J waves were observed in 16 patients (26%) and VF events were documented in 11 (18%). The incidence of VF in the patients with J waves was significantly higher than that in those without J waves (38% vs 11%, p=0.026). J waves were observed in the inferior leads in 14 patients, lateral leads in 5, and anterior leads in 3. A univariate analysis indicated that the incidence of VF in the inferior leads of J wave positive patients (46%=6/14) was significantly (p=0.01) higher than that in the inferior leads of J wave negative patients (10%=5/48). The J waves in the anterior and/or lateral leads were not related to the incidence of VF. Notched type and slurred type J waves were not associated with VF. A multivariate analysis revealed that J waves in VSA patients were associated with VF [odds ratio (OR) 6.41, 95% confidence interval (CI) 1.37-29.93, p=0.02] and organic stenosis (OR 6.98, 95% CI 1.39-35.08, p=0.02). Further, J waves in the inferior leads were strongly correlated with VF (OR 11.85, 95% CI 2.05-68.42, p=0.006). The results suggest that the existence of J waves, especially in the inferior leads, might be a risk factor for VF in VSA patients. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Double Elevator Palsy, Subtypes and Outcomes of Surgery

PubMed Central

Bagheri, Abbas; Sahebghalam, Ramin; Abrishami, Mohammad

2008-01-01

Purpose To describe the clinical manifestations of subtypes of double elevator palsy and to report the outcomes of surgery in these patients. Methods This retrospective study was conducted on hospital records of patients with double elevator palsy at Labbafinejad Medical Center over a ten-year period from 1994 to 2004. Patients were classified into three subgroups of primary elevator muscle palsy (9 subjects), primary supranuclear palsy with secondary inferior rectus restriction (4 subjects) and pure inferior rectus restriction (7 subjects) according to forced duction test (FDT), force generation test (FGT) and Bell’s reflex. Patients in the first group underwent Knapp procedure, the second group received Knapp procedure and inferior rectus recession simultaneously and in the third group vertical recess-resect or mere inferior rectus recess operation was performed. Success was defined as final residual deviation ≤5 PD and ≥25% improvement in restriction after all operations. Results Overall 20 subjects including 10 male and 10 female patients with mean age of 12.6±9.3 (range 1.5–32) years were operated during the mentioned period which included 9 cases of primary elevator muscle palsy, 4 patients with primary supranuclear palsy and secondary inferior rectus restriction, and 7 subjects with pure inferior rectus restriction. Mean follow-up was 22.0±20.0 (range 3–63.5) months. Mean pre and postoperative deviation was 32.0±8.0 PD and 3.8±8.0 PD (P<0.001) respectively, and mean restriction before and after the operation(s) was −3.5±0.7 and −2.3±1.2 (P<0.001), respectively. Success rate was 77% for correction of deviation and 80% for improvement in muscle restriction. Conclusion Surgery for double elevator palsy must be individualized according to FDT, FGT and Bell’s reflex. The outcomes are favorable with appropriate surgical planning. PMID:23479532

Testing for dual brain processing routes in reading: a direct contrast of chinese character and pinyin reading using FMRI.

PubMed

Chen, Yiping; Fu, Shimin; Iversen, Susan D; Smith, Steve M; Matthews, Paul M

2002-10-01

Chinese offers a unique tool for testing the effects of word form on language processing during reading. The processes of letter-mediated grapheme-to-phoneme translation and phonemic assembly (assembled phonology) critical for reading and spelling in any alphabetic orthography are largely absent when reading nonalphabetic Chinese characters. In contrast, script-to-sound translation based on the script as a whole (addressed phonology) is absent when reading the Chinese alphabetic sound symbols known as pinyin, for which the script-to-sound translation is based exclusively on assembled phonology. The present study aims to contrast patterns of brain activity associated with the different cognitive mechanisms needed for reading the two scripts. fMRI was used with a block design involving a phonological and lexical task in which subjects were asked to decide whether visually presented, paired Chinese characters or pinyin "sounded like" a word. Results demonstrate that reading Chinese characters and pinyin activate a common brain network including the inferior frontal, middle, and inferior temporal gyri, the inferior and superior parietal lobules, and the extrastriate areas. However, some regions show relatively greater activation for either pinyin or Chinese reading. Reading pinyin led to a greater activation in the inferior parietal cortex bilaterally, the precuneus, and the anterior middle temporal gyrus. In contrast, activation in the left fusiform gyrus, the bilateral cuneus, the posterior middle temporal, the right inferior frontal gyrus, and the bilateral superior frontal gyrus were greater for nonalphabetic Chinese reading. We conclude that both alphabetic and nonalphabetic scripts activate a common brain network for reading. Overall, there are no differences in terms of hemispheric specialization between alphabetic and nonalphabetic scripts. However, differences in language surface form appear to determine relative activation in other regions. Some of these regions (e.g., the inferior parietal cortex for pinyin and fusiform gyrus for Chinese characters) are candidate regions for specialized processes associated with reading via predominantly assembled (pinyin) or addressed (Chinese character) procedures.

Homeopathic Individualized Q-Potencies versus Fluoxetine for Moderate to Severe Depression: Double-Blind, Randomized Non-Inferiority Trial

PubMed Central

Adler, U. C.; Paiva, N. M. P.; Cesar, A. T.; Adler, M. S.; Molina, A.; Padula, A. E.; Calil, H. M.

2011-01-01

Homeopathy is a complementary and integrative medicine used in depression, The aim of this study is to investigate the non-inferiority and tolerability of individualized homeopathic medicines [Quinquagintamillesmial (Q-potencies)] in acute depression, using fluoxetine as active control. Ninety-one outpatients with moderate to severe depression were assigned to receive an individualized homeopathic medicine or fluoxetine 20 mg day−1 (up to 40 mg day−1) in a prospective, randomized, double-blind double-dummy 8-week, single-center trial. Primary efficacy measure was the analysis of the mean change in the Montgomery & Åsberg Depression Rating Scale (MADRS) depression scores, using a non-inferiority test with margin of 1.45. Secondary efficacy outcomes were response and remission rates. Tolerability was assessed with the side effect rating scale of the Scandinavian Society of Psychopharmacology. Mean MADRS scores differences were not significant at the 4th (P = .654) and 8th weeks (P = .965) of treatment. Non-inferiority of homeopathy was indicated because the upper limit of the confidence interval (CI) for mean difference in MADRS change was less than the non-inferiority margin: mean differences (homeopathy-fluoxetine) were −3.04 (95% CI −6.95, 0.86) and −2.4 (95% CI −6.05, 0.77) at 4th and 8th week, respectively. There were no significant differences between the percentages of response or remission rates in both groups. Tolerability: there were no significant differences between the side effects rates, although a higher percentage of patients treated with fluoxetine reported troublesome side effects and there was a trend toward greater treatment interruption for adverse effects in the fluoxetine group. This study illustrates the feasibility of randomized controlled double-blind trials of homeopathy in depression and indicates the non-inferiority of individualized homeopathic Q-potencies as compared to fluoxetine in acute treatment of outpatients with moderate to severe depression. PMID:19687192

Genetic Factors and Orofacial Motor Learning Selectively Influence Variability in Central Sulcus Morphology in Chimpanzees (Pan troglodytes).

PubMed

Hopkins, William D; Coulon, Oliver; Meguerditchian, Adrien; Autrey, Michelle; Davidek, Kendall; Mahovetz, Lindsay; Pope, Sarah; Mareno, Mary Catherine; Schapiro, Steven J

2017-05-31

Captive chimpanzees ( Pan troglodytes ) have been shown to learn the use of novel attention-getting (AG) sounds to capture the attention of humans as a means of requesting or drawing their attention to a desired object or food. There are significant individual differences in the use of AG sounds by chimpanzees and, here, we examined whether changes in cortical organization of the central sulcus (CS) were associated with AG sound production. MRI scans were collected from 240 chimpanzees, including 122 that reliably produced AG sounds and 118 that did not. For each subject, the depth of CS was quantified along the superior-inferior plane with specific interest in the inferior portion corresponding to the region of the motor cortex where the mouth and orofacial movements are controlled. Results indicated that CS depth in the inferior, but not superior, portion was significantly greater in chimpanzees that reliably produced AG sounds compared with those who did not. Quantitative genetic analyses indicated that overall CS surface area and depth were significantly heritable, particularly in the superior regions, but less so in the inferior and central portions. Further, heritability in CS depth was altered as a function of acquisition of AG sounds. The collective results suggest that learning to produce AG sounds resulted in region-specific cortical reorganization within the inferior portion of the CS, a finding previously undocumented in chimpanzees or any nonhuman primate. SIGNIFICANCE STATEMENT Recent studies in chimpanzees ( Pan troglodytes ) have shown that some can learn to produce novel sounds by configuring different orofacial movement patterns and these sounds are used in communicatively relevant contexts. Here, we examined the neuromorphological correlates in the production of these sounds in chimpanzees. We show that chimpanzees that have learned to produce these sounds show significant differences in central sulcus (CS) morphology, particularly in the inferior region. We further show that overall CS morphology and regions within the superior portion are significantly heritable, whereas central and inferior portions of the CS are not. The collective findings suggest chimpanzees exhibit cortical plasticity in regions of the brain that were central to the emergence of speech functions in humans. Copyright © 2017 the authors 0270-6474/17/375476-09$15.00/0.

Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study.

PubMed

Konya, Mehmet Nuri; Verim, Özgür

2017-09-29

Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Biomechanical study. Computed tomography images of patients' right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°0) and posterior-anterior directions of the femur neck significantly increased these stresses. The most suitable position of the proximal lag screw was confirmed as the middle of the femoral neck by using optimized finite element analysis.

Biomarcadores de função endotelial em doenças cardiovasculares: hipertensão

PubMed Central

Neves, Josynaria Araújo; Neves, Josyanne Araújo; Oliveira, Rita de Cássia Meneses

2016-01-01

Resumo A incidência de hipertensão arterial sistêmica está aumentando mundialmente. Sua prevenção baseia-se na identificação dos hipertensos. Atualmente, biomarcadores são utilizados com fins de diagnosticar, estratificar e prognosticar doenças. Neste estudo, objetivou-se revisar artigos dos últimos cinco anos relacionados a biomarcadores nas doenças cardiovasculares. Pesquisaram-se dados de PubMed, SciELO, Science Direct e MEDLINE, mediante as palavras-chave: hipertensão arterial, biomarcadores cardiovasculares, óxido nítrico, função endotelial e dimetilarginina assimétrica. Os estudos levantados mostram que as doenças cardiovasculares possuem uma etiologia complexa. Neste artigo, evidenciaram-se interações entre o óxido nítrico e a dimetilarginina assimétrica na regulação, no metabolismo e na determinação dos níveis intracelulares, e reviram-se outros biomarcadores relacionados à hipertensão. Alguns estudos indicam os biomarcadores como uma ferramenta útil na predição de eventos cardíacos, e outros reportam que eles contribuem pouco para a avaliação. A seleção e combinação desses pode ser uma alternativa para validar o uso dos biomarcadores devido à pouca especificidade existente para diagnosticar a hipertensão. PMID:29930594

Effective Brain Connectivity in Children with Reading Difficulties during Phonological Processing

ERIC Educational Resources Information Center

Cao, Fan; Bitan, Tali; Booth, James R.

2008-01-01

Using Dynamic Causal Modeling (DCM) and functional magnetic resonance imaging (fMRI), we examined effective connectivity between three left hemisphere brain regions (inferior frontal gyrus, inferior parietal lobule, fusiform gyrus) and bilateral medial frontal gyrus in 12 children with reading difficulties (M age = 12.4, range: 8.11-14.10) and 12…

Lexical Retrieval Constrained by Sound Structure: The Role of the Left Inferior Frontal Gyrus

ERIC Educational Resources Information Center

Sharp, David J.; Scott, Sophie K.; Cutler, Anne; Wise, Richard J. S.

2005-01-01

Positron emission tomography was used to investigate two competing hypotheses about the role of the left inferior frontal gyrus (IFG) in word generation. One proposes a domain-specific organization, with neural activation dependent on the type of information being processed, i.e., surface sound structure or semantic. The other proposes a…

The Contribution of the Inferior Parietal Cortex to Spoken Language Production

ERIC Educational Resources Information Center

Geranmayeh, Fatemeh; Brownsett, Sonia L. E.; Leech, Robert; Beckmann, Christian F.; Woodhead, Zoe; Wise, Richard J. S.

2012-01-01

This functional MRI study investigated the involvement of the left inferior parietal cortex (IPC) in spoken language production (Speech). Its role has been apparent in some studies but not others, and is not convincingly supported by clinical studies as they rarely include cases with lesions confined to the parietal lobe. We compared Speech with…

Course of the inferior vena cava on lateral films exposed in different positions.

PubMed

Lien, H H; Bakke, S J

1981-01-01

The distance from the posterior border of the inferior vena cava to the anterior vertebral margin was measured in 100 presumably normal patients in the supine position. Seventeen of these were also examined in the right and left lateral positions and the changes in course of the vena cava compared with the supine position.

Alternating Wolff-Parkinson-White syndrome associated with attack of angina

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

Mangiafico, R.A.; Petralito, A.; Grimaldi, D.R.

1990-07-01

In a patient with Wolff-Parkinson-White syndrome and an inferior-posterior bypass tract, transient restoration of normal conduction occurred during an attack of angina. The ECG pattern of inferior posterior ischemia was present when the conduction was normal. Thallium scintigraphy showed a reversible posterolateral perfusion defect. The possible mechanisms for production of intermittent preexcitation are discussed.

Transection of the inferior vena cava from blunt thoracic trauma: case reports.

PubMed

Peitzman, A B; Udekwu, A O; Pevec, W; Albrink, M

1989-04-01

Blunt thoracic trauma is a frequent cause of death in multiple trauma victims. Myocardial rupture may occur in up to 65% of patients who die with thoracic injuries. Two cases are presented with intrapericardial transection of the inferior vena cava, pericardial rupture, and myocardial rupture from blunt thoracic trauma. Both patients died.

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…

Inferior Vena Cava Filter from Left-Sided Superior Vena Cava

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

Nair, Sujit, E-mail: drsnnair@hotmail.com; Ettles, Duncan; Robinson, Graham

We describe the unusual case of a 71-year-old male with a history of deep vein thrombosis and recurrent multiple pulmonary embolism (PE) despite adequate anticoagulation. Computed tomography (CT) and brachiocephalic venography revealed a left-sided superior vena cava. We describe successful placement of an inferior vena cava filter via a left-sided superior vena cava.

Retrieval of Cement Embolus from Inferior Vena Cava After Percutaneous Vertebroplasty

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

Athreya, S., E-mail: sathreya@stjoes.c; Mathias, N.; Rogers, P.

Percutaneous vertebroplasty is an accepted treatment for painful vertebral compression fractures caused by osteoporosis and malignant disease. Venous leakage of cement and pulmonary cement embolism have been reported complications. We describe a paravertebral venous cement leak resulting in the deposition of a cement cast in the inferior vena cava and successful retrieval of the cement embolus.

Morton, Agassiz, and the Origins of Scientific Racism in the United States.

ERIC Educational Resources Information Center

Menand, Louis

2002-01-01

Describes how the racist academic consensus was established at Harvard University, focusing on two professors, Samuel George Morton and Louis Agassiz, who worked to convince U.S. scholars of the inherent inferiority and subhuman status of the black race. Morton published data on the inferiority of the black race based on analysis of his collection…

Prominence vs. Aboutness in Sequencing: A Functional Distinction within the Left Inferior Frontal Gyrus

ERIC Educational Resources Information Center

Bornkessel-Schlesewsky, Ina; Grewe, Tanja; Schlesewsky, Matthias

2012-01-01

Prior research on the neural bases of syntactic comprehension suggests that activation in the left inferior frontal gyrus (lIFG) correlates with the processing of word order variations. However, there are inconsistencies with respect to the specific subregion within the IFG that is implicated by these findings: the pars opercularis or the pars…

Isolated nonpulsatile enophthalmos in neurofibromatosis: An uncommon entity

PubMed Central

Singh, Swati; Mulay, Kaustubh; Mittal, Vikas

2017-01-01

Isolated enophthalmos is a rarely observed entity in neurofibromatosis (NF). A 12-year-old male presented with right lower eyelid fat prolapse and enophthalmos for the past 7 years. There was no history of antecedent trauma/surgery. Computed tomography of orbit revealed an ill-defined intraconal hyperdense lesion located between lateral and inferior rectus along with an enlarged inferior orbital fissure (IOF). Superior orbital fissure was minimally widened without prolapse of any intracranial contents. Excision biopsy along with repair of widened IOF was performed through inferior transconjunctival route. Histopathology was suggestive of plexiform neurofibroma with positivity for S-100 and epithelial membrane antigen. No associated cutaneous lesions were present. Nonpulsatile enophthalmos with eyelid fat prolapse can be a presenting sign of NF. PMID:29044092

Arched needle technique for inferior alveolar mandibular nerve block.

PubMed

Chakranarayan, Ashish; Mukherjee, B

2013-03-01

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

Ultrasound-Accelerated, Catheter-Directed Thrombolysis for Inferior Vena Cava Thrombosis After an Orthotopic Liver Transplant

PubMed Central

Latchana, Nicholas; Dowell, Joshua D.; Taani, Jamal Al; Michaels, Anthony; Elkhammas, Elmadhi; Black, Sylvester M.

2015-01-01

Inferior vena cava thrombosis is a rare occurrence after an orthotopic liver transplant that is associated with a high rate of retransplant and mortality. There is no consensus regarding the optimal therapeutic strategy. Surgical management, including thrombectomy with revision of the cavocaval anastomosis, has been described. With the use of endovascular therapies, several minimally invasive approaches are available that are effective and avoid the high morbidity associated with reoperative surgery. We describe our successful experience using an approach after a liver transplant in which the inferior vena cava thrombosis in a patient presenting with acute renal failure, anorexia, weight loss, and fatigue using an ultrasound-accelerated, catheter-directed thrombolysis platform in conjunction with systemic anticoagulation. PMID:24918871

Isolated nonpulsatile enophthalmos in neurofibromatosis: An uncommon entity.

PubMed

Singh, Swati; Mulay, Kaustubh; Mittal, Vikas

2017-10-01

Isolated enophthalmos is a rarely observed entity in neurofibromatosis (NF). A 12-year-old male presented with right lower eyelid fat prolapse and enophthalmos for the past 7 years. There was no history of antecedent trauma/surgery. Computed tomography of orbit revealed an ill-defined intraconal hyperdense lesion located between lateral and inferior rectus along with an enlarged inferior orbital fissure (IOF). Superior orbital fissure was minimally widened without prolapse of any intracranial contents. Excision biopsy along with repair of widened IOF was performed through inferior transconjunctival route. Histopathology was suggestive of plexiform neurofibroma with positivity for S-100 and epithelial membrane antigen. No associated cutaneous lesions were present. Nonpulsatile enophthalmos with eyelid fat prolapse can be a presenting sign of NF.

Testing of Hypothesis in Equivalence and Non Inferiority Trials-A Concept.

PubMed

Juneja, Atul; Aggarwal, Abha R; Adhikari, Tulsi; Pandey, Arvind

2016-04-01

Establishing the appropriate hypothesis is one of the important steps for carrying out the statistical tests/analysis. Its understanding is important for interpreting the results of statistical analysis. The current communication attempts to provide the concept of testing of hypothesis in non inferiority and equivalence trials, where the null hypothesis is just reverse of what is set up for conventional superiority trials. It is similarly looked for rejection for establishing the fact the researcher is intending to prove. It is important to mention that equivalence or non inferiority cannot be proved by accepting the null hypothesis of no difference. Hence, establishing the appropriate statistical hypothesis is extremely important to arrive at meaningful conclusion for the set objectives in research.

Neural representations of social status hierarchy in human inferior parietal cortex.

PubMed

Chiao, Joan Y; Harada, Tokiko; Oby, Emily R; Li, Zhang; Parrish, Todd; Bridge, Donna J

2009-01-01

Mental representations of social status hierarchy share properties with that of numbers. Previous neuroimaging studies have shown that the neural representation of numerical magnitude lies within a network of regions within inferior parietal cortex. However the neural basis of social status hierarchy remains unknown. Using fMRI, we studied subjects while they compared social status magnitude of people, objects and symbols, as well as numerical magnitude. Both social status and number comparisons recruited bilateral intraparietal sulci. We also observed a semantic distance effect whereby neural activity within bilateral intraparietal sulci increased for semantically close relative to far numerical and social status comparisons. These results demonstrate that social status and number comparisons recruit distinct and overlapping neuronal representations within human inferior parietal cortex.

The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip.

PubMed

Grose, A W; Gardner, M J; Sussmann, P S; Helfet, D L; Lorich, D G

2008-10-01

The inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an anastomosis with the medial femoral circumflex artery. The site(s) of the anastomosis has not been described previously. We undertook an injection study to define the anastomotic connections between these two arteries and to determine whether the inferior gluteal artery could supply the lateral epiphyseal arteries alone. From eight fresh-frozen cadaver pelvic specimens we were able to inject the vessels in 14 hips with latex moulding compound through either the medial femoral circumflex artery or the inferior gluteal artery. Injected vessels around the hip were then carefully exposed and documented photographically. In seven of the eight specimens a clear anastomosis was shown between the two arteries adjacent to the tendon of obturator externus. The terminal vessel arising from this anastomosis was noted to pass directly beneath the posterior capsule of the hip before ascending the superior aspect of the femoral neck and terminating in the lateral epiphyseal vessels. At no point was the terminal vessel found between the capsule and the conjoined tendon. The medial femoral circumflex artery receives a direct supply from the inferior gluteal artery immediately before passing beneath the capsule of the hip. Detailed knowledge of this anatomy may help to explain the development of avascular necrosis after hip trauma, as well as to allow additional safe surgical exposure of the femoral neck and head.

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars.

PubMed

Venkat Narayanan, J; Gurram, Prashanthi; Krishnan, Radhika; Muthusubramanian, Veerabahu; Sadesh Kannan, V

2017-09-01

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline. A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias. The pain scores in both groups were analyzed using the Mann-Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted. From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

Comparison of Foveal, Macular, and Peripapillary Intraretinal Thicknesses Between Autism Spectrum Disorder and Neurotypical Subjects.

PubMed

García-Medina, José Javier; García-Piñero, María; Del-Río-Vellosillo, Mónica; Fares-Valdivia, Jesarán; Ragel-Hernández, Ana Belén; Martínez-Saura, Salvador; Cárcel-López, María Dolores; Zanon-Moreno, Vicente; Pinazo-Duran, María Dolores; Villegas-Pérez, María Paz

2017-11-01

To compare thicknesses of intraretinal layers segmented by spectral-domain optical coherence tomography (SD-OCT) between autism spectrum disorder (ASD) and neurotypical (NT) individuals. We performed 2 scans on 108 eyes from 54 participants (27 high-functioning ASD and 27 age- and sex-matched NT subjects): macular fast volume and peripapillary retinal nerve fiber layer (pRNFL). Macula was automatically segmented. The mean foveal and macular thickness of nine different layers and the thickness of nine pRNFL sectors were considered. Data from the right and left eyes were averaged for each participant. The results were compared between the ASD and NT groups. Associations between the Kaufman brief intelligence test (K-BIT), head circumference and SD-OCT results were also investigated in ASD individuals. ASD subjects showed greater foveal thickness at total retina, total inner retina, inner plexiform and inner nuclear layers, and greater macular thickness at total retina and total inner retina. Inferior, nasal inferior and temporal inferior sectors of pRNFL were also thicker in the ASD participants than in the controls (P < 0.05, unpaired t-test). Significant correlations were found between some K-BIT results and temporal inferior and inferior pRNFL thicknesses in the ASD group (P < 0.05, Spearman's rank correlation). No associations were seen between head circumference and OCT parameters. There are intraretinal thickenings at different locations in ASD subjects when compared to NT controls. This fact should be taken into account when interpreting SD-OCT examinations in ASD individuals. Plus, some pRNFL thicknesses present positive correlations with scores of cognitive status in ASD.

Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis

PubMed Central

Donkol, Ragab Hani; Nada, Aml Mohamed; Boughattas, Sami

2013-01-01

AIM: To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS: Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups: 18 cases with Graves’ disease and 8 cases with Hashimoto’s thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves’ disease and Hashimoto’s thyroiditis was supported by the clinical picture and follow up of patients. RESULTS: Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves’ disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION: Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients. PMID:23671754

A multicenter randomized trial indicates initial prednisolone treatment for childhood nephrotic syndrome for two months is not inferior to six-month treatment.

PubMed

Yoshikawa, Norishige; Nakanishi, Koichi; Sako, Mayumi; Oba, Mari S; Mori, Rintaro; Ota, Erika; Ishikura, Kenji; Hataya, Hiroshi; Honda, Masataka; Ito, Shuichi; Shima, Yuko; Kaito, Hiroshi; Nozu, Kandai; Nakamura, Hidefumi; Igarashi, Takashi; Ohashi, Yasuo; Iijima, Kazumoto

2015-01-01

In this multicenter, open-label, randomized controlled trial, we determined whether 2-month prednisolone therapy for steroid-sensitive nephrotic syndrome was inferior or not to 6-month therapy despite significantly less steroid exposure. The primary end point was time from start of initial treatment to start of frequently relapsing nephrotic syndrome. The pre-specified non-inferiority margin was a hazard ratio of 1.3 with one-sided significance of 5%. We randomly assigned 255 children with an initial episode of steroid-sensitive nephrotic syndrome to either 2 - or 6-month treatment of which 246 were eligible for final analysis. The total prednisolone exposure counted both initial and relapse prednisolone treatment administered over 24 months. Median follow-up in months was 36.7 in the 2-month and 38.2 in the 6-month treatment group. Time to frequent relaps was similar in both groups; however, the median was reached only in the 6-month group (799 days). The hazard ratio was 0.86 (90% confidence interval, 0.64-1.16) and met the non-inferior margin. Time to first relapse was also similar in both groups: median day 242 (2-month) and 243 (6-month). Frequency and severity of adverse events were similar in both groups. Most adverse events were transient and occurred during initial or relapse therapy. Thus, 2 months of initial prednisolone therapy for steroid-sensitive nephrotic syndrome, despite less prednisolone exposure, is not inferior to 6 months of initial therapy in terms of time to onset of frequently relapsing nephrotic syndrome.

Release of the Inferior Crus in Antihelix Plasty.

PubMed

Raunig, Hermann; Ofner, Michael

2016-07-01

Protruding ears with a hypoplastic antihelix often have poorly developed inferior cura. Publications on this topic until now have only dealt with absent inferior crus and have neglected its importance in everyday antihelix plasty. This article describes a new surgical technique to improve treatment of the antihelix. Patients with protruding upper third ears received either standard otoplasty with crus superior remodeling (ST) or the newly developed surgical procedure including crus inferior release (STI). To evaluate the results, a survey containing 10 questions about different outcome parameters was conducted with the patients. Each question was given a score ranging from 0 to 10, where 10 meant the best outcome and 0 the worst. From January 2013 to March 2014, 216 patients underwent otoplasty, of which 99 completed the questionnaire. No differences could be found between ST and STI patients except for their duration of pain, which was significantly less in group STI. Overall, the scores from the questionnaire were 89.85 in ST and 92.35 in STI. Mean values for satisfaction were 9.33 in group ST and 9.56 in group STI. When correcting the antihelix, the inferior crus must always be checked because the protruding upper third cannot be compensated only by overcorrecting the superior crus. It should be a matter of routine to recognize the degree of malformation and determine the best possible treatment. This novel technique is an additional valuable option in otoplasty to improve the upper third in a more natural way and create highly satisfactory results. © The Author(s) 2016.

Feasibility and reliability of pocket-size ultrasound examinations of the pleural cavities and vena cava inferior performed by nurses in an outpatient heart failure clinic.

PubMed

Dalen, Havard; Gundersen, Guri H; Skjetne, Kyrre; Haug, Hilde H; Kleinau, Jens O; Norekval, Tone M; Graven, Torbjorn

2015-08-01

Routine assessment of volume state by ultrasound may improve follow-up of heart failure patients. We aimed to study the feasibility and reliability of focused pocket-size ultrasound examinations of the pleural cavities and the inferior vena cava performed by nurses to assess volume state at an outpatient heart failure clinic. Ultrasound examinations were performed in 62 included heart failure patients by specialized nurses with a pocket-size imaging device (PSID). Patients were then re-examined by a cardiologist with a high-end scanner for reference within 1 h. Specialized nurses were able to obtain and interpret images from both pleural cavities and the inferior vena cava and estimate the volume status in all patients. Time consumption for focused ultrasound examination was median 5 min. In total 26 patients had any kind of pleural effusion (in 39 pleural cavities) by reference. The sensitivity, specificity, positive and negative predictive values were high, all ≥ 92%. The correlations with reference were high for all measurements, all r ≥ 0.79. Coefficients of variation for end-expiratory dimension of inferior vena cava and quantification of pleural effusion were 10.8% and 12.7%, respectively. Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by PSID and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy. © The European Society of Cardiology 2014.

Efficacy and safety of loxoprofen hydrogel patch versus loxoprofen tablet in patients with knee osteoarthritis: a randomized controlled non-inferiority trial.

PubMed

Mu, Rong; Bao, Chun-de; Chen, Zhi-wei; Zheng, Yi; Wang, Guo-chun; Zhao, Dong-bao; Hu, Shao-xian; Li, Yu-jun; Shao, Zeng-wu; Zhang, Zhi-yi; Xiao, Wei-guo; Zhang, Weiya; Li, Zhan-guo

2016-01-01

This study is aimed at comparing the efficacy and safety of loxoprofen sodium hydrogel patch (LX-P) with loxoprofen sodium tablet (LX-T) in patients with knee osteoarthritis (OA). One hundred sixty-nine patients were enrolled in a randomized, controlled, double-blind, double-dummy, multicenter, non-inferiority trial of LX-P. Patients were randomly assigned to either LX-P or LX-T groups for a 4-week treatment. The primary efficacy endpoint was the proportion of patients with an overall improvement of ≥50%, and the secondary efficacy endpoint was the proportion of patients with an improvement of ≥25% from baseline in each of the seven main symptoms. The non-inferiority trial was based on a power of 80% and significance level of 2.5% with a non-inferiority margin of -10%. In both intention-to-treat (ITT) and per-protocol (PP) analyses, LX-P was as effective as LX-T in regard to the primary endpoint. In the ITT analysis, the difference between the two groups was 12.6% [95% confidence interval, -1.7 to 26.9%]. No significant differences were found between the two groups in any of the secondary efficacy outcomes. A lower incidence of adverse events was observed in LX-P group; however, the difference was not statistically significant. No serious adverse events were reported in the LX-P group, whereas one case was reported in LX-T group. Based on the present study, topical loxoprofen patch was non-inferior to oral loxoprofen in patients with knee osteoarthritis.

Multimodality language mapping in patients with left-hemispheric language dominance on Wada test.

PubMed

Kojima, Katsuaki; Brown, Erik C; Rothermel, Robert; Carlson, Alanna; Matsuzaki, Naoyuki; Shah, Aashit; Atkinson, Marie; Mittal, Sandeep; Fuerst, Darren; Sood, Sandeep; Asano, Eishi

2012-10-01

We determined the utility of electrocorticography (ECoG) and stimulation for detecting language-related sites in patients with left-hemispheric language-dominance on Wada test. We studied 13 epileptic patients who underwent language mapping using event-related gamma-oscillations on ECoG and stimulation via subdural electrodes. Sites showing significant gamma-augmentation during an auditory-naming task were defined as language-related ECoG sites. Sites at which stimulation resulted in auditory perceptual changes, failure to verbalize a correct answer, or sensorimotor symptoms involving the mouth were defined as language-related stimulation sites. We determined how frequently these methods revealed language-related sites in the superior-temporal, inferior-frontal, dorsolateral-premotor, and inferior-Rolandic regions. Language-related sites in the superior-temporal and inferior-frontal gyri were detected by ECoG more frequently than stimulation (p < 0.05), while those in the dorsolateral-premotor and inferior-Rolandic regions were detected by both methods equally. Stimulation of language-related ECoG sites, compared to the others, more frequently elicited language symptoms (p < 0.00001). One patient developed dysphasia requiring in-patient speech therapy following resection of the dorsolateral-premotor and inferior-Rolandic regions containing language-related ECoG sites not otherwise detected by stimulation. Language-related gamma-oscillations may serve as an alternative biomarker of underlying language function in patients with left-hemispheric language-dominance. Measurement of language-related gamma-oscillations is warranted in presurgical evaluation of epileptic patients. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Dynamic Responses of Intact Post Mortem Human Surrogates from Inferior-to-Superior Loading at the Pelvis.

PubMed

Yoganandan, Narayan; Moore, Jason; Arun, Mike W J; Pintar, Frank A

2014-11-01

During certain events such as underbody blasts due to improvised explosive devices, occupants in military vehicles are exposed to inferior-to-superior loading from the pelvis. Injuries to the pelvis-sacrum-lumbar spine complex have been reported from these events. The mechanism of load transmission and potential variables defining the migration of injuries between pelvis and or spinal structures are not defined. This study applied inferior-to-superior impacts to the tuberosities of the ischium of supine-positioned five post mortem human subjects (PMHS) using different acceleration profiles, defined using shape, magnitude and duration parameters. Seventeen tests were conducted. Overlay temporal plots were presented for normalized (impulse momentum approach) forces and accelerations of the sacrum and spine. Scatter plots showing injury and non-injury data as a function of peak normalized forces, pulse characteristics, impulse and power, loading rate and sacrum and spine accelerations were evaluated as potential metrics related to pathological outcomes with the focus of examining the role of the pulse characteristics from inferior-to-superior loading of the pelvis-sacrum-lumbar spine complex. Interrelationships were explored between non-fracture and fracture outcomes, and fracture patterns with a focus on migration of injuries from the hip-only to hip and spine to spine-only regions. Observations indicate that injury to the pelvis and or spine from inferior-to-superior loading is associated with pulse and not just peak velocity. The role of the effect of mass recruitment and injury migration parallel knee-thigh-hip complex studies, suggest a wider application of the recruitment concept and the role of the pulse characteristics.

Clinical significance and developmental changes of auditory-language-related gamma activity

PubMed Central

Kojima, Katsuaki; Brown, Erik C.; Rothermel, Robert; Carlson, Alanna; Fuerst, Darren; Matsuzaki, Naoyuki; Shah, Aashit; Atkinson, Marie; Basha, Maysaa; Mittal, Sandeep; Sood, Sandeep; Asano, Eishi

2012-01-01

OBJECTIVE We determined the clinical impact and developmental changes of auditory-language-related augmentation of gamma activity at 50–120 Hz recorded on electrocorticography (ECoG). METHODS We analyzed data from 77 epileptic patients ranging 4 – 56 years in age. We determined the effects of seizure-onset zone, electrode location, and patient-age upon gamma-augmentation elicited by an auditory-naming task. RESULTS Gamma-augmentation was less frequently elicited within seizure-onset sites compared to other sites. Regardless of age, gamma-augmentation most often involved the 80–100 Hz frequency band. Gamma-augmentation initially involved bilateral superior-temporal regions, followed by left-side dominant involvement in the middle-temporal, medial-temporal, inferior-frontal, dorsolateral-premotor, and medial-frontal regions and concluded with bilateral inferior-Rolandic involvement. Compared to younger patients, those older than 10 years had a larger proportion of left dorsolateral-premotor and right inferior-frontal sites showing gamma-augmentation. The incidence of a post-operative language deficit requiring speech therapy was predicted by the number of resected sites with gamma-augmentation in the superior-temporal, inferior-frontal, dorsolateral-premotor, and inferior-Rolandic regions of the left hemisphere assumed to contain essential language function (r2=0.59; p=0.001; odds ratio=6.04 [95% confidence-interval: 2.26 to 16.15]). CONCLUSIONS Auditory-language-related gamma-augmentation can provide additional information useful to localize the primary language areas. SIGNIFICANCE These results derived from a large sample of patients support the utility of auditory-language-related gamma-augmentation in presurgical evaluation. PMID:23141882

Increased gray matter density in the parietal cortex of mathematicians: a voxel-based morphometry study.

PubMed

Aydin, K; Ucar, A; Oguz, K K; Okur, O O; Agayev, A; Unal, Z; Yilmaz, S; Ozturk, C

2007-01-01

The training to acquire or practicing to perform a skill, which may lead to structural changes in the brain, is called experience-dependent structural plasticity. The main purpose of this cross-sectional study was to investigate the presence of experience-dependent structural plasticity in mathematicians' brains, which may develop after long-term practice of mathematic thinking. Twenty-six volunteer mathematicians, who have been working as academicians, were enrolled in the study. We applied an optimized method of voxel-based morphometry in the mathematicians and the age- and sex-matched control subjects. We assessed the gray and white matter density differences in mathematicians and the control subjects. Moreover, the correlation between the cortical density and the time spent as an academician was investigated. We found that cortical gray matter density in the left inferior frontal and bilateral inferior parietal lobules of the mathematicians were significantly increased compared with the control subjects. Furthermore, increase in gray matter density in the right inferior parietal lobule of the mathematicians was strongly correlated with the time spent as an academician (r = 0.84; P < .01). Left-inferior frontal and bilateral parietal regions are involved in arithmetic processing. Inferior parietal regions are also involved in high-level mathematic thinking, which requires visuospatial imagery, such as mental creation and manipulation of 3D objects. The voxel-based morphometric analysis of mathematicians' brains revealed increased gray matter density in the cortical regions related to mathematic thinking. The correlation between cortical density increase and the time spent as an academician suggests experience-dependent structural plasticity in mathematicians' brains.

Coronectomy versus surgical removal of the lower third molars with a high risk of injury to the inferior alveolar nerve. A bibliographical review

PubMed Central

Moreno-Vicente, Javier; Schiavone-Mussano, Rocío; Clemente-Salas, Enrique; Marí-Roig, Antoni; Jané-Salas, Enric

2015-01-01

Background Coronectomy is the surgical removal of the crown of the tooth deliberately leaving part of its roots. This is done with the hope of eliminating the pathology caused, and since the roots are still intact, the integrity of the inferior alveolar nerve is preserved. Objectives The aim is to carry out a systematic review in order to be able to provide results and conclusions with the greatest scientific evidence possible. Material and Methods A literature review is carried out through the following search engines: Pubmed MEDLINE, Scielo, Cochrane library and EMI. The level of evidence criteria from the Agency for Healthcare Research and Quality was applied, and the clinical trials’ level of quality was analyzed by means of the JADAD criteria. Results The following articles were obtained which represents a total of 17: 1 systematic review, 2 randomized clinical trials and 2 non-randomized clinical trials, 3 cohort studies, 2 retrospective studies, 3 case studies and 4 literature reviews. Conclusions Coronectomy is an adequate preventative technique in protecting the inferior alveolar nerve, which is an alternative to the conventional extraction of third molars, which unlike the former technique, presents a high risk of injury to the inferior alveolar nerve. However, there is a need for new clinical studies, with a greater number of samples and with a longer follow-up period in order to detect potential adverse effects of the retained roots. Key words: Coronectomy, inferior alveolar nerve, nerve injury, wisdom tooth removal, paresthesia, and systematic review. PMID:25858081

A phase III, randomized, non-inferiority study comparing the efficacy and safety of biosimilar filgrastim versus originator filgrastim for chemotherapy-induced neutropenia in breast cancer patients

PubMed Central

Hegg, Roberto; Mattar, André; de Matos, João Nunes; Pedrini, José Luiz; Aleixo, Sabina Bandeira; Rocha, Roberto Odebrecht; Cramer, Renato Peixoto; van-Eyll-Rocha, Sylvie

2016-01-01

OBJECTIVES: To compare the efficacy and safety of two filgrastim formulations for controlling chemotherapy-induced neutropenia and to evaluate the non-inferiority of the test drug relative to the originator. METHODS: This phase III non-inferiority study had a randomized, multicenter, and open-label design. The patients were randomized at a ratio of 1:1 with a follow-up period of 6 weeks for each patient. In both study arms, filgrastim was administered subcutaneously at a daily dose of 5 mg/kg body weight. The primary endpoint was the rate of grade 4 neutropenia in the first treatment cycle. The secondary endpoints were the duration of grade 4 neutropenia, the generation of anti-filgrastim antibodies, and the rates of adverse events, laboratory abnormalities, febrile neutropenia, and neutropenia of any grade. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of the test drug compared with the originator drug; the upper limit of the 90% confidence interval (CI) for the rate of neutropenia between the two groups (12.61%) was lower than the established margin of non-inferiority. The two treatments were similar with respect to the secondary endpoints and safety. CONCLUSION: The efficacy and safety profile of the test drug were similar to those of the originator product based on the rate of grade 4 neutropenia in the first treatment cycle. This study supports Anvisa's approval of the first biosimilar drug manufactured by the Brazilian industry (Fiprima®). PMID:27759847

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part II: a Systematic Review of Neurosensory Complications.

PubMed

Abayev, Boris; Juodzbalys, Gintaras

2015-01-01

This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included. A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent. Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

Simulation of the Inferior Mirage

ERIC Educational Resources Information Center

Branca, Mario

2010-01-01

A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

Left Inferior Frontal Cortex and Syntax: Function, Structure and Behaviour in Patients with Left Hemisphere Damage

ERIC Educational Resources Information Center

Tyler, Lorraine K.; Marslen-Wilson, William D.; Randall, Billi; Wright, Paul; Devereux, Barry J.; Zhuang, Jie; Papoutsi, Marina; Stamatakis, Emmanuel A.

2011-01-01

For the past 150 years, neurobiological models of language have debated the role of key brain regions in language function. One consistently debated set of issues concern the role of the left inferior frontal gyrus in syntactic processing. Here we combine measures of functional activity, grey matter integrity and performance in patients with left…

Osteochondrosis of the inferior pole of the scapula (Roca disease).

PubMed

Skaf, Abdalla; Taneja, Atul K

2014-03-01

We report a rare case of osteochondrosis of the inferior pole of the scapula in a 14-year-old boy, an amateur swimmer, that was diagnosed by a combination of clinical and imaging findings. Also known as Roca disease, this is the first article to report this entity in the English literature and demonstrates its computerized tomography and MRI features.

Azygos Vein Dialysis Catheter Placement Using the Translumbar Approach in a Patient with Inferior Vena Cava Occlusion

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

Jaber, Mohammad R., E-mail: raffatj@msn.co; Thomson, Matthew J.; Smith, Douglas C.

We describe percutaneous, translumbar placement of a 14-Fr dialysis catheter into an ascending lumbar vein to achieve tip position in an enlarged azygos vein. The patient had thrombosis of all traditional vascular sites, as well as the inferior vena cava. This catheter functioned well for 7 months before fatal catheter-related infection developed.

Academic Achievement and Behavioral Health among Asian American and African American Adolescents: Testing the Model Minority and Inferior Minority Assumptions

ERIC Educational Resources Information Center

Whaley, Arthur L.; Noel, La Tonya

2013-01-01

The present study tested the model minority and inferior minority assumptions by examining the relationship between academic performance and measures of behavioral health in a subsample of 3,008 (22%) participants in a nationally representative, multicultural sample of 13,601 students in the 2001 Youth Risk Behavioral Survey, comparing Asian…

AUDITORY NUCLEI: DISTINCTIVE RESPONSE PATTERNS TO WHITE NOISE AND TONES IN UNANESTHETIZED CATS.

PubMed

GALIN, D

1964-10-09

Electrical responses to "white" noise and tonal stimuli were recorded from unanesthetized cats with permanently implanted bipolar electrodes. The cochlear nucleus, inferior colliculus, and medial geniculate each showed distinctive patterns of evoked activity. White noise and tones produced qualitatively different types of response. A decrease in activity characterized the response of the inferior colliculus to tonal stimuli.

Automatic Activation of Phonological Templates for Native but Not Nonnative Phonemes: An Investigation of the Temporal Dynamics of Mu Activation

ERIC Educational Resources Information Center

Santos-Oliveira, Daniela Cristina

2017-01-01

Models of speech perception suggest a dorsal stream connecting the temporal and inferior parietal lobe with the inferior frontal gyrus. This stream is thought to involve an auditory motor loop that translates acoustic information into motor/articulatory commands and is further influenced by decision making processes that involve maintenance of…

"A Hidden Part of Me": Latino/a Students, Silencing, and the Epidermalization of Inferiority

ERIC Educational Resources Information Center

Irizarry, Jason G.; Raible, John

2014-01-01

Using Critical Race Theory (CRT) and Latino/a Critical Race Theory (LatCrit) as analytical tools, this article examines the experiences of a seven Latino/a high school students at various points of engagement with the school-to-prison pipeline. Building on and extending Franz Fanon's (1952) concept of the epidermalization of inferiority, the…

Are Rural Schools Inferior to Urban Schools? A Multilevel Analysis of School Accountability Trends in Kentucky

ERIC Educational Resources Information Center

Reeves, Edward B.; Bylund, Robert A.

2005-01-01

Recent research does not provide clear evidence that rural schools are inferior to urban schools. For example, one prominent study finds that students in rural schools perform less well than their urban counterparts, but other studies using the same national data set have reached divergent conclusions. The present study reassesses the issue using…

Traumatic longitudinal splitting of the inferior rectus muscle

PubMed Central

Laursen, Jessica; Demer, Joseph L.

2011-01-01

Orbital floor fractures and associated injuries can cause strabismus. We present the case of a 34-year-old man with incomitant strabismus following orbital reconstruction after a high-impact baseball injury. Multipositional, high-resolution magnetic resonance imaging (MRI) revealed extensive longitudinal splitting of the inferior rectus muscle by an orbital floor implant that separated its orbital and global layers. PMID:21463958

Angioarchitecture of the coeliac sympathetic ganglion complex in the common tree shrew (Tupaia glis)

PubMed Central

PROMWIKORN, WARAPORN; THONGPILA, SAKPORN; PRADIDARCHEEP, WISUIT; MINGSAKUL, THAWORN; CHUNHABUNDIT, PANJIT; SOMANA, REON

1998-01-01

The angioarchitecture of the coeliac sympathetic ganglion complex (CGC) of the common tree shrew (Tupaia glis) was studied by the vascular corrosion cast technique in conjunction with scanning electron microscopy. The CGC of the tree shrew was found to be a highly vascularised organ. It normally received arterial blood supply from branches of the inferior phrenic, superior suprarenal and inferior suprarenal arteries and of the abdominal aorta. In some animals, its blood supply was also derived from branches of the middle suprarenal arteries, coeliac artery, superior mesenteric artery and lumbar arteries. These arteries penetrated the ganglion at variable points and in slightly different patterns. They gave off peripheral branches to form a subcapsular capillary plexus while their main trunks traversed deeply into the inner part before branching into the densely packed intraganglionic capillary networks. The capillaries merged to form venules before draining into collecting veins at the peripheral region of the ganglion complex. Finally, the veins coursed to the dorsal aspect of the ganglion to drain into the renal and inferior phrenic veins and the inferior vena cava. The capillaries on the coeliac ganglion complex do not possess fenestrations. PMID:9877296

Comparison of Radiofrequency Thermal Ablation and Microdebrider-Assisted Turbinoplasty in Inferior Turbinate Hypertrophy: A Prospective, Randomized, and Clinical Study

PubMed Central

Akagün, Fatih; İmamoğlu, Mehmet; Çobanoğlu, Hatice Bengü; Ural, Ahmet

2016-01-01

Objective To compare the effectiveness of radiofrequency thermal ablation with those of microdebrider-assisted turbinoplasty, we designed a prospective, randomized clinical study. Methods Forty patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Half of the patients were operated by radiofrequency thermal ablation, while the other half underwent microdebrider-assisted turbinoplasty. The outcomes of both techniques were compared in terms of symptomatology, nasal patency, and mucociliary transport. Results A statistically significant difference existed between the two groups with respect to nasal obstruction and the frequency of obstruction at the first post-operative week and first and third post-operative months (p<0.05). Rhinomanometry detected a significant decrease in nasal resistance values in both surgical groups compared to the preoperative values. The mucociliary transport time was significantly prolonged in the first postoperative week and first postoperative month in microdebrider-assisted inferior turbinoplasty group. Conclusion Both radiofrequency thermal ablation and microdebrider-assisted turbinoplasty are effective techniques for treating inferior turbinate hypertrophy. The treatment modality should be individually determined, and parameters such as tissue healing, volume reduction, and mucociliary activity must be taken into account. PMID:29392030

Gesture in the developing brain

PubMed Central

Dick, Anthony Steven; Goldin-Meadow, Susan; Solodkin, Ana; Small, Steven L.

2011-01-01

Speakers convey meaning not only through words, but also through gestures. Although children are exposed to co-speech gestures from birth, we do not know how the developing brain comes to connect meaning conveyed in gesture with speech. We used functional magnetic resonance imaging (fMRI) to address this question and scanned 8- to 11-year-old children and adults listening to stories accompanied by hand movements, either meaningful co-speech gestures or meaningless self-adaptors. When listening to stories accompanied by both types of hand movements, both children and adults recruited inferior frontal, inferior parietal, and posterior temporal brain regions known to be involved in processing language not accompanied by hand movements. There were, however, age-related differences in activity in posterior superior temporal sulcus (STSp), inferior frontal gyrus, pars triangularis (IFGTr), and posterior middle temporal gyrus (MTGp) regions previously implicated in processing gesture. Both children and adults showed sensitivity to the meaning of hand movements in IFGTr and MTGp, but in different ways. Finally, we found that hand movement meaning modulates interactions between STSp and other posterior temporal and inferior parietal regions for adults, but not for children. These results shed light on the developing neural substrate for understanding meaning contributed by co-speech gesture. PMID:22356173

Lateralization of the human mirror neuron system.

PubMed

Aziz-Zadeh, Lisa; Koski, Lisa; Zaidel, Eran; Mazziotta, John; Iacoboni, Marco

2006-03-15

A cortical network consisting of the inferior frontal, rostral inferior parietal, and posterior superior temporal cortices has been implicated in representing actions in the primate brain and is critical to imitation in humans. This neural circuitry may be an evolutionary precursor of neural systems associated with language. However, language is predominantly lateralized to the left hemisphere, whereas the degree of lateralization of the imitation circuitry in humans is unclear. We conducted a functional magnetic resonance imaging study of imitation of finger movements with lateralized stimuli and responses. During imitation, activity in the inferior frontal and rostral inferior parietal cortex, although fairly bilateral, was stronger in the hemisphere ipsilateral to the visual stimulus and response hand. This ipsilateral pattern is at variance with the typical contralateral activity of primary visual and motor areas. Reliably increased signal in the right superior temporal sulcus (STS) was observed for both left-sided and right-sided imitation tasks, although subthreshold activity was also observed in the left STS. Overall, the data indicate that visual and motor components of the human mirror system are not left-lateralized. The left hemisphere superiority for language, then, must be have been favored by other types of language precursors, perhaps auditory or multimodal action representations.

Endoscopic modified medial maxillectomy for treatment of inverted papilloma originating from the maxillary sinus.

PubMed

Erbek, Selim S; Koycu, Alper; Buyuklu, Fuat

2015-05-01

Endoscopic approaches have become an alternative to external approaches in the treatment of sinonasal inverted papillomas (IPs) in recent years. The aim of this study was to analyze the outcomes of endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate in selected IP cases. Medical charts of patients diagnosed with IP originating from the maxillary sinus between July 2008 and August 2013 were reviewed. Eight patients who had undergone endoscopic modified medial maxillectomy were included in the study. Attachment of IP was located on the medial wall of the maxillary sinus in all cases. The nasolacrimal duct was preserved in all of the patients. The inferior turbinate was completely preserved in 5 patients, and the anterior part of the inferior turbinate was preserved in 3 patients. The mean follow-up period of the patients was 30.8 months (12-60  mo). None of the patients had recurrence or major complications. The postoperative complaints were minor hemorrhagic discharge and crusting for the first few weeks. Endoscopic modified medial maxillectomy preserving the nasolacrimal duct and the inferior turbinate provides good surgical and functional outcomes in selected IP cases.

Social hierarchy modulates neural responses of empathy for pain

PubMed Central

Feng, Chunliang; Li, Zhihao; Feng, Xue; Wang, Lili; Tian, Tengxiang

2016-01-01

Recent evidence indicates that empathic responses to others’ pain are modulated by various situational and individual factors. However, few studies have examined how empathy and underlying brain functions are modulated by social hierarchies, which permeate human society with an enormous impact on social behavior and cognition. In this study, social hierarchies were established based on incidental skill in a perceptual task in which all participants were mediumly ranked. Afterwards, participants were scanned with functional magnetic resonance imaging while watching inferior-status or superior-status targets receiving painful or non-painful stimulation. The results revealed that painful stimulation applied to inferior-status targets induced higher activations in the anterior insula (AI) and anterior medial cingulate cortex (aMCC), whereas these empathic brain activations were significantly attenuated in response to superior-status targets’ pain. Further, this neural empathic bias to inferior-status targets was accompanied by stronger functional couplings of AI with brain regions important in emotional processing (i.e. thalamus) and cognitive control (i.e. middle frontal gyrus). Our findings indicate that emotional sharing with others’ pain is shaped by relative positions in a social hierarchy such that underlying empathic neural responses are biased toward inferior-status compared with superior-status individuals. PMID:26516169

The Involvement of Occipital and Inferior Frontal Cortex in the Phonological Learning of Chinese Characters

PubMed Central

Deng, Yuan; Chou, Tai-li; Ding, Guo-sheng; Peng, Dan-ling; Booth, James R.

2016-01-01

Neural changes related to the learning of the pronunciation of Chinese characters in English speakers were examined using fMRI. We examined the item-specific learning effects for trained characters and the generalization of phonetic knowledge to novel transfer characters that shared a phonetic radical (part of a character that gives a clue to the whole character’s pronunciation) with trained characters. Behavioral results showed that shared phonetic information improved performance for transfer characters. Neuroimaging results for trained characters over learning found increased activation in the right lingual gyrus, and greater activation enhancement in the left inferior frontal gyrus (Brodmann’s area 44) was correlated with higher accuracy improvement. Moreover, greater activation for transfer characters in these two regions at the late stage of training was correlated with better knowledge of the phonetic radical in a delayed recall test. The current study suggests that the right lingual gyrus and the left inferior frontal gyrus are crucial for the learning of Chinese characters and the generalization of that knowledge to novel characters. Left inferior frontal gyrus is likely involved in phonological segmentation, whereas right lingual gyrus may subserve processing visual–orthographic information. PMID:20807053

[Injection of methylene blue into inferior mesenteric artery improves lymph node harvest in rectal cancer after neoadjuvant chemotherapy].

PubMed

Liu, Jianpei; Huang, Pinjie; Huang, Jianglong; Chen, Tufeng; Wei, Hongbo

2015-06-09

To confirm the feasibility of improving lymph node harvest by injecting methylene blue into inferior mesenteric artery in rectal cancer after neoadjuvant therapy. Forty two ex vivo specimens were collected from rectal cancer patients with neoadjuvant therapy and radical operation at our hospital. Traditional method with palpation and injection of methylene blue into inferior mesenteric artery were employed. The data of lymph node harvest were analyzed by paired t and chi-square tests. The average number of detected lymph node in traditional method and methylene blue groups were 6.1 ± 4.3 and 15.2 ± 6.4 respectively (P<0.001). The proportions of lymph nodes <5 mm were 14.1% and 46.7% in traditional method and methylene blue groups respectively (P<0.001). And the injection of methylene blue added 13 extra metastatic lymph nodes and caused a shift to node-positive stage (P=0.89). Neoadjuvant therapy decrease lymph node retrieval in rectal cancer. Injecting methylene blue into inferior mesenteric artery improves lymph node harvest especially for small nodes and helps to acquire more metastatic nodes for accurate pathological staging.

Radiofrequency Coblation Versus Intramural Bipolar Cautery for the Treatment of Inferior Turbinate Hypertrophy.

PubMed

Shah, Anil N; Brewster, Douglas; Mitzen, Kelly; Mullin, David

2015-09-01

Compare intramural bipolar electrocautery and radiofrequency coblation in the treatment of inferior turbinate hypertrophy with regards to objective and subjective improvement in nasal obstruction, rate and type of complications, experience during the procedure, and rate of recovery. Prospective, single-blinded study. Single tertiary medical center from 2008 to 2010. Forty-one adult patients with inferior turbinate hypertrophy refractory to medical management were treated with radiofrequency coblation in one nostril and intramural bipolar cautery in the other. Subjective and objective data, including use of a Visual Analog Scale (VAS) for subjective outcomes, acoustic rhinometry, and nasal endoscopy, were then obtained from each patient comparing the 2 techniques. Radiofrequency coblation was significantly less painful than intramural bipolar cautery during the procedure (P = .03) and during the early postoperative period (P < .02) and produced less crusting at 3 weeks (P = .009). Both interventions were similar in subjective and objective improvements in nasal obstruction as measured by acoustic rhinometry and subjective VAS outcomes. Radiofrequency coblation seems to offer an equivalent alternative to bipolar electrocautery for the treatment of inferior turbinate hypertrophy with less discomfort during the procedure and early post-operative period. © The Author(s) 2015.

Modality Specific Cerebro-Cerebellar Activations in Verbal Working Memory: An fMRI Study

PubMed Central

Kirschen, Matthew P.; Chen, S. H. Annabel; Desmond, John E.

2010-01-01

Verbal working memory (VWM) engages frontal and temporal/parietal circuits subserving the phonological loop, as well as, superior and inferior cerebellar regions which have projections from these neocortical areas. Different cerebro-cerebellar circuits may be engaged for integrating aurally- and visually-presented information for VWM. The present fMRI study investigated load (2, 4, or 6 letters) and modality (auditory and visual) dependent cerebro-cerebellar VWM activation using a Sternberg task. FMRI revealed modality-independent activations in left frontal (BA 6/9/44), insular, cingulate (BA 32), and bilateral inferior parietal/supramarginal (BA 40) regions, as well as in bilateral superior (HVI) and right inferior (HVIII) cerebellar regions. Visual presentation evoked prominent activations in right superior (HVI/CrusI) cerebellum, bilateral occipital (BA19) and left parietal (BA7/40) cortex while auditory presentation showed robust activations predominately in bilateral temporal regions (BA21/22). In the cerebellum, we noted a visual to auditory emphasis of function progressing from superior to inferior and from lateral to medial regions. These results extend our previous findings of fMRI activation in cerebro-cerebellar networks during VWM, and demonstrate both modality dependent commonalities and differences in activations with increasing memory load. PMID:20714061

Do turbinate reduction procedures restore epithelial integrity in patients with turbinate hypertrophy secondary to allergic rhinitis? A histopathological study.

PubMed

Lukka, Vijaya Kumar; Jacob, Tripti Meriel; Jeyaseelan, Visalakshi; Rupa, Vedantam

2018-06-01

Consensus has not been reached regarding the optimal reduction procedure for inferior turbinate hypertrophy in allergic rhinitis and whether such procedures result in improvement in mucosal architecture. Twenty-nine patients aged 18-45 years (mean 26.8 years), with allergic rhinitis and inferior turbinate hypertrophy not responsive to medical therapy who underwent endoscopic submucosal diathermy (ESMD) (14 patients) or endoscopic submucosal resection (ESMR) (15 patients) with intraoperative and 3-6 months postoperative inferior turbinate biopsies, were included in the study. Epithelial and mucosal architecture was compared between the two groups. Both groups showed a significant decrease in epithelial denudation (p < 0.001), reversal of basement membrane thickening (p < 0.001) and increase in density of cilia (p < 0.001). The degree of improvement in histological characteristics between ESMD and ESMR groups was not significant. Surgical intervention for inferior turbinate hypertrophy by both ESMD and ESMR results in significant restoration of nasal mucosal epithelium in patients with allergic rhinitis as early as 3-month postoperatively. There was, however, no significant difference in the histological changes between those who underwent ESMD and ESMR. CTRI/2015/01/005373.

Neural systems for speech and song in autism

PubMed Central

Pantazatos, Spiro P.; Schneider, Harry

2012-01-01

Despite language disabilities in autism, music abilities are frequently preserved. Paradoxically, brain regions associated with these functions typically overlap, enabling investigation of neural organization supporting speech and song in autism. Neural systems sensitive to speech and song were compared in low-functioning autistic and age-matched control children using passive auditory stimulation during functional magnetic resonance and diffusion tensor imaging. Activation in left inferior frontal gyrus was reduced in autistic children relative to controls during speech stimulation, but was greater than controls during song stimulation. Functional connectivity for song relative to speech was also increased between left inferior frontal gyrus and superior temporal gyrus in autism, and large-scale connectivity showed increased frontal–posterior connections. Although fractional anisotropy of the left arcuate fasciculus was decreased in autistic children relative to controls, structural terminations of the arcuate fasciculus in inferior frontal gyrus were indistinguishable between autistic and control groups. Fractional anisotropy correlated with activity in left inferior frontal gyrus for both speech and song conditions. Together, these findings indicate that in autism, functional systems that process speech and song were more effectively engaged for song than for speech and projections of structural pathways associated with these functions were not distinguishable from controls. PMID:22298195

Creativity and the default network: A functional connectivity analysis of the creative brain at rest.

PubMed

Beaty, Roger E; Benedek, Mathias; Wilkins, Robin W; Jauk, Emanuel; Fink, Andreas; Silvia, Paul J; Hodges, Donald A; Koschutnig, Karl; Neubauer, Aljoscha C

2014-11-01

The present research used resting-state functional magnetic resonance imaging (fMRI) to examine whether the ability to generate creative ideas corresponds to differences in the intrinsic organization of functional networks in the brain. We examined the functional connectivity between regions commonly implicated in neuroimaging studies of divergent thinking, including the inferior prefrontal cortex and the core hubs of the default network. Participants were prescreened on a battery of divergent thinking tests and assigned to high- and low-creative groups based on task performance. Seed-based functional connectivity analysis revealed greater connectivity between the left inferior frontal gyrus (IFG) and the entire default mode network in the high-creative group. The right IFG also showed greater functional connectivity with bilateral inferior parietal cortex and the left dorsolateral prefrontal cortex in the high-creative group. The results suggest that the ability to generate creative ideas is characterized by increased functional connectivity between the inferior prefrontal cortex and the default network, pointing to a greater cooperation between brain regions associated with cognitive control and low-level imaginative processes. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Liver hanging maneuver for right hemiliver in situ donation – anatomical considerations

PubMed Central

Gadžijev, E.M.; Ravnik, D.; Hribernik, M.

2006-01-01

Background. An anatomical study was carried out to evaluate the safety of the liver hanging maneuver for the right hemiliver in living donor and in situ splitting transplantation. During this procedure a 4–6 cm blind dissection is performed between the inferior vena cava and the liver. Short subhepatic veins entering the inferior vena cava from segments 1 and 9 could be torn with consequent hemorrhage. Materials and methods. One hundred corrosive casts of livers were evaluated to establish the position and diameter of short subhepatic veins and the inferior right hepatic vein. Results. The average distance from the right border of the inferior vena cava to the opening of segment 1 veins was 16.7±3.4 mm and to the entrance of segment 9 veins was 5.0±0.5 mm. The width of the narrowest point on the route of blind dissection was determined, with the average value being 8.7±2.3 mm (range 2–15 mm). Discussion. The results show that the liver hanging maneuver is a safe procedure. A proposed route of dissection minimizes the risk of disrupting short subhepatic veins (7%). PMID:18333236

Modality specific cerebro-cerebellar activations in verbal working memory: an fMRI study.

PubMed

Kirschen, Matthew P; Chen, S H Annabel; Desmond, John E

2010-01-01

Verbal working memory (VWM) engages frontal and temporal/parietal circuits subserving the phonological loop, as well as, superior and inferior cerebellar regions which have projections from these neocortical areas. Different cerebro-cerebellar circuits may be engaged for integrating aurally- and visually-presented information for VWM. The present fMRI study investigated load (2, 4, or 6 letters) and modality (auditory and visual) dependent cerebro-cerebellar VWM activation using a Sternberg task. FMRI revealed modality-independent activations in left frontal (BA 6/9/44), insular, cingulate (BA 32), and bilateral inferior parietal/supramarginal (BA 40) regions, as well as in bilateral superior (HVI) and right inferior (HVIII) cerebellar regions. Visual presentation evoked prominent activations in right superior (HVI/CrusI) cerebellum, bilateral occipital (BA19) and left parietal (BA7/40) cortex while auditory presentation showed robust activations predominantly in bilateral temporal regions (BA21/22). In the cerebellum, we noted a visual to auditory emphasis of function progressing from superior to inferior and from lateral to medial regions. These results extend our previous findings of fMRI activation in cerebro-cerebellar networks during VWM, and demonstrate both modality dependent commonalities and differences in activations with increasing memory load.

A new teaching model for demonstrating the movement of the extraocular muscles.

PubMed

Iwanaga, Joe; Refsland, Jason; Iovino, Lee; Holley, Gary; Laws, Tyler; Oskouian, Rod J; Tubbs, R Shane

2017-09-01

The extraocular muscles consist of the superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles. This study aimed to create a new teaching model for demonstrating the function of the extraocular muscles. A coronal section of the head was prepared and sutures attached to the levator palpebral superioris muscle and six extraocular muscles. Tension was placed on each muscle from a posterior approach and movement of the eye documented from an anterior view. All movements were clearly seen less than that of the inferior rectus muscle. To our knowledge, this is the first cadaveric teaching model for demonstrating the movements of the extraocular muscles. Clin. Anat. 30:733-735, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Neural Mechanism of Inferring Person's Inner Attitude towards Another Person through Observing the Facial Affect in an Emotional Context.

PubMed

Kim, Ji-Woong; Kim, Jae-Jin; Jeong, Bumseok; Kim, Sung-Eun; Ki, Seon Wan

2010-03-01

The goal of the present study was to identify the brain mechanism involved in the attribution of person's attitude toward another person, using facial affective pictures and pictures displaying an affectively-loaded situation. Twenty four right-handed healthy subjects volunteered for our study. We used functional magnetic resonance imaging (MRI) to examine brain activation during attitude attribution task as compared to gender matching tasks. We identified activation in the left inferior frontal cortex, left superior temporal sulcus, and left inferior parietal lobule during the attitude attribution task, compared to the gender matching task. This study suggests that mirror neuron system and ventrolateral inferior frontal cortex play a critical role in the attribution of a person's inner attitude towards another person in an emotional situation.

[Anomalous connection of inferior vena cava to left atrium: infrequent entity that can be a diagnosis and surgical challenge].

PubMed

Archundia García, A; Gómez Alvarez, E; Ixcamparij Rosales, C; Blanco Canto, M; Hernández Ruiz, M A

2000-01-01

This is the diagnostic experiences as well as the surgical mode of treatment used in a 31 years old women suffering diversion of the inferior vena cava into the left atrium associated with atrial septal defect. The patient had been previously studied and operated thrice under conventional circumstances at different institutions in order to solve the septal defect. The hemodynamic solution had not been reached due to a missing pathological definition. The cineangiogram through the saphenous vein specified the left atrium form the inferior vena cava. Some considerations are made on the surgical methods used for the fourth operation, and in regard of the fact that the patient refused blood transfusion because of religious convictions (Jehova Witness).

Bard Denali inferior vena cava filter fracture and embolization resulting in cardiac tamponade: a device failure analysis.

PubMed

Kuo, William T; Robertson, Scott W

2015-01-01

A 46-year-old woman underwent inferior vena cava filter placement before bariatric surgery and returned within 6 months for routine removal. She complained of a 1-week history of severe chest pain, and during retrieval, two fractured filter components were identified including one arm in the right ventricle. The filter body and one fragment were successfully retrieved, but the fragment in the right ventricle was refractory to percutaneous retrieval. During open-heart surgery, the fragment was found traversing through the ventricular wall resulting in cardiac tamponade. Electron microscopic fragment analysis revealed high-cycle metal fatigue indicating the filter design failed to withstand this patient's natural inferior vena cava biomechanical motions. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

When standards are wide of the mark: nonselective superiority and inferiority biases in comparative judgments of objects and concepts.

PubMed

Giladi, Eilath E; Klar, Yechiel

2002-12-01

People are frequently required to judge how particular group members measure up against others in their group. According to the local-comparisons-general-standards (LOGE) approach, in these member-to-group comparisons, people fail to use the normatively appropriate local (group) standard and are infelicitously affected by a more general standard (involving instances from outside the judged group). Within positive groups, target group members are judged superior to the other members of the group, and within negative groups, inferior. To date, these nonselective superiority and inferiority biases have been demonstrated solely in judgments about human beings. In 6 experiments, nonselective biases were found in perceptual, affective, and cognitive judgments of nonhuman targets, objects, and concepts, thus supporting a cognitive rather than a social account.

Differential expression of c-fos following administration of two tremorgenic agents: harmaline and oxotremorine.

PubMed

Miwa, H; Nishi, K; Fuwa, T; Mizuno, Y

2000-08-03

The regional distribution of c-Fos expression in the brain after the administration of two tremorgenic agents was studied. In both the harmaline- and oxotremorin-treated rats, c-Fos-positive neurons were extensively distributed in the basal ganglia nuclei and the cerebellum. Additionally, in the harmaline-treated rats, numerous c-Fos-positive neurons were also distributed throughout the inferior olivary nucleus. In the oxotremorine-treated rats, while the inferior olive was not involved, c-Fos was strongly expressed in the neurons of the reticular thalamic nucleus, possibly due to the muscarinic effects of oxotremorine. The present study revealed that the inferior olive is selectively activated in the harmaline-administered animals and that the basal ganglia are involved in both harmaline- and oxotremorine-induced tremors.

[Inferior hemiarthroplasty of the temporo-mandibular joint with articulated condylar prosthesis type Stryker].

PubMed

Bucur, A; Dincă, O; Totan, C; Ghită, V

2007-01-01

The optimal reconstruction of the mandible and of the temporo-mandibular joint after mandibular hemi-resection with disarticulation is still controversial in literature. This paperwork presents our experience on four cases in the reconstruction of the mandible together with the inferior arthroplasty of the temporo-mandibular joint, after the resection of extended benign tumors of the mandible, based on fibular free vascularized grafts having attached a Stryker titanium condylar prosthesis reconstructing the inferior segment of the temporo-mandibular joint. Our results for the this technique were excellent, with a functional rehabilitation very close to normal. After reviewing the various techniques and their arguments in literature, with accent on the TMJ reconstruction, we consider this method to be optimal for the reconstruction of mandibular defects in patients with neoplastic conditions.

The Medial Temporal Lobe and the Left Inferior Prefrontal Cortex Jointly Support Interference Resolution in Verbal Working Memory

ERIC Educational Resources Information Center

Oztekin, Ilke; Curtis, Clayton E.; McElree, Brian

2009-01-01

During working memory retrieval, proactive interference (PI) can be induced by semantic similarity and episodic familiarity. Here, we used fMRI to test hypotheses about the role of the left inferior frontal gyrus (LIFG) and the medial temporal lobe (MTL) regions in successful resolution of PI. Participants studied six-word lists and responded to a…

The Right Posterior Inferior Frontal Gyrus Contributes to Phonological Word Decisions in the Healthy Brain: Evidence from Dual-Site TMS

ERIC Educational Resources Information Center

Hartwigsen, Gesa; Price, Cathy J.; Baumgaertner, Annette; Geiss, Gesine; Koehnke, Maria; Ulmer, Stephan; Siebner, Hartwig R.

2010-01-01

There is consensus that the left hemisphere plays a dominant role in language processing, but functional imaging studies have shown that the right as well as the left posterior inferior frontal gyri (pIFG) are activated when healthy right-handed individuals make phonological word decisions. Here we used online transcranial magnetic stimulation…

The Loss and Search for the Puer, A Consideration of Inferiority Feelings in Certain Male Adolescents.

ERIC Educational Resources Information Center

Daher, Douglas

1981-01-01

A sense of inferiority in adolescent males can result from a split senex-puer archetype, a Jungian construct focused on the individual's identification with and/or repression of psychic age and youth. Adolescents experience healing of the split senex-puer archetype to the degrees to which they involve themselves in the eros and power of their life…

Pioneer Venus observations during Comet Halley's inferior conjunction

NASA Technical Reports Server (NTRS)

Russell, C. T.; Luhmann, J. G.; Scarf, F. L.

1985-01-01

On Feb. 4, 1986, Halley passed through inferior conjunction with Venus but was at high latitudes. Not all data for this time period have been received. However, the data that are available suggest that at most only weak effects associated with Halley were seen at Pioneer Venus. The data during this time, however, are useful for correlating with the behavior of the plasma tail.

Nephroblastoma with right atrial extension: preoperative diagnosis and management.

PubMed

Vaughan, E D; Crosby, I K; Tegtmeyer, C J

1977-04-01

A 14-year-old black boy, with a large nephroblastoma of the right kidney, had preoperative identification of inferior vena cava and right atrial involvement. Renal arteriography revealed linear arterial channels in the anatomic distribution of the inferior vena cava and venography revealed total caval occlusion and a right atrial mass. Radical excision, using a cardiopulmonary bypass, resulted in a 6-month postoperative survival.

Bird's Nest Filter Causing Symptomatic Hydronephrosis Following Transmural Penetration of the Inferior Vena Cava

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

Stacey, C.S., E-mail: cheika@doctors.org.uk; Manhire, A.R.; Rose, D.H.

2004-01-15

We report a case of symptomatic hydronephrosis caused by transcaval penetration of a Bird's Nest filter. Perforation of the wall of the inferior vena cava (IVC) following insertion of a caval filter is a well-recognized complication. Whilst two cases of hydronephrosis have been described with Greenfield filters, no case involving a Bird's Nest filter has been reported previously.

Procedural and Indwelling Complications with Inferior Vena Cava Filters: Frequency, Etiology, and Management

PubMed Central

Milovanovic, Lazar; Kennedy, Sean A.; Midia, Mehran

2015-01-01

Inferior vena cava (IVC) filters are commonly used in select high-risk patients for the prevention of pulmonary embolism. Potentially serious complications can arise from the use of IVC filters, including thrombosis of the filter itself and filter fragment embolization. This article discusses the utility of IVC filters and reviews the management of two cases of filter-related complications. PMID:25762846

Online versus Live Delivery of Education to Pharmacists in a Large Multicentre Health Region: A Non-inferiority Assessment of Learning Outcomes.

PubMed

Taylor, Robert; Jung, Joanne; Loewen, Peter; Spencer, Carrie; Dossa, Anar; de Lemos, Jane

2013-07-01

The prevalence of online modules for continuing education in the health professions has been increasing in recent years. However, the effectiveness of online modules for pharmacist learning has not been thoroughly studied. The primary aim of this study was to determine if providing education to pharmacists through a self-paced enhanced online module was non-inferior to a face-to-face learning module with respect to knowledge application on the topic of postoperative insulin dosing. Secondary aims were to determine pharmacists' knowledge gain and retention, as well as their satisfaction with the modules. The participants in this prospective, randomized, parallel-group non-inferiority trial were pharmacists in a large multicentre health region. Outcomes were measured by comparing scores obtained on pre- and post-module knowledge-assessment questionnaires. A between-group difference in change on knowledge application scores of less than 25 percentage points was the predetermined non-inferiority margin. A total of 74 pharmacists consented to participate, 38 randomly assigned to use the enhanced online module and 36 to attend the face-to-face learning session. For questions examining knowledge application, the mean improvement achieved by the online learning group was 26 percentage points greater than that achieved by the face-to-face learning group (95% confidence interval [CI] 25 to 27; p < 0.001). For questions testing knowledge gain, the improvement achieved by the online learning group was 7 percentage points less than that achieved by the face-to-face learning group (95% CI 2 to 12; p = 0.008). Therefore, the enhanced online module was deemed to be non-inferior to the face-to-face learning session in terms of knowledge application and knowledge gain. Insufficient data were available to analyze the secondary outcome of knowledge retention over time. Participant satisfaction was similar for the 2 groups (p = 0.62). The self-paced enhanced online module was non-inferior to facilitated face-to-face learning in terms of improving application and knowledge of insulin dosing. Pharmacists had similar levels of satisfaction with the 2 modes of learning.

The signer and the sign: cortical correlates of person identity and language processing from point-light displays.

PubMed

Campbell, Ruth; Capek, Cheryl M; Gazarian, Karine; MacSweeney, Mairéad; Woll, Bencie; David, Anthony S; McGuire, Philip K; Brammer, Michael J

2011-09-01

In this study, the first to explore the cortical correlates of signed language (SL) processing under point-light display conditions, the observer identified either a signer or a lexical sign from a display in which different signers were seen producing a number of different individual signs. Many of the regions activated by point-light under these conditions replicated those previously reported for full-image displays, including regions within the inferior temporal cortex that are specialised for face and body-part identification, although such body parts were invisible in the display. Right frontal regions were also recruited - a pattern not usually seen in full-image SL processing. This activation may reflect the recruitment of information about person identity from the reduced display. A direct comparison of identify-signer and identify-sign conditions showed these tasks relied to a different extent on the posterior inferior regions. Signer identification elicited greater activation than sign identification in (bilateral) inferior temporal gyri (BA 37/19), fusiform gyri (BA 37), middle and posterior portions of the middle temporal gyri (BAs 37 and 19), and superior temporal gyri (BA 22 and 42). Right inferior frontal cortex was a further focus of differential activation (signer>sign). These findings suggest that the neural systems supporting point-light displays for the processing of SL rely on a cortical network including areas of the inferior temporal cortex specialized for face and body identification. While this might be predicted from other studies of whole body point-light actions (Vaina, Solomon, Chowdhury, Sinha, & Belliveau, 2001) it is not predicted from the perspective of spoken language processing, where voice characteristics and speech content recruit distinct cortical regions (Stevens, 2004) in addition to a common network. In this respect, our findings contrast with studies of voice/speech recognition (Von Kriegstein, Kleinschmidt, Sterzer, & Giraud, 2005). Inferior temporal regions associated with the visual recognition of a person appear to be required during SL processing, for both carrier and content information. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

3D navigated implantation of the glenoid component in reversed shoulder arthroplasty. Feasibility and results in an anatomic study.

PubMed

Stübig, Timo; Petri, Maximilian; Zeckey, Christian; Hawi, Nael; Krettek, Christian; Citak, Musa; Meller, Rupert

2013-12-01

Reversed shoulder arthroplasty is an alternative to total shoulder arthroplasty for various indications. The long-term results depend on stable bone fixation, and correct positioning of the glenoid component. The potential contribution of image guidance for reversed shoulder arthroplasty procedures was tested in vitro. 27 positioning procedures (15 navigated, 12 non-navigated) of the glenoid baseplate in reverse shoulder arthroplasty were performed by a single experienced orthopaedic surgeon. A Kirschner wire was placed freehand or with the use of a navigated drill guide. For the navigated procedures, a flat detector 3D C-arm with navigation system was used. The Kirschner wire was to be inserted 12 mm from the inferior glenoid, with an inferior tilt of 10° and centrally in the axial scapular axis. The insertion point in the glenoid as well as the position of the K-wire in the axial and sagittal planes were measured. For statistical analysis, t-tests were performed with a significance level of 0.05. The inferior glenoid drilling distance was 14.1 ± 3.4 mm for conventional placement and 15.1 ± 3.4 mm for the navigated procedure (P = 0.19). The inferior tilt showed no significant difference between the two methods (conventional 7.4 ± 5.2°, navigated 7.7 ± 4.9°, P = 0.63). The glenoid version in the axial plane showed significantly higher accuracy for the navigated procedure, with a mean deviation of 1.6 ±4.5° for the navigated procedure compared with 11.5 ± 6.5° for the conventional procedure(P = 0.004). Accurate positioning of the glenoidal baseplate in the axial scapular plane can be improved using 3D C-arm navigation for reversed shoulder arthroplasty. However, computer navigation may not improve the inferior tilt of the component or the position in the inferior glenoid to avoid scapular notching. Nevertheless, further studies are required to confirm these findings in the clinical setup. Copyright © 2013 John Wiley & Sons, Ltd.

Anterior loop of the inferior alveolar nerve: Averages and prevalence based on CT scans.

PubMed

Juan, Del Valle Lovato; Grageda, Edgar; Gómez Crespo, Salvador

2016-02-01

The treatment of edentulous patients by using a complete implant-supported fixed prosthetic with distal extension has been widely studied; success is mainly dependent upon the placement of the distal implants. The location of the inferior alveolar nerve determines implant placement, but the length, prevalence, and symmetry between the left and right side of the anterior loop of the alveolar nerve are unknown. The purpose of this clinical study was to measure the anterior loop of the inferior alveolar nerve, which determines the placement of distal implants, in a group of 55 Mexican participants. The study expected to ascertain the average length, prevalence, and symmetry between left and right side and any sex differences. To differentiate the inferior alveolar nerve path, a new technique was applied using Hounsfield unit (HU) thresholds. The null hypothesis was that no significant differences would be found between the left and right sides or between men and women for the anterior loop of the inferior alveolar nerve. Fifty-five computed tomography (CT) scans were made (Somatom Sensation 16; Siemens Healthcare) and were visualized with InVesalius software. Anterior loop measurements were made on 3-dimensional surfaces. To determine statistical differences between the left and right side and between the sexes, the t test was used. The interclass correlation coefficient test was also applied to verify the reliability of the measurements. Ninety percent of participants showed the anterior loop of the inferior alveolar nerve. The length of the anterior loop ranged between 0 and 6.68 mm, with a mean of 2.19 mm. No significant differences were found between the left and right sides or between men and women. The mean length for the anterior loop in the sample was 2.19 mm. As the anterior loop length shows a high degree of variability, these findings suggest that a CT scan for each patient is recommended in order to visualize a safety zone before placing implants close to the mental foramen. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Relationship between the occlusal plane corresponding to the lateral borders of the tongue and ala-tragus line in edentulous patients.

PubMed

Ghosn, Carole Abi; Zogheib, Carla; Makzoumé, Joseph E

2012-09-01

Definitions of the ala-tragus line (ATL) cause confusion, because the exact points of reference for this line do not agree. This study determined the relationship between the prosthetic occlusal plane (OP) corresponding to the lateral borders of the tongue and ATL which was established by using the inferior border of the ala of the nose and (1) the superior border of the tragus (ATL 1), (2) the tip (ATL 2) and (3) the inferior border of the tragus (ATL 3). Neutral zone moldings using phonation and autopolymerizing acrylic resin were recorded and leveled with the lateral borders of the tongue. Lateral cephalometric radiographs were taken of each subject by a standard method. Tracings were obtained on acetate paper to show the prosthetic OP and the three ATLs. The relationship between the prosthetic OP and each of ATL was measured for each subject. Mean and standard deviation values were then calculated for the relationship. Statistical analysis was performed using repeated measure analysis of variance followed by Bonferroni pairwise comparisons and Student's t-test (α = 0.05). Significant difference was found between the three mean angles (p = 0.001). There was no significant difference between the mean angle (5.00° ± 4.38) formed by OP and ATL 2, and the mean angle (4.90° ± 3.50) formed by OP and ATL 3 (p = 1.00) which revealed the smallest. The findings of this study indicated that ATLs, extending from the inferior border of the ala of the nose to (1) the tip of the tragus of the ear, and (2) the inferior border of the tragus presented the closest relationship to the prosthetic OP corresponding to the lateral borders of the tongue. When the ATL is used for orientation of the OP in denture construction, it would seem preferable to define it as running from the inferior border of the ala of the nose to the tip or to the inferior border of the tragus of the ear.

Fos-defined activity in rat brainstem following centripetal acceleration.

PubMed

Kaufman, G D; Anderson, J H; Beitz, A J

1992-11-01

To identify rat brainstem nuclei involved in the initial, short-term response to a change in gravito-inertial force, adult Long-Evans rats were rotated in the horizontal plane for 90 min in complete darkness after they were eccentrically positioned off the axis of rotation (off-axis) causing a centripetal acceleration of 2 g. Neural activation was defined by the brainstem distribution of the c-fos primary response gene protein, Fos, using immunohistochemistry. The Fos labeling in off-axis animals was compared with that of control animals who were rotated on the axis of rotation (on-axis) with no centripetal acceleration, or who were restrained but not rotated. In the off-axis animals there was a significant labeling of neurons: in the inferior, medial, and y-group subnuclei of the vestibular complex; in subnuclei of the inferior olive, especially the dorsomedial cell column; in midbrain nuclei, including the interstitial nucleus of Cajal, nucleus of Darkschewitsch, Edinger-Westphal nucleus, and dorsolateral periaqueductal gray; in autonomic centers including the solitary nucleus, area postrema, and locus coeruleus; and in reticular nuclei including the lateral reticular nucleus and the lateral parabrachial nucleus. Also, there was greater Fos expression in the dorsomedial cell column, the principal inferior olive subnuclei, inferior vestibular nucleus, the dorsolateral central gray, and the locus coeruleus in animals who had their heads restrained compared to animals whose heads were not restrained. As one control, the vestibular neuroepithelium was destroyed by injecting sodium arsanilate into the middle ear, bilaterally. This resulted in a complete lack of Fos labeling in the vestibular nuclei and the inferior olive, and a significant reduction in labeling in other nuclei in the off-axis condition, indicating that these nuclei have a significant labyrinth-sensitive component to their Fos labeling. The data indicate that several novel brainstem regions, including the dorsomedial cell column of the inferior olive and the periaqueductal gray, as well as more traditional brainstem nuclei including vestibular and oculomotor related nuclei, respond to otolith activation during a sustained centripetal acceleration.

Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

PubMed Central

Wolfson, Julie; Sun, Can-Lan; Wyatt, Laura; Stock, Wendy; Bhatia, Smita

2017-01-01

Background Adolescents and young adults (AYA: 15-39y) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared to children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC; or Children's Oncology Group sites [COG]) on survival disparities remains unstudied. Methods Using the Los Angeles Cancer registry, we identified 1,870 ALL or AML patients between 1 and 39y at diagnosis. Cox regression analyses assessed risk of mortality; younger age+CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. Results ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21y: HR=1.9, p=0.005; 22-29y: HR=2.6, p<0.001; 30-39y: HR=3.0, p<0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21y: HR=1.3, p=0.3; 22-29y: HR=1.2, p=0.2) but was inferior for 30-39yo (HR=3.4, p<0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21y: HR=1.8, p=0.02; 22-39y: HR=1.4, p=0.06). Outcome at CCC/COG was comparable between children and 15-21yo (HR=1.3, p=0.4) but was inferior for 22-39yo (HR=1.7, p=0.05). Access: 15-21yo were less likely to use CCC/COG than children (p<0.001). In 22-39yo, public/uninsured (ALL: p=0.004; AML<0.001), African-American/Hispanics (ALL: p=0.03), and 30-39yo (ALL: p=0.03) were less likely to use CCC/COG. Conclusions Poor survival in AYAs with ALL and AML is mitigated by care at CCC/COG. Barriers to CCC/COG care include public/uninsured, and African-American/Hispanic race/ethnicity. Impact Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers. PMID:28209594

A Subset of Palisade Endings Only in the Medial and Inferior Rectus Muscle in Monkey Contain Calretinin

PubMed Central

Lienbacher, Karoline; Ono, Seiji; Fleuriet, Jérome; Mustari, Michael; Horn, Anja K. E.

2018-01-01

Purpose To further chemically characterize palisade endings in extraocular muscles in rhesus monkeys. Methods Extraocular muscles of three rhesus monkeys were studied for expression of the calcium-binding protein calretinin (CR) in palisade endings and multiple endings. The complete innervation was visualized with antibodies against the synaptosomal-associated protein of 25 kDa and combined with immunofluorescence for CR. Six rhesus monkeys received tracer injections of choleratoxin subunit B or wheat germ agglutinin into either the belly or distal myotendinous junction of the medial or inferior rectus muscle to allow retrograde tracing in the C-group of the oculomotor nucleus. Double-immunofluorescence methods were used to study the CR content in retrogradely labeled neurons in the C-group. Results A subgroup of palisade and multiple endings was found to express CR, only in the medial and inferior rectus muscle. In contrast, the en plaque endings lacked CR. Accordingly, within the tracer-labeled neurons of the C-group, a subgroup expressed CR. Conclusions The study indicates that two different neuron populations targeting nontwitch muscle fibers are present within the C-group for inferior rectus and medial rectus, respectively, one expressing CR, one lacking CR. It is possible that the CR-negative neurons represent the basic population for all extraocular muscles, whereas the CR-positive neurons giving rise to CR-positive palisade endings represent a specialized, perhaps more excitable type of nerve ending in the medial and inferior rectus muscles, being more active in vergence. The malfunction of this CR-positive population of neurons that target nontwitch muscle fibers could play a significant role in strabismus.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

PubMed

Pourkazemi, Maryam; Erfanparast, Leila; Sheykhgermchi, Sanaz; Ghanizadeh, Milad

2017-01-01

Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children. In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21. The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth. According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars' buccal mucosa is not anesthetized. How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method.

PubMed

Bae, Hyoung Won; Lee, Sang Yeop; Kim, Sangah; Park, Chan Keum; Lee, Kwanghyun; Kim, Chan Yun; Seong, Gong Je

2018-01-01

To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma. © Copyright: Yonsei University College of Medicine 2018

Scanning laser polarimetry, but not optical coherence tomography predicts permanent visual field loss in acute nonarteritic anterior ischemic optic neuropathy.

PubMed

Kupersmith, Mark J; Anderson, Susan; Durbin, Mary; Kardon, Randy

2013-08-15

Scanning laser polarimetry (SLP) reveals abnormal retardance of birefringence in locations of the edematous peripapillary retinal nerve fiber layer (RNFL), which appear thickened by optical coherence tomography (OCT), in nonarteritic anterior ischemic optic neuropathy (NAION). We hypothesize initial sector SLP RNFL abnormalities will correlate with long-term regional visual field loss due to ischemic injury. We prospectively performed automated perimetry, SLP, and high definition OCT (HD-OCT) of the RNFL in 25 eyes with acute NAION. We grouped visual field threshold and RNFL values into Garway-Heath inferior/superior disc sectors and corresponding superior/inferior field regions. We compared sector SLP RNFL thickness with corresponding visual field values at presentation and at >3 months. At presentation, 12 eyes had superior sector SLP reduction, 11 of which had inferior field loss. Six eyes, all with superior field loss, had inferior sector SLP reduction. No eyes had reduced OCT-derived RNFL acutely. Eyes with abnormal field regions had corresponding SLP sectors thinner (P = 0.003) than for sectors with normal field regions. During the acute phase, the SLP-derived sector correlated with presentation (r = 0.59, P = 0.02) and with >3-month after presentation (r = 0.44, P = 0.02) corresponding superior and inferior field thresholds. Abnormal RNFL birefringence occurs in sectors corresponding to regional visual field loss during acute NAION when OCT-derived RNFL shows thickening. Since the visual field deficits show no significant recovery, SLP can be an early marker for axonal injury, which may be used to assess recovery potential at RNFL locations with respect to new treatments for acute NAION.

The Magical Activation of Left Amygdala when Reading Harry Potter: An fMRI Study on How Descriptions of Supra-Natural Events Entertain and Enchant

PubMed Central

Hsu, Chun-Ting; Jacobs, Arthur M.; Altmann, Ulrike; Conrad, Markus

2015-01-01

Literature containing supra-natural, or magical events has enchanted generations of readers. When reading narratives describing such events, readers mentally simulate a text world different from the real one. The corresponding violation of world-knowledge during this simulation likely increases cognitive processing demands for ongoing discourse integration, catches readers’ attention, and might thus contribute to the pleasure and deep emotional experience associated with ludic immersive reading. In the present study, we presented participants in an MR scanner with passages selected from the Harry Potter book series, half of which described magical events, while the other half served as control condition. Passages in both conditions were closely matched for relevant psycholinguistic variables including, e.g., emotional valence and arousal, passage-wise mean word imageability and frequency, and syntactic complexity. Post-hoc ratings showed that readers considered supra-natural contents more surprising and more strongly associated with reading pleasure than control passages. In the fMRI data, we found stronger neural activation for the supra-natural than the control condition in bilateral inferior frontal gyri, bilateral inferior parietal lobules, left fusiform gyrus, and left amygdala. The increased activation in the amygdala (part of the salience and emotion processing network) appears to be associated with feelings of surprise and the reading pleasure, which supra-natural events, full of novelty and unexpectedness, brought about. The involvement of bilateral inferior frontal gyri likely reflects higher cognitive processing demand due to world knowledge violations, whereas increased attention to supra-natural events is reflected in inferior frontal gyri and inferior parietal lobules that are part of the fronto-parietal attention network. PMID:25671315

Diagnostic Capability of Peripapillary Retinal Thickness in Glaucoma Using 3D Volume Scans

PubMed Central

Simavli, Huseyin; Que, Christian John; Akduman, Mustafa; Rizzo, Jennifer L.; Tsikata, Edem; de Boer, Johannes F.; Chen, Teresa C.

2015-01-01

Purpose To determine the diagnostic capability of spectral domain optical coherence tomography (SD-OCT) peripapillary retinal thickness (RT) measurements from 3-dimensional (3D) volume scans for primary open angle glaucoma (POAG). Design Cross-sectional study. Methods Setting Institutional Study population 156 patients (89 POAG and 67 normal subjects) Observation procedures One eye of each subject was included. SD-OCT peripapillary RT values from 3D volume scans were calculated for four quadrants of three different sized annuli. Peripapillary retinal nerve fiber layer (RNFL) thickness values were also determined. Main outcome measures Area under the receiver operating characteristic curve (AUROC) values, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Results The top five RT AUROCs for all glaucoma patients and for a subset of early glaucoma patients were for the inferior quadrant of outer circumpapillary annulus of circular grid (OCA) 1 (0.959, 0.939), inferior quadrant of OCA2 (0.945, 0.921), superior quadrant of OCA1 (0.890, 0.811), inferior quadrant of OCA3 (0.887, 0.854), and superior quadrant of OCA2 (0.879, 0.807). Smaller RT annuli OCA1 and OCA2 consistently showed better diagnostic performance than the larger RT annulus OCA3. For both RNFL and RT measurements, best AUROC values were found for inferior RT OCA1 and OCA2, followed by inferior and overall RNFL thickness. Conclusion Peripapillary RT measurements from 3D volume scans showed excellent diagnostic performance for detecting both glaucoma and early glaucoma patients. Peripapillary RT values have the same or better diagnostic capability compared to peripapillary RNFL thickness measurements, while also having fewer algorithm errors. PMID:25498354

Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial.

PubMed

Kim, Ho-Joong; Ahn, Hyo Sae; Nam, Yunjin; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

2017-11-01

To compare the efficacy of a transdermal buprenorphine patch (5, 10, 15, and 20 μg/h) with that of oral tramadol (150, 200, 250, and 300 mg) for postoperative pain control after single level spinal fusion surgery. The present study (ClinicalTrials.gov, number NCT02416804) was a prospective, randomized controlled non-inferiority trial designed to determine the efficacy of buprenorphine TDS for alleviating postoperative pain following patient controlled analgesia (PCA) in persons underwent a single level posterior lumbar interbody fusion surgery through 1:1 allocation. The primary outcome was the Visual Analog Pain Scale (VAS) score for postoperative back pain at 7 days after surgery. The non-inferior margin of the VAS was set at δ = 1.5 points. The VAS score (primary outcome) for postoperative back pain at 7 days after surgery in the Buprenorphine group was not inferior compared to the Tramadol group. The overall changes in VAS scores for postoperative pain during follow-up assessments over a 2-week period did not differ between both groups. However, the VAS scores for postoperative pain significantly improved with time after surgery in both groups. The patterns of changes in the VAS scores for postoperative pain during the follow-up period were not significantly different between the both groups. The efficacy of buprenorphine TDS was not inferior to that of oral tramadol medication for alleviating postoperative pain in the subacute period from 72 h after surgery, following PCA administration. In addition, adverse events were similar between both groups.

Analysis of Relative Parallelism Between Hamular-Incisive-Papilla Plane and Campers Plane in Edentulous Subjects: A Comparative Study.

PubMed

Tambake, Deepti; Shetty, Shilpa; Satish Babu, C L; Fulari, Sangamesh G

2014-12-01

The study was undertaken to evaluate the parallelism between hamular-incisive-papilla plane (HIP) and the Campers plane. And to determine which part of the posterior reference of the tragus i.e., the superior, middle or the inferior of the Camper's plane is parallel to HIP using digital lateral cephalograms. Fifty edentulous subjects with well formed ridges were selected for the study. The master casts were obtained using the standard selective pressure impression procedure. On the deepest point of the hamular notches and the centre of the incisive papilla stainless steel spherical bearings were glued to the cast at the marked points. The study templates were fabricated with autopolymerizing acrylic resin. The subjects were prepared for the lateral cephalograms. Stainless steel spherical bearings were adhered to the superior, middle, inferior points of the tragus of the ear and inferior border of the ala of the nose using surgical adhesive tape. The subjects with study templates were subjected to lateral cephalograms. Cephalometric tracings were done using Autocad 2010 software. Lines were drawn connecting the incisive papilla and hamular notch and the stainless steel spherical bearings placed on the superior, middle and inferior points on the tragus and the ala of the nose i.e., the Campers line S, Campers line M, Campers line I. The angles between the three Camper's line and the HIP were measured and recorded. Higher mean angulation was recorded in Campers line S -HIP (8.03) followed by Campers line M-HIP (4.60). Campers line I-HIP recorded the least angulation (3.80). The HIP is parallel to the Camper's plane. The Camper's plane formed with the posterior reference point as inferior point of the tragus is relatively parallel to the HIP.

Rethinking non-inferiority: a practical trial design for optimising treatment duration.

PubMed

Quartagno, Matteo; Walker, A Sarah; Carpenter, James R; Phillips, Patrick Pj; Parmar, Mahesh Kb

2018-06-01

Background Trials to identify the minimal effective treatment duration are needed in different therapeutic areas, including bacterial infections, tuberculosis and hepatitis C. However, standard non-inferiority designs have several limitations, including arbitrariness of non-inferiority margins, choice of research arms and very large sample sizes. Methods We recast the problem of finding an appropriate non-inferior treatment duration in terms of modelling the entire duration-response curve within a pre-specified range. We propose a multi-arm randomised trial design, allocating patients to different treatment durations. We use fractional polynomials and spline-based methods to flexibly model the duration-response curve. We call this a 'Durations design'. We compare different methods in terms of a scaled version of the area between true and estimated prediction curves. We evaluate sensitivity to key design parameters, including sample size, number and position of arms. Results A total sample size of ~ 500 patients divided into a moderate number of equidistant arms (5-7) is sufficient to estimate the duration-response curve within a 5% error margin in 95% of the simulations. Fractional polynomials provide similar or better results than spline-based methods in most scenarios. Conclusion Our proposed practical randomised trial 'Durations design' shows promising performance in the estimation of the duration-response curve; subject to a pending careful investigation of its inferential properties, it provides a potential alternative to standard non-inferiority designs, avoiding many of their limitations, and yet being fairly robust to different possible duration-response curves. The trial outcome is the whole duration-response curve, which may be used by clinicians and policymakers to make informed decisions, facilitating a move away from a forced binary hypothesis testing paradigm.

Individual structural differences in left inferior parietal area are associated with schoolchildrens' arithmetic scores

PubMed Central

Li, Yongxin; Hu, Yuzheng; Wang, Yunqi; Weng, Jian; Chen, Feiyan

2013-01-01

Arithmetic skill is of critical importance for academic achievement, professional success and everyday life, and childhood is the key period to acquire this skill. Neuroimaging studies have identified that left parietal regions are a key neural substrate for representing arithmetic skill. Although the relationship between functional brain activity in left parietal regions and arithmetic skill has been studied in detail, it remains unclear about the relationship between arithmetic achievement and structural properties in left inferior parietal area in schoolchildren. The current study employed a combination of voxel-based morphometry (VBM) for high-resolution T1-weighted images and fiber tracking on diffusion tensor imaging (DTI) to examine the relationship between structural properties in the inferior parietal area and arithmetic achievement in 10-year-old schoolchildren. VBM of the T1-weighted images revealed that individual differences in arithmetic scores were significantly and positively correlated with the gray matter (GM) volume in the left intraparietal sulcus (IPS). Fiber tracking analysis revealed that the forceps major, left superior longitudinal fasciculus (SLF), bilateral inferior longitudinal fasciculus (ILF) and inferior fronto-occipital fasciculus (IFOF) were the primary pathways connecting the left IPS with other brain areas. Furthermore, the regression analysis of the probabilistic pathways revealed a significant and positive correlation between the fractional anisotropy (FA) values in the left SLF, ILF and bilateral IFOF and arithmetic scores. The brain structure-behavior correlation analyses indicated that the GM volumes in the left IPS and the FA values in the tract pathways connecting left IPS were both related to children's arithmetic achievement. The present findings provide evidence that individual structural differences in the left IPS are associated with arithmetic scores in schoolchildren. PMID:24367320

The magical activation of left amygdala when reading Harry Potter: an fMRI study on how descriptions of supra-natural events entertain and enchant.

PubMed

Hsu, Chun-Ting; Jacobs, Arthur M; Altmann, Ulrike; Conrad, Markus

2015-01-01

Literature containing supra-natural, or magical events has enchanted generations of readers. When reading narratives describing such events, readers mentally simulate a text world different from the real one. The corresponding violation of world-knowledge during this simulation likely increases cognitive processing demands for ongoing discourse integration, catches readers' attention, and might thus contribute to the pleasure and deep emotional experience associated with ludic immersive reading. In the present study, we presented participants in an MR scanner with passages selected from the Harry Potter book series, half of which described magical events, while the other half served as control condition. Passages in both conditions were closely matched for relevant psycholinguistic variables including, e.g., emotional valence and arousal, passage-wise mean word imageability and frequency, and syntactic complexity. Post-hoc ratings showed that readers considered supra-natural contents more surprising and more strongly associated with reading pleasure than control passages. In the fMRI data, we found stronger neural activation for the supra-natural than the control condition in bilateral inferior frontal gyri, bilateral inferior parietal lobules, left fusiform gyrus, and left amygdala. The increased activation in the amygdala (part of the salience and emotion processing network) appears to be associated with feelings of surprise and the reading pleasure, which supra-natural events, full of novelty and unexpectedness, brought about. The involvement of bilateral inferior frontal gyri likely reflects higher cognitive processing demand due to world knowledge violations, whereas increased attention to supra-natural events is reflected in inferior frontal gyri and inferior parietal lobules that are part of the fronto-parietal attention network.

The Role of Superior Oblique Posterior Tenectomy Along With Inferior Rectus Recessions for the Treatment of Chin-up Head Positioning in Patients With Nystagmus.

PubMed

Escuder, Anna G; Ranka, Milan P; Lee, Kathy; Nam, Julie N; Steele, Mark A

2018-05-29

To evaluate the clinical outcomes of bilateral superior oblique posterior 7/8th tenectomy with inferior rectus recession on improving chin-up head positioning in patients with horizontal nystagmus. Medical records were reviewed from 2007 to 2017 for patients with nystagmus and chin-up positioning of 15° or more who underwent combined bilateral superior oblique posterior 7/8th tenectomy with an inferior rectus recession of at least 5 mm. Thirteen patients (9 males and 4 females) were included, with an average age of 7.3 years (range: 1.8 to 15 years). Chin-up positioning ranged from 15° to 45° degrees (average: 30°). Three patients had prior horizontal muscle surgeries, 1 for esotropia and 2 for horizontal null zones causing anomalous face turns. Ten patients underwent other concomitant eye muscle surgery: 3 had esotropia, 1 had exotropia, and 2 had biplanar nystagmus null point requiring a horizontal Anderson procedure. Four patients underwent simultaneous bilateral medial rectus tenotomy and reattachment. All patients had improved chin-up positioning. Eight patients had complete resolution, whereas 5 had minimal residual chin-up positioning. Three patients developed an eccentric horizontal gaze null point with compensatory anomalous face turn with onset 2 weeks, 2 years, and 3 years postoperatively. Average follow-up was 42.7 months. No postoperative pattern deviations, cyclodeviations, or inferior oblique overaction were seen. No surgical complications were noted. Bilateral superior oblique posterior 7/8th tenectomy in conjunction with bilateral inferior rectus recession is a safe and effective procedure for improving chin-up head positioning in patients with horizontal nystagmus with a down gaze null point. [J Pediatr Ophthalmol Strabismus. 201X;XX(X):XX-XX.]. Copyright 2018, SLACK Incorporated.

Clinically relevant anatomy of recurrent laryngeal nerve.

PubMed

Haller, Justin M; Iwanik, Michael; Shen, Francis H

2012-01-15

An anatomic study of anterior cervical dissection of 11 embalmed cadavers. To determine the anatomic relationship of the recurrent laryngeal nerve (RLN) to the cervical spine and demonstrate vulnerability of the nerve during anterior surgical approach. The most common complications of anterior neck surgery are dysphagia and RLN palsy. The morbidity of these complications has led to the investigation of the impact of sidedness in anterior cervical spine surgery. Eleven adult cadavers (5 male/6 female) were dissected bilaterally to expose the path of the recurrent laryngeal nerve. The right RLN branched from the vagus nerve at the level of T1-T2 or inferior in all specimens. After looping around the subclavian artery, the right RLN became invested in the tracheoesophageal fascia greater than 0.5 cm inferior to C7-T1 in all specimens. The RLN traveled superiorly, slightly anterior to the tracheoesophageal groove, before coursing between the trachea and the thyroid. In 82% (9 of 11) of right-sided dissections, the RLN entered the larynx at or inferior to C6-C7. After looping around the aortic arch, the left RLN was invested in the tracheoesophageal fascia inferior to the T2 level in 100% (10 of 10) of cadavers. The nerve traveled slightly anterior to the tracheoesophageal groove and within the tracheoesophageal fascia before coursing between the trachea and thyroid. In all the left-sided dissections, the RLN entered the larynx at or inferior to C6-C7. This study found that superior to C7-T1, both RLNs had similar anatomic courses and received similar protection via surrounding soft-tissue structures. From an anatomic perspective, the authors did not appreciate a side-to-side difference superior to this level that could place either nerve under greater risk for injury.

Superior Recess Access of the Lumbar Facet Joint.

PubMed

Demir-Deviren, Sibel; Singh, Sukhminder; Hanelin, Joshua

2017-04-01

Descriptive approach to accessing the lumbar facet joint by superior recess. This study is aimed to describe an approach to accessing the lumbar facet joint through targeting the superior recess during lumbar facet joint injections. Lumbar facet joint injections are routinely performed for both the diagnosis and treatment of chronic low back pain. Previous studies either did not specify which part of the joint to target, or recommended targeting the inferior aspect of the joint to access the inferior recess. One study did mention the superior recess as an alternative to injecting the inferior recess, but none has focused on description of the technique. This is the first time this technique has been described. The records and fluoroscopic images were reviewed for all patients over a period of 9 months (January-September 2012) using the proposed technique. This resulted in a total of 48 patients; 15 men, 29 women, and a total of 117 facet joint intra-articular injections. Among these 48 patients, injections were repeated in total of 4 cases. The average time of injections among 4 repeat cases was 121 days. The success of the procedure was confirmed with an arthrogram demonstrating contrast flowing from the superior recess inferiorly through the joint space. Successful access of the lumbar facet joint through puncture of the superior recess was seen in 114 cases, with 3 unsuccessful attempts to enter facet joints due to osteophytes at involved levels. There were no complications observed during the procedure. We find this approach to be highly successful, safe, and well tolerated by the patient and recommend it as a technique for access of the lumbar facet joint in those patients in whom direct puncture of the inferior recess is difficult.

Parecoxib, propacetamol, and their combination for analgesia after total hip arthroplasty: a randomized non-inferiority trial.

PubMed

Camu, F; Borgeat, A; Heylen, R J; Viel, E J; Boye, M E; Cheung, R Y

2017-01-01

This study assessed non-inferiority of parecoxib vs. combination parecoxib+propacetamol and compared the opioid-sparing effects of parecoxib, propacetamol, and parecoxib+propacetamol vs. placebo after total hip arthroplasty. In this randomized, placebo-controlled, parallel-group, non-inferiority study, patients received one of four IV treatments after surgery: parecoxib 40 mg bid (n = 72); propacetamol 2 g qid (n = 71); parecoxib 40 mg bid plus propacetamol 2 g qid (n = 72); or placebo (n = 38) with supplemental IV patient-controlled analgesia (morphine). Patients and investigators were blinded to treatment. Pain intensity at rest and with movement was assessed regularly, together with functional recovery (modified Brief Pain Inventory-Short Form) and opioid-related side effects (Opioid-Related Symptom Distress Scale) questionnaires up to 48 h. After 24 h, cumulative morphine consumption was reduced by 59.8% (P < 0.001), 38.9% (P < 0.001), and 26.8% (P = 0.005) in the parecoxib+propacetamol, parecoxib, and propacetamol groups, respectively, compared with placebo. Parecoxib did not meet criteria for non-inferiority to parecoxib+propacetamol. Parecoxib+propacetamol and parecoxib significantly reduced least-squares mean pain intensity scores at rest and with movement compared with propacetamol (P < 0.05). One day after surgery, parecoxib+propacetamol significantly reduced opioid-related symptom distress and decreased pain interference with function compared with propacetamol or placebo. Parecoxib and parecoxib+propacetamol provided significant opioid-sparing efficacy compared with placebo; non-inferiority of parecoxib to parecoxib+propacetamol was not demonstrated. Opioid-sparing efficacy was accompanied by significant reductions in pain intensity on movement, improved functional outcome, and less opioid-related symptom distress. Study medications were well tolerated. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Left inferior frontal cortex and syntax: function, structure and behaviour in patients with left hemisphere damage

PubMed Central

Marslen-Wilson, William D.; Randall, Billi; Wright, Paul; Devereux, Barry J.; Zhuang, Jie; Papoutsi, Marina; Stamatakis, Emmanuel A.

2011-01-01

For the past 150 years, neurobiological models of language have debated the role of key brain regions in language function. One consistently debated set of issues concern the role of the left inferior frontal gyrus in syntactic processing. Here we combine measures of functional activity, grey matter integrity and performance in patients with left hemisphere damage and healthy participants to ask whether the left inferior frontal gyrus is essential for syntactic processing. In a functional neuroimaging study, participants listened to spoken sentences that either contained a syntactically ambiguous or matched unambiguous phrase. Behavioural data on three tests of syntactic processing were subsequently collected. In controls, syntactic processing co-activated left hemisphere Brodmann areas 45/47 and posterior middle temporal gyrus. Activity in a left parietal cluster was sensitive to working memory demands in both patients and controls. Exploiting the variability in lesion location and performance in the patients, voxel-based correlational analyses showed that tissue integrity and neural activity—primarily in left Brodmann area 45 and posterior middle temporal gyrus—were correlated with preserved syntactic performance, but unlike the controls, patients were insensitive to syntactic preferences, reflecting their syntactic deficit. These results argue for the essential contribution of the left inferior frontal gyrus in syntactic analysis and highlight the functional relationship between left Brodmann area 45 and the left posterior middle temporal gyrus, suggesting that when this relationship breaks down, through damage to either region or to the connections between them, syntactic processing is impaired. On this view, the left inferior frontal gyrus may not itself be specialized for syntactic processing, but plays an essential role in the neural network that carries out syntactic computations. PMID:21278407

[Morphological and laminar distribution of cholecystokinin-immunoreactive neurons in cortex of human inferior parietal lobe and their clinical significance].

PubMed

Puskas, Laslo; Draganić-Gajić, Saveta; Malobabić, Slobodan; Puskas, Nela; Krivokuća, Dragan; Stanković, Gordana

2008-01-01

Cholecystocinine is a neuropeptide whose function in the cortex has not yet been clarified, although its relation with some psychic disorders has been noticed. Previous studies have not provided detailed data about types, or arrangement of neurons that contain those neuropeptide in the cortex of human inferior parietal lobe. The aim of this study was to examine precisely the morphology and typography of neurons containing cholecytocinine in the human cortex of inferior parietal lobule. There were five human brains on which we did the immunocystochemical research of the shape and laminar distribution of cholecystocinine immunoreactive neurons on serial sections of supramarginal gyrus and angular gyrus. The morphological analysis of cholecystocinine-immunoreactive neurons was done on frozen sections using avidin-biotin technique, by antibody to cholecystocinine diluted in the proportion 1:6000 using diamine-benzedine. Cholecystocinine immunoreactive neurons were found in the first three layers of the cortex of inferior parietal lobule, and their densest concentration was in the 2nd and 3rd layer. The following types of neurons were found: bipolar neurons, then its fusiform subtype, Cajal-Retzius neurons (in the 1st layer), reverse pyramidal (triangular) and unipolar neurons. The diameters of some types of neurons were from 15 to 35 microm, and the diameters of dendritic arborization were from 85-207 microm. A special emphasis is put on the finding of Cajal-Retzius neurons that are immunoreactive to cholecystocinine, which demands further research. Bearing in mind numerous clinical studies pointing out the role of cholecystokinine in the pathogenesis of schizophrenia, the presence of a great number of cholecystokinine immunoreactive neurons in the cortex of inferior parietal lobule suggests their role in the pathogenesis of schizophrenia.

Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery.

PubMed

Cleva, Roberto de; Assumpção, Marianna Siqueira de; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Fló, Claudia; Lunardi, Adriana C; Jacob Filho, Wilson

2014-07-01

Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.

Neurogenic regulation of cochlear blood flow occurs along the basilar artery, the anterior inferior cerebellar artery and at branch points of the spiral modiolar artery.

PubMed

Wangemann, Philine; Wonneberger, Kai

2005-11-01

The cochlea receives its main blood supply from the basilar artery via the anterior inferior cerebellar artery and the spiral modiolar artery. Morphologic studies have shown sympathetic innervation along the spiral modiolar artery of the gerbil and the guinea pig and functional studies in the isolated in vitro superfused spiral modiolar artery of the gerbil have demonstrated norepinephrine-induced vasoconstrictions via alpha(1A)-adrenergic receptors. It is current unclear whether the sympathetic innervation is physiologically relevant. Stimulation of sympathetic ganglia in guinea pigs has been shown to alter cochlear blood flow in situ. Whether these changes originated from local or more systemic changes in the vascular diameter remained uncertain. The goal of the present study was to demonstrate the presence or absence of neurogenic changes in the diameter of the isolated in vitro superfused spiral modiolar artery, anterior inferior cerebellar artery and basilar artery from the gerbil and the guinea pig. Vascular diameter was monitored by videomicroscopy. Electric field stimulation was used to elicit neurotransmitter release. A reversible inhibitory effect of 10(-6) M tetrodotoxin was taken as criterion to discriminate between neurogenic and myogenic changes in vascular diameter. Mesentery arteries of comparable diameter, which are known to respond with a neurogenic vasoconstriction to electric field stimulation, served as controls. Basilar artery, anterior inferior cerebellar artery, spiral modiolar artery and mesentery arteries constricted in response to electric field stimulation. No dilations were observed. Myogenic and neurogenic vasoconstrictions were observed in all vessels. These observations suggest that the sympathetic innervation of the basilar artery, the anterior inferior cerebellar artery and branch points of the spiral modiolar artery is involved in a physiologically relevant control of the vascular diameter in the gerbil and the guinea pig.

Differential Clinical Implications of High-Degree Atrioventricular Block Complicating ST-Segment Elevation Myocardial Infarction according to the Location of Infarction in the Era of Primary Percutaneous Coronary Intervention

PubMed Central

Kim, Kyung Hwan; Ahn, Youngkeun; Kim, Young Jo; Cho, Myeong Chan; Kim, Wan

2016-01-01

Background and Objectives The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901). Conclusion In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent. PMID:27275168

A prospective cohort study of light transmission platelet aggregometry for bleeding disorders: is testing native platelet-rich plasma non-inferior to testing platelet count adjusted samples?

PubMed

Castilloux, Jean Francois; Moffat, Karen A; Liu, Yang; Seecharan, Jodi; Pai, Menaka; Hayward, Catherine P M

2011-10-01

Light transmission platelet aggregometry (LTA) is important to diagnose bleeding disorders. Experts recommend testing LTA with native (N) rather than platelet count adjusted (A) platelet-rich plasma (PRP), although it is unclear if this provides non-inferior, or superior, detection of bleeding disorders. Our goal was to determine if LTA with NPRP is non-inferior to LTA with APRP for bleeding disorder assessments. A prospective cohort of patients, referred for bleeding disorder testing, and healthy controls, were evaluated by LTA using common agonists, NPRP and APRP (adjusted to 250 x 10⁹ platelets/l). Recruitment continued until 40 controls and 40 patients with definite bleeding disorders were tested. Maximal aggregation (MA) data were assessed for the detection of abnormalities from bleeding disorders (all causes combined to limit bias), using sample-type specific reference intervals. Areas under receiver-operator curves (AUROC) were evaluated using pre-defined criteria (area differences: < 0.15 for non-inferiority, > 0 for superiority). Forty-four controls and 209 patients were evaluated. Chart reviews for 169 patients indicated 67 had bleeding disorders, 28 from inherited platelet secretion defects. Mean MA differences between NPRP and APRP were small for most agonists (ranges, controls: -3.3 to 5.8; patients: -3.0 to 13.7). With both samples, reduced MA with two or more agonists was associated with a bleeding disorder. AUROC differences between NPRP and APRP were small and indicated that NPRP were non-inferior to APRP for detecting bleeding disorders by LTA, whereas APRP met superiority criteria. Our study validates using either NPRP or APRP for LTA assessments of bleeding disorders.

Inferior parietal and right frontal contributions to trial-by-trial adaptations of attention to memory.

PubMed

Kizilirmak, Jasmin M; Rösler, Frank; Bien, Siegfried; Khader, Patrick H

2015-07-21

The attention to memory theory (AtoM) proposes that the same brain regions might be involved in selective processing of perceived stimuli (selective attention) and memory representations (selective retrieval). Although this idea is compelling, given consistently found neural overlap between perceiving and remembering stimuli, recent comparisons brought evidence for overlap as well as considerable differences. Here, we present a paradigm that enables the investigation of the AtoM hypothesis from a novel perspective to gain further insight into the neural resources involved in AtoM. Selective attention in perception is often investigated as a control process that shows lingering effects on immediately following trials. Here, we employed a paradigm capable of modulating selective retrieval in a similarly dynamic manner as in such selective-attention paradigms by inducing trial-to-trial shifts between relevant and irrelevant memory representations as well as changes of the width of the internal focus on memory. We found evidence for an involvement of bilateral inferior parietal lobe and right inferior frontal gyrus in reorienting the attentional focus on previously accessed memory representations. Moreover, we could dissociate the right inferior from the parietal activation in separate contrasts, suggesting that the right inferior frontal gyrus plays a role in facilitating attentional reorienting to memory representations when competing representations have been activated in the preceding trial, potentially by resolving this competition. Our results support the AtoM theory, i.e. that ventral frontal and parietal regions are involved in automatic attentional reorienting in memory, and highlight the importance of further investigations of the overlap and differences between regions involved in internal (memory) and external (perceptual) attentional selection. Copyright © 2015 Elsevier B.V. All rights reserved.

The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation: a randomized controlled non-inferiority trial.

PubMed

Wistrand, Camilla; Söderquist, Bo; Magnusson, Anders; Nilsson, Ulrica

2015-01-01

In clinical practice, patients who are awake often comment that cold surgical skin disinfectant is unpleasant. This is not only a problem of patients' experience; heat loss during the disinfection process is a problem that can result in hypothermia. Evidence for the efficacy of preheated disinfection is scarce. We tested whether preheated skin disinfectant was non-inferior to room-temperature skin disinfectant on reducing bacterial colonization during pacemaker implantation. This randomized, controlled, non-inferiority trial included 220 patients allocated to skin disinfection with preheated (36 °C) or room-temperature (20 °C) chlorhexidine solution in 70 % ethanol. Cultures were obtained by swabbing at 4 time-points; 1) before skin disinfection (skin surface), 2) after skin disinfection (skin surface), 3) after the incision (subcutaneously in the wound), and 4) before suturing (subcutaneously in the wound). The absolute difference in growth between patients treated with preheated versus room-temperature skin disinfectant was zero (90 % CI -0.101 to 0.101; preheated: 30 of 105 [28.6 %] vs. room-temperature: 32 of 112 [28.6 %]). The pre-specified margin for statistical non-inferiority in the protocol was set at 10 % for the preheated disinfectant. There were no significant differences between groups regarding SSIs three month postoperatively, which occurred in 0.9 % (1 of 108) treated with preheated and 1.8 % (2 of 112) treated with room-temperature skin disinfectant. Preheated skin disinfection is non-inferior to room-temperature disinfection in bacterial reduction. We therefore suggest that preheated skin disinfection become routine in clean surgery. The study is registered at ClinicalTrials.gov (NCTO2260479).

Inferior or double joint spaces injection versus superior joint space injection for temporomandibular disorders: a systematic review and meta-analysis.

PubMed

Li, Chunjie; Zhang, Yifan; Lv, Jun; Shi, Zongdao

2012-01-01

To compare the effect and safety of inferior or double temporomandibular joint spaces drug injection versus superior temporomandibular joint space injection in the treatment of temporomandibular disorders. MEDLINE (via Ovid, 1948 to March 2011), CENTRAL (Issue 1, 2011), Embase (1984 to March 2011), CBM (1978 to March 2011), and World Health Organization International Clinical Trials Registry Platform were searched electronically; relevant journals as well as references of included studies were hand-searched for randomized controlled trials comparing effect or safety of inferior or double joint spaces drug injection technique with those of superior space injection technique. Risk of bias assessment with the tool recommended by Cochrane Collaboration, reporting quality assessment with CONSORT and data extraction, were carried out independently by 2 reviewers. Meta-analysis was delivered with RevMan 5.0.23. Four trials with 349 participants were included. All the included studies had moderate risk of bias. Meta-analysis showed that inferior or double spaces injection technique could significantly increase 2.88 mm more maximal mouth opening (P = .0001) and alleviate pain intensity in the temporomandibular area on average by 9.01 mm visual analog scale scores (P = .0001) compared with superior space injection technique, but could not markedly change synthesized clinical index (P = .05) in the short term; nevertheless, they showed more beneficial maximal mouth opening (P = .002), pain relief (P < .0001), and synthesized clinical variable (P < .0001) in the long term than superior space injection. No serious adverse events were reported. Inferior or double temporomandibular joint spaces drug injection technique shows better effect than superior space injection technique, and their safety is affirmative. However, more high-quality studies are still needed to test and verify the evidence. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Valomaciclovir versus valacyclovir for the treatment of acute herpes zoster in immunocompetent adults: a randomized, double-blind, active-controlled trial.

PubMed

Tyring, Stephen K; Plunkett, Stephanie; Scribner, Anita R; Broker, Robert E; Herrod, John N; Handke, Lane T; Wise, John M; Martin, Paul A

2012-08-01

Herpes zoster is a common infectious disease that can result in significant acute and chronic morbidity. The safety and efficacy of once-daily oral valomaciclovir (EPB-348) was evaluated for non-inferiority to 3-times daily valacyclovir, an approved therapy. In this study, 373 immunocompetent adults with onset of a herpes zoster rash within the preceding 72 hr were randomly assigned to receive one of four treatments for 7 days: (1) EPB-348 1,000 mg once-daily; (2) EPB-348 2,000 mg once-daily; (3) EPB-348 3,000 mg once-daily; or (4) valacyclovir 1,000 mg 3-times daily. A 20% margin was the reference for non-inferiority assessment. For the primary efficacy measure of time to complete crusting of the zoster rash by Day 28, non-inferiority criteria were met for once-daily EPB-348 2,000 mg and once-daily EPB-348 3,000 mg compared to 3-times daily valacyclovir. Additionally, EPB-348 3,000 mg significantly shortened the time to complete rash crusting by Day 28 compared to valacyclovir. For secondary efficacy measures, non-inferiority was achieved for the EPB-348 1,000 and 2,000 mg groups compared to the valacyclovir group for time to rash resolution by Day 28. No EPB-348 group was non-inferior to valacyclovir for time to cessation of new lesion formation or time to cessation of pain by Day 120, though no significant differences occurred between treatment groups. Nausea, headache, and vomiting were the most common adverse events. Based on these results, additional studies are warranted to define further EPB-348's potential as an effective and safe therapy for acute herpes zoster. Copyright © 2012 Wiley Periodicals, Inc.

E-learning in pediatric basic life support: a randomized controlled non-inferiority study.

PubMed

Krogh, Lise Qvirin; Bjørnshave, Katrine; Vestergaard, Lone Due; Sharma, Maja Bendtsen; Rasmussen, Stinne Eika; Nielsen, Henrik Vendelbo; Thim, Troels; Løfgren, Bo

2015-05-01

Dissemination of pediatric basic life support (PBLS) skills is recommended. E-learning is accessible and cost-effective, but it is currently unknown whether laypersons can learn PBLS through e-learning. The hypothesis of this study was to investigate whether e-learning PBLS is non-inferior to instructor-led training. Participants were recruited among child-minders and parents of children aged 0-6 years. Participants were randomized to either 2-h instructor-led training or e-learning using an e-learning program (duration 17 min) including an inflatable manikin. After training, participants were assessed in a simulated pediatric cardiac arrest scenario. Tests were video recorded and PBLS skills were assessed independently by two assessors blinded to training method. Primary outcome was the pass rate of the PBLS test (≥8 of 15 skills adequately performed) with a pre-specified non-inferiority margin of 20%. In total 160 participants were randomized 1:1. E-learning was non-inferior to instructor-led training (difference in pass rate -4%; 95% CI -9:0.5). Pass rates were 100% among instructor-led trained (n=67) and 96% among e-learned (n=71). E-learners median time spent on the e-learning program was 30 min (range: 15-120 min) and the median number of log-ons was 2 (range: 1-5). After the study, all participants felt that their skills had improved. E-learning PBLS is non-inferior to instructor-led training among child-minders and parents with children aged 0-6 years, although the pass rate was 4% (95% CI -9:0.5) lower with e-learning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Pheochromocytoma with inferior vena cava thrombosis: An unusual association.

PubMed

Kota, Sunil K; Kota, Siva K; Jammula, Sruti; Meher, Lalit K; Modi, Kirtikumar D

2012-04-01

Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.

Cerebrocerebellar networks during articulatory rehearsal and verbal working memory tasks.

PubMed

Chen, S H Annabel; Desmond, John E

2005-01-15

Converging evidence has implicated the cerebellum in verbal working memory. The current fMRI study sought to further characterize cerebrocerebellar participation in this cognitive process by revealing regions of activation common to a verbal working task and an articulatory control task, as well as regions that are uniquely activated by working memory. Consistent with our model's predictions, load-dependent activations were observed in Broca's area (BA 44/6) and the superior cerebellar hemisphere (VI/CrusI) for both working memory and motoric rehearsal. In contrast, activations unique to verbal working memory were found in the inferior parietal lobule (BA 40) and the right inferior cerebellum hemisphere (VIIB). These findings provide evidence for two cerebrocerebellar networks for verbal working memory: a frontal/superior cerebellar articulatory control system and a parietal/inferior cerebellar phonological storage system.

Discrete model of the olivo-cerebellar system: structure and dynamics

NASA Astrophysics Data System (ADS)

Maslennikov, O. V.; Nekorkin, V. I.

2012-08-01

We propose a discrete model of the olivo-cerebellar system. The model consists of three layers of interacting elements, namely, inferior olive neurons, Purkinje cells, and deep cerebellar nuclear neurons combined into a structure by axonal connections. Each element of the structure is described by a two-dimensional map with an individual set of parameters for each type of neurons. Dynamic properties of different types of neurons are described and spontaneous and stimulusinduced dynamics of the system is explored. Unlike the previously proposed models, this study takes into account the axonal interaction of neurons of different layers, as well as the interaction of the inferior olive neurons through electrical synapses with the property of plasticity. It is shown that the inclusion of these factors plays a significant role in the formation of spatio-temporal activity of the inferior olive neurons.

Meandering Right Pulmonary Vein to the Left Atrium and Inferior Vena Cava

PubMed Central

Tortoriello, Tia A.; Vick, G. Wesley; Chung, Taylor; Bezold, Louis I.; Vincent, Julie A.

2002-01-01

We report a case of a healthy, asymptomatic 6-year-old boy in whom an anomalous right pulmonary vein was noted to drain into both the inferior vena cava and left atrium in association with findings consistent with scimitar syndrome. The anomalous pulmonary vein took a very circuitous route through the lungs before draining into the left atrium, a condition previously termed “meandering pulmonary vein.” To aid in the diagnosis, cardiovascular magnetic resonance imaging and magnetic resonance angiography were used to delineate this complex course and the connection of the anomalous pulmonary vein. To our knowledge, this is the 1st reported case of a meandering pulmonary vein with dual drainage to the inferior vena cava and left atrium in association with other anomalies. (Tex Heart Inst J 2002;29:319–23) PMID:12484618

Preliminary Evaluation of Atomization Characteristics of Improved Biodiesel for Gas Turbine Application

NASA Astrophysics Data System (ADS)

Kumaran, P.; Gopinathan, M.; Razali, N. M.; Kuperjans, Isabel; Hariffin, B.; Hamdan, H.

2013-06-01

Biodiesel is one of the clean burning alternative fuels derived from natural resources and animal fats which is promising fuel for gas turbine application. However, inferior properties of biodiesel such as high viscosity, density and surface tension results in inferior atomization and high emission, hence impedes the fuel compatible for gas turbine application and emits slightly higher emission pollutants due to inferior atomization. This research work focuses on preliminary evaluation of the atomization characteristics of derived from Malaysian waste cooking oil which is the physical properties are subsequently improved by a microwave assisted post treatment scheme. The results shows with improvement in physical properties achieved through the post treatment, biodiesel exhibits significantly better atomization characteristics in terms of spray angle, spray length, sauter mean diameter and shorter evaporation time compared to the biodiesel before improvement and fossil diesel.

Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials

PubMed Central

Markham, Donna; Plumb, Samantha; May, Kerry; Philip, Kathleen; Haas, Romi; Sarkies, Mitchell N.; Ghaly, Marcelle; Shackell, Melina; McPhail, Steven; McDermott, Fiona

2017-01-01

Background Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. Methods and findings We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the ‘current’ weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a ‘newly developed’ service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The ‘no weekend allied health service’ condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [−0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference −1.6 days [−2.0 to −1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [−0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: −0.01 [−0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [−0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (−0.03 [−0.05 to −0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. Conclusions In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796 PMID:29088237

Taking the mystery out of endodontics, Part 6. Painless anesthesia for the "hot" tooth.

PubMed

Weathers, A

1999-12-01

Much of what we were taught in dental school is no longer valid. In this article, I've examined some of the myths surrounding what I have dubbed the "inferior" inferior alveolar nerve block. Using the X-tip anesthesia system, it is now possible to achieve total, instant and profound anesthesia of the "hot" tooth, without the problems formerly associated with intraosseous injections.

Ophthalmic manifestations of maxillary sinus mucoceles.

PubMed

Ormerod, L D; Weber, A L; Rauch, S D; Feldon, S E

1987-08-01

Mucoceles involving any of the paranasal sinuses may present with ophthalmic disturbances. Maxillary antral mucoceles can encroach on the inferior orbit with ocular displacement and compression, proptosis or enophthalmos, lower lid distortion, tethering of extraocular muscles, and ptosis. Periocular pain, erosion of the inferior orbital rim, infraorbital nerve compression, epiphora, and inner canthal swellings are other important presentations. Postoperative mucoceles may involve only a portion of the antrum. Five illustrative cases are presented.

The position of lingula as an index for inferior alveolar nerve block injection in 7-11-year-old children.

PubMed

Ezoddini Ardakani, Fatemeh; Bahrololoumi, Zahra; Zangouie Booshehri, Maryam; Navab Azam, Alireza; Ayatollahi, Fatemeh

2010-01-01

Inferior alveolar nerve block injection is one of the common intra oral anesthetic techniques, with a failure rate of 15-20%. The aim of this study was to evaluate the position of the lingula as an index for this injection. Thirty eight panoramic radiographs of 7-11 year old patients were analyzed and the distance between the lingula index and occlusal plane was measured. Then, lower alveolar nerve block injection was performed on 88 children. Finally, a visual analogue scale was used to measure the rate of pain in the patients. This distance increased with age and in children younger than nine years is -0.45 mm on the right side and -0.95 mm on the left side. This distance in children older than 9 years is -0.23 mm on the right side and 0.47 mm on the left side. The success rates of inferior alveolar nerve block injection based on lingual index were 49% on the right side and 53.8% on the left side. As the lingual index has various positions and its distance from the occlusal plane increases with age, it is not an appropriate landmark for inferior alveolar nerve block injection.

The Position of Lingula as an Index for Inferior Alveolar Nerve Block Injection in 7-11-Year-Old Children

PubMed Central

Ezoddini Ardakani, Fatemeh; Bahrololoumi, Zahra; Zangouie Booshehri, Maryam; Navab Azam, Alireza; Ayatollahi, Fatemeh

2010-01-01

Background and aims Inferior alveolar nerve block injection is one of the common intra oral anesthetic techniques, with a failure rate of 15-20%. The aim of this study was to evaluate the position of the lingula as an index for this injection. Materials and methods Thirty eight panoramic radiographs of 7–11 year old patients were analyzed and the distance between the lingula index and occlusal plane was measured. Then, lower alveolar nerve block injection was performed on 88 children. Finally, a visual analogue scale was used to measure the rate of pain in the patients. Results This distance increased with age and in children younger than nine years is −0.45 mm on the right side and −0.95 mm on the left side. This distance in children older than 9 years is −0.23 mm on the right side and 0.47 mm on the left side. The success rates of inferior alveolar nerve block injection based on lingual index were 49% on the right side and 53.8% on the left side. Conclusion As the lingual index has various positions and its distance from the occlusal plane increases with age, it is not an appropriate landmark for inferior alveolar nerve block injection. PMID:22991596

Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars.

PubMed

Chopra, Radhika; Marwaha, Mohita; Bansal, Kalpana; Mittal, Meenu

2016-01-01

Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001). Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

Double-Blind Crossover Study to Compare Pain Experience During Inferior Alveolar Nerve Block Administration Using Buffered Two Percent Lidocaine in Children.

PubMed

Chopra, Radhika; Jindal, Garima; Sachdev, Vinod; Sandhu, Meera

2016-01-01

Buffering of anesthetic solutions has been suggested to reduce pain on injection and onset of anesthesia. The purpose of this study was to assess the reduction in pain on injection during inferior alveolar nerve block administration in children. A double blind crossover study was designed where 30 six- to 12-year-old patients received two sessions of inferior alveolar nerve block scheduled one week apart. Two percent lidocaine with 1:200,000 epinephrine was given during one appointment, and a buffered solution was given during the other. Pain on injection was assessed using the sound, eye, and motor (SEM) scale, and the time to onset was assessed after gingival probing. The Heft-Parker visual analogue scale (HP-VAS) was self recorded by the patient after administration of local anesthesia. When tested using Mann-Whitney analysis, no significant differences were found between the SEM scores (P=0.71) and HP-VAS scores (P=0.93) for the two solutions used. Student's t test was used to assess the difference in the onset of anesthesia, which was also found to be statistically insignificant (P=0.824). Buffered lidocaine did not reduce the pain on injection or time to onset of anesthesia for inferior alveolar nerve block in children.

Comparative study of the novel and conventional injection approach for inferior alveolar nerve block.

PubMed

Boonsiriseth, K; Sirintawat, N; Arunakul, K; Wongsirichat, N

2013-07-01

This study aimed to evaluate the efficacy of anesthesia obtained with a novel injection approach for inferior alveolar nerve block compared with the conventional injection approach. 40 patients in good health, randomly received each of two injection approaches of local anesthetic on each side of the mandible at two separate appointments. A sharp probe and an electric pulp tester were used to test anesthesia before injection, after injection when the patients' sensation changed, and 5 min after injection. This study comprised positive aspiration and intravascular injection 5% and neurovascular bundle injection 7.5% in the conventional inferior alveolar nerve block, but without occurrence in the novel injection approach. A visual analog scale (VAS) pain assessment was used during injection and surgery. The significance level used in the statistical analysis was p<0.05. For the novel injection approach compared with the conventional injection approach, no significant difference was found on the subjective onset, objective onset, operation time, duration of anesthesia and VAS pain score during operation, but the VAS pain score during injection was significantly different. The efficacy of inferior alveolar nerve block by the novel injection approach provided adequate anesthesia and caused less pain and greater safety during injection. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Subliminal semantic priming changes the dynamic causal influence between the left frontal and temporal cortex.

PubMed

Matsumoto, Atsushi; Kakigi, Ryusuke

2014-01-01

Recent neuroimaging experiments have revealed that subliminal priming of a target stimulus leads to the reduction of neural activity in specific regions concerned with processing the target. Such findings lead to questions about the degree to which the subliminal priming effect is based only on decreased activity in specific local brain regions, as opposed to the influence of neural mechanisms that regulate communication between brain regions. To address this question, this study recorded EEG during performance of a subliminal semantic priming task. We adopted an information-based approach that used independent component analysis and multivariate autoregressive modeling. Results indicated that subliminal semantic priming caused significant modulation of alpha band activity in the left inferior frontal cortex and modulation of gamma band activity in the left inferior temporal regions. The multivariate autoregressive approach confirmed significant increases in information flow from the inferior frontal cortex to inferior temporal regions in the early time window that was induced by subliminal priming. In the later time window, significant enhancement of bidirectional causal flow between these two regions underlying subliminal priming was observed. Results suggest that unconscious processing of words influences not only local activity of individual brain regions but also the dynamics of neural communication between those regions.

Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

PubMed Central

Aguirre-Avalos, Guadalupe; Covarrubias-Velasco, Marco Antonio; Rojas-Sánchez, Antonio Gerardo

2013-01-01

Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine Objective: Unusual clinical course Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the “piggyback” technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications. PMID:24046802

Comminuted inferior pole fracture of patella can be successfully treated with rim-plate-augmented separate vertical wiring.

PubMed

Cho, Jae-Woo; Kim, Jinil; Cho, Won-Tae; Gujjar, Pranay H; Oh, Chang-Wug; Oh, Jong-Keon

2018-02-01

We present the surgical technique of rim-plate-augmented separate vertical wiring for comminuted inferior pole fracture of the patella and report the clinical outcomes. Between July 2013 and January 2016, 13 patients (7 male and 6 female) who were diagnosed with comminuted inferior pole fracture of the patella in preoperative computed tomography and underwent a minimum of 1 year of follow-up were enrolled in this study. Mean patient age was 57.7 years (range 28-72 years). All patients underwent open reduction and internal fixation by rim-plate-augmented separate vertical wiring. Bony union, complications, range of motion and Bostman score were the clinical outcomes. Bony union was achieved in all cases at an average of 10 weeks after surgery (range 8-12). There was no loss of reduction and fixative failure during follow-up. The average range of motion was 127° (range 120°-130°). The mean Bostman score at last follow-up was 29.6 points (range 27-30) and graded excellent in 12 patients. Rim-plate-augmented separate vertical wiring demonstrated secure fixation and favorable clinical outcomes. This study provides evidence for its effectiveness as a fixation method for treating displaced, comminuted inferior pole fracture of the patella.

CBT4BN versus CBTF2F: Comparison of Online versus Face-To-FaceTreatment for Bulimia Nervosa

PubMed Central

Bulik, Cynthia M.; Marcus, Marsha D.; Zerwas, Stephanie; Levine, Michele D.; Hofmeier, Sara; Trace, Sara E.; Hamer, Robert M.; Zimmer, Benjamin; Moessner, Markus; Kordy, Hans

2012-01-01

Cognitive-behavioral therapy (CBT) is currently the “gold standard” for treatment of bulimia nervosa (BN), and is effective for approximately 40–60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN. PMID:22659072

Anesthetic efficacy of the supplemental X-tip intraosseous injection using 4% articaine with 1:100,000 adrenaline in patients with irreversible pulpitis: An in vivo study.

PubMed

Bhuyan, Atool Chandra; Latha, Satheesh Sasidharan; Jain, Shefali; Kataki, Rubi

2014-11-01

Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist-patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis.

Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing.

PubMed

Oh, Hyoung-Keun; Choo, Suk-Kyu; Kim, Ji-Wan; Lee, Mark

2015-12-01

We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function. Copyright © 2015 Elsevier Ltd. All rights reserved.

Development of Right-hemispheric Dominance of Inferior Parietal Lobule in Proprioceptive Illusion Task.

PubMed

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

2017-11-01

Functional lateralization can be an indicator of brain maturation. We have consistently shown that, in the adult brain, proprioceptive processing of muscle spindle afferents generating illusory movement of the right hand activates inferior frontoparietal cortical regions in a right-side dominant manner in addition to the cerebrocerebellar motor network. Here we provide novel evidence regarding the development of the right-dominant use of the inferior frontoparietal cortical regions in humans using this task. We studied brain activity using functional magnetic resonance imaging while 60 right-handed blindfolded healthy children (8-11 years), adolescents (12-15 years), and young adults (18-23 years) (20 per group) experienced the illusion. Adult-like right-dominant use of the inferior parietal lobule (IPL) was observed in adolescents, while children used the IPL bilaterally. In contrast, adult-like lateralized cerebrocerebellar motor activation patterns were already observable in children. The right-side dominance progresses during adolescence along with the suppression of the left-sided IPL activity that emerges during childhood. Therefore, the neuronal processing implemented in the adult's right IPL during the proprioceptive illusion task is likely mediated bilaterally during childhood, and then becomes right-lateralized during adolescence at a substantially later time than the lateralized use of the cerebrocerebellar motor system for kinesthetic processing. © The Author 2017. Published by Oxford University Press.

Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.

PubMed

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

2006-09-01

Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival. A consecutive sample clinical study with a mean follow-up of 40 months. The surgical department of an academic tertiary center and an affiliated secondary care center. Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava. All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases. Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis. No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years. Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava.

Social hierarchy modulates neural responses of empathy for pain.

PubMed

Feng, Chunliang; Li, Zhihao; Feng, Xue; Wang, Lili; Tian, Tengxiang; Luo, Yue-Jia

2016-03-01

Recent evidence indicates that empathic responses to others' pain are modulated by various situational and individual factors. However, few studies have examined how empathy and underlying brain functions are modulated by social hierarchies, which permeate human society with an enormous impact on social behavior and cognition. In this study, social hierarchies were established based on incidental skill in a perceptual task in which all participants were mediumly ranked. Afterwards, participants were scanned with functional magnetic resonance imaging while watching inferior-status or superior-status targets receiving painful or non-painful stimulation. The results revealed that painful stimulation applied to inferior-status targets induced higher activations in the anterior insula (AI) and anterior medial cingulate cortex (aMCC), whereas these empathic brain activations were significantly attenuated in response to superior-status targets' pain. Further, this neural empathic bias to inferior-status targets was accompanied by stronger functional couplings of AI with brain regions important in emotional processing (i.e. thalamus) and cognitive control (i.e. middle frontal gyrus). Our findings indicate that emotional sharing with others' pain is shaped by relative positions in a social hierarchy such that underlying empathic neural responses are biased toward inferior-status compared with superior-status individuals. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

[Amplitude Changes of Low Frequency Fluctuation in Brain Spontaneous Nervous Activities Induced by Needling at Hand Taiyin Lung Channel].

PubMed

Zhou, You-long; Su, Cheng-guo; Liu, Shou-fang; Jin, Xiang-yu; Duan, Yan-li; Chen, Xiao-yan; Zhao, Shu-hua; Wang, Quan-liang; Dang, Chang-lin

2016-05-01

To observe amplitude changes of low frequency fluctuation in brain spontaneous nervous activities induced by needling at Hand Taiyin Lung Channel, and to preliminarily explore the possible brain function network of Hand Taiyin Lung Channel. By using functional magnetic resonance imaging (fMRI), 16 healthy volunteers underwent resting-state scanning (R1) and scanning with retained acupuncture at Hand Taiyin Lung Channel (acupuncture, AP). Data of fMRI collected were statistically calculated using amplitude of low frequency fluctuations (ALFF). Under R1 significantly enhanced ALFF occurred in right precuneus, left inferior parietal lobule, bilateral superior temporal gyrus, bilateral middle frontal gyrus, left superior frontal gyrus, left inferior frontal gyrus, left medial frontal gyrus. Under AP significantly enhanced ALFF occurred in right precuneus, bilateral superior frontal gyrus, cerebellum, bilateral middle frontal gyrus, right medial frontal gyrus, and so on. Compared with R1, needing at Hand Taiyin Lung Channel could significantly enhance ALFF in right gyrus subcallosum and right inferior frontal gyrus. Significant decreased ALFF appeared in right postcentral gyrus, left precuneus, left superior temporal gyrus, left middle temporal gyrus, and so on. Needing at Hand Taiyin Lung Channel could significantly change fixed activities of cerebral cortex, especially in right subcallosal gyrus, right inferior frontal gyrus, and so on.

Partial abnormal drainage of superior and inferior caval veins into the left atrium: two case reports.

PubMed

Chessa, Massimo; Carminati, Mario; Cinteză, Eliza Elena; Butera, Gianfranco; Giugno, Luca; Arcidiacono, Carmelo; Piazza, Luciane; Bulescu, Nicolae Cristian; Pome, Giuseppe; Frigiola, Alessandro; Giamberti, Alessandro

2016-01-01

Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic vein drainage anomaly, with only a few cases reported among congenital heart disease (CHD), around 20 cases published in the medical literature. The inferior vena cava connection with the left atrium, also very rare, can appear directly or in heterotaxy. Clinical suspicion arises due to the presence of cyanosis in the absence of other specific clinical signs (without other associated CHD). We present the cases of two children with abnormal superior and inferior systemic venous return. The first case is an abnormal connection of right superior vena cava to the left atrium associated with persistent left superior vena cava draining into the right atrium through the coronary sinus. The second case is an interruption of the inferior vena cava with hemiazygos continuation, drained into the left superior vena cava, which drained into the left atrium. The diagnosis was imagistic - echocardiography and angiography. Surgical treatment solutions vary from one case to another, usually following anatomic correction. Hypoxia accompanied by cyanosis must bring into question the pathology of systemic venous drainage anomaly, after other common causes have been excluded. Surgery is indicated in all cases due to the risk associated with the presence of right-to-left shunt.

Processing and representation of social communication sounds in the brainstem auditory system of bats

NASA Astrophysics Data System (ADS)

Pollak, George D.

2003-10-01

While bats are best known for their abilities to orient and capture prey via echolocation, they are also highly social animals who use a rich repertoire of species-specific sounds for social communication. This talk explores how communication signals are progressively transformed and represented in the ascending auditory system. One principal transformation that distinguishes the inferior colliculus from lower nuclei is a change from processing that emphasizes response homogeneity among the neuronal population in each lower nucleus, to one that emphasizes heterogeneity and selectivity in the inferior colliculus. Collicular neurons are selective in that each neuron fails to respond to some, or even all calls, even though those calls have energy that encroaches upon their excitatory response regions, and are heterogeneous since each collicular neuron responds to a different subset of calls. The transformation from homogeneity to heterogeneity may largely be a consequence of the difference in the ways that the various excitatory and inhibitory inputs distribute along frequency contours in lower nuclei compared to the inferior colliculus. One important consequence is that those features endow the population in the inferior colliculus with the ability to respond to any signal with a unique and pronounced spatiotemporal pattern of activity. [Work supported by NIH Grant No. DC 00268.

Prediction During Natural Language Comprehension.

PubMed

Willems, Roel M; Frank, Stefan L; Nijhof, Annabel D; Hagoort, Peter; van den Bosch, Antal

2016-06-01

The notion of prediction is studied in cognitive neuroscience with increasing intensity. We investigated the neural basis of 2 distinct aspects of word prediction, derived from information theory, during story comprehension. We assessed the effect of entropy of next-word probability distributions as well as surprisal A computational model determined entropy and surprisal for each word in 3 literary stories. Twenty-four healthy participants listened to the same 3 stories while their brain activation was measured using fMRI. Reversed speech fragments were presented as a control condition. Brain areas sensitive to entropy were left ventral premotor cortex, left middle frontal gyrus, right inferior frontal gyrus, left inferior parietal lobule, and left supplementary motor area. Areas sensitive to surprisal were left inferior temporal sulcus ("visual word form area"), bilateral superior temporal gyrus, right amygdala, bilateral anterior temporal poles, and right inferior frontal sulcus. We conclude that prediction during language comprehension can occur at several levels of processing, including at the level of word form. Our study exemplifies the power of combining computational linguistics with cognitive neuroscience, and additionally underlines the feasibility of studying continuous spoken language materials with fMRI. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Development of Right-hemispheric Dominance of Inferior Parietal Lobule in Proprioceptive Illusion Task

PubMed Central

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

2017-01-01

Abstract Functional lateralization can be an indicator of brain maturation. We have consistently shown that, in the adult brain, proprioceptive processing of muscle spindle afferents generating illusory movement of the right hand activates inferior frontoparietal cortical regions in a right-side dominant manner in addition to the cerebrocerebellar motor network. Here we provide novel evidence regarding the development of the right-dominant use of the inferior frontoparietal cortical regions in humans using this task. We studied brain activity using functional magnetic resonance imaging while 60 right-handed blindfolded healthy children (8–11 years), adolescents (12–15 years), and young adults (18–23 years) (20 per group) experienced the illusion. Adult-like right-dominant use of the inferior parietal lobule (IPL) was observed in adolescents, while children used the IPL bilaterally. In contrast, adult-like lateralized cerebrocerebellar motor activation patterns were already observable in children. The right-side dominance progresses during adolescence along with the suppression of the left-sided IPL activity that emerges during childhood. Therefore, the neuronal processing implemented in the adult's right IPL during the proprioceptive illusion task is likely mediated bilaterally during childhood, and then becomes right-lateralized during adolescence at a substantially later time than the lateralized use of the cerebrocerebellar motor system for kinesthetic processing. PMID:28968653

Anesthetic efficacy of the supplemental X-tip intraosseous injection using 4% articaine with 1:100,000 adrenaline in patients with irreversible pulpitis: An in vivo study

PubMed Central

Bhuyan, Atool Chandra; Latha, Satheesh Sasidharan; Jain, Shefali; Kataki, Rubi

2014-01-01

Introduction: Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist–patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. Aim: The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. Materials and Methods: X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. Results: The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. Conclusion: When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis. PMID:25506137

Effects of age and gender on neural networks of motor response inhibition: from adolescence to mid-adulthood.

PubMed

Rubia, Katya; Lim, Lena; Ecker, Christine; Halari, Rozmin; Giampietro, Vincent; Simmons, Andrew; Brammer, Michael; Smith, Anna

2013-12-01

Functional inhibitory neural networks mature progressively with age. However, nothing is known about the impact of gender on their development. This study employed functional magnetic resonance imaging (fMRI) to investigate the effects of age, sex, and sex by age interactions on the brain activation of 63 healthy males and females, between 13 and 38 years, performing a Stop task. Increasing age was associated with progressively increased activation in typical response inhibition areas of right inferior and dorsolateral prefrontal and temporo-parietal regions. Females showed significantly enhanced activation in left inferior and superior frontal and striatal regions relative to males, while males showed increased activation relative to females in right inferior and superior parietal areas. Importantly, left frontal and striatal areas that showed increased activation in females, also showed significantly increased functional maturation in females relative to males, while the right inferior parietal activation that was increased in males showed significantly increased functional maturation relative to females. The findings demonstrate for the first time that sex-dimorphic activation patterns of enhanced left fronto-striatal activation in females and enhanced right parietal activation in males during motor inhibition appear to be the result of underlying gender differences in the functional maturation of these brain regions. © 2013. Published by Elsevier Inc. All rights reserved.

A supramodal brain substrate of word form processing--an fMRI study on homonym finding with auditory and visual input.

PubMed

Balthasar, Andrea J R; Huber, Walter; Weis, Susanne

2011-09-02

Homonym processing in German is of theoretical interest as homonyms specifically involve word form information. In a previous study (Weis et al., 2001), we found inferior parietal activation as a correlate of successfully finding a homonym from written stimuli. The present study tries to clarify the underlying mechanism and to examine to what extend the previous homonym effect is dependent on visual in contrast to auditory input modality. 18 healthy subjects were examined using an event-related functional magnetic resonance imaging paradigm. Participants had to find and articulate a homonym in relation to two spoken or written words. A semantic-lexical task - oral naming from two-word definitions - was used as a control condition. When comparing brain activation for solved homonym trials to both brain activation for unsolved homonyms and solved definition trials we obtained two activations patterns, which characterised both auditory and visual processing. Semantic-lexical processing was related to bilateral inferior frontal activation, whereas left inferior parietal activation was associated with finding the correct homonym. As the inferior parietal activation during successful access to the word form of a homonym was independent of input modality, it might be the substrate of access to word form knowledge. Copyright © 2011 Elsevier B.V. All rights reserved.

Splenic marginal zone lymphoma: excellent outcomes in 64 patients treated in the rituximab era.

PubMed

Starr, Adam G; Caimi, Paolo F; Fu, PingFu; Massoud, Mira R; Meyerson, Howard; Hsi, Eric D; Mansur, David B; Cherian, Sheen; Cooper, Brenda W; De Lima, Marcos J G; Lazarus, Hillard M; Gerson, Stanton L; Jagadeesh, Deepa; Smith, Mitchell R; Dean, Robert M; Pohlman, Brad L; Hill, Brian T; William, Basem M

2017-08-01

Splenic marginal zone lymphoma (SMZL) is a rare non-Hodgkin lymphoma. We sought to identify prognostic factors and define outcomes in a cohort of 64 patients with SMZL who were treated at two large academic medical centers in North America in the rituximab era. Over a median follow-up of 37.8 (range 6-167.1) months, Kaplan-Meier estimate of median OS was 156.3 months and median PFS was 52.9 months. On univariate analysis, baseline hemoglobin <12 g/dl was associated with inferior OS (p = 0.045). High-risk FLIPI score was associated with inferior PFS when compared with intermediate/low risk (p = 0.05) and marginally significant with regard to OS (p = 0.056). Splenectomy was not predictive of OS or PFS (p = 0.563 and 0.937, respectively). Transformation to diffuse large B-cell lymphoma occurred in four (6.3%) patients during the observation period. OS was comparable to contemporaneous cohorts of patients with extranodal and nodal marginal lymphomas and FLIPI score was highly predictive for inferior PFS and OS when all three cohorts were analyzed together. Outcomes of SMZL, in our series, were excellent, with a median OS of >13 years. Low hemoglobin and high-risk FLIPI were associated with inferior outcomes.

Where do bright ideas occur in our brain? Meta-analytic evidence from neuroimaging studies of domain-specific creativity

PubMed Central

Boccia, Maddalena; Piccardi, Laura; Palermo, Liana; Nori, Raffaella; Palmiero, Massimiliano

2015-01-01

Many studies have assessed the neural underpinnings of creativity, failing to find a clear anatomical localization. We aimed to provide evidence for a multi-componential neural system for creativity. We applied a general activation likelihood estimation (ALE) meta-analysis to 45 fMRI studies. Three individual ALE analyses were performed to assess creativity in different cognitive domains (Musical, Verbal, and Visuo-spatial). The general ALE revealed that creativity relies on clusters of activations in the bilateral occipital, parietal, frontal, and temporal lobes. The individual ALE revealed different maximal activation in different domains. Musical creativity yields activations in the bilateral medial frontal gyrus, in the left cingulate gyrus, middle frontal gyrus, and inferior parietal lobule and in the right postcentral and fusiform gyri. Verbal creativity yields activations mainly located in the left hemisphere, in the prefrontal cortex, middle and superior temporal gyri, inferior parietal lobule, postcentral and supramarginal gyri, middle occipital gyrus, and insula. The right inferior frontal gyrus and the lingual gyrus were also activated. Visuo-spatial creativity activates the right middle and inferior frontal gyri, the bilateral thalamus and the left precentral gyrus. This evidence suggests that creativity relies on multi-componential neural networks and that different creativity domains depend on different brain regions. PMID:26322002

Radiofrequency Thermal Ablation versus Bipolar Electrocautery for the Treatment of Inferior Turbinate Hypertrophy: Comparison of Efficacy and Postoperative Morbidity

PubMed Central

Uluyol, Sinan; Karakaya, Nermin Erdas; Gur, Mehmet Hafit; Kilicaslan, Saffet; Kantarcioglu, Esin Ozlem; Yagiz, Ozlem; Arslan, Ilker Burak

2015-01-01

Introduction Numerous surgical methods are used to treat nasal obstruction due to inferior turbinate hypertrophy. The primary goal of the therapy is to maximize the nasal airway for as extended a period of time as possible while minimizing therapeutic complications. Objectives The aim of this study was to assess the effects of radiofrequency thermal ablation (RFTA) and bipolar electrocautery (BEC) on the removal of nasal obstruction in patients with inferior turbinate hypertrophy and on nasal mucociliary clearance (MCC). Patients in both groups were also evaluated in terms of postoperative morbidity. Methods We compared the outcomes of two groups of patients: those treated with RFTA (n = 23) and those who underwent BEC (n = 20). Nasal obstruction was graded using a visual analog scale (VAS) and MCC was measured using a saccharin clearance test. Both measurements were performed before and 2 months after treatment. Results Pre- and postoperative VAS scores showed significant improvement for both groups. However, MCC results did not significantly differ between two groups. Neither edema nor crust formation persisted for more than 1 week in any patients. Conclusion Submucosal cauterization with preservation of the nasal mucosa and periosteum is as effective and safe as RFTA and should be considered when planning inferior turbinate interventions. PMID:26722337

Working hours associated with unintentional sleep at work among airline pilots.

PubMed

Marqueze, Elaine Cristina; Nicola, Ana Carolina B; Diniz, Dag Hammarskjoeld M D; Fischer, Frida Marina

2017-06-26

Tto identify factors associated with unintentional sleep at work of airline pilots. This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health. Identificar fatores associados aos cochilos não intencionais durante as jornadas de trabalho de pilotos da aviação regular. Estudo epidemiológico transversal conduzido com 1.235 pilotos brasileiros de avião do transporte aéreo regular, que realizavam voos nacionais ou internacionais, sendo a coleta de dados realizada on-line. Foi realizada análise de regressão logística bivariada e múltipla, tendo como variável dependente o cochilo não intencional durante o horário de trabalho. As variáveis independentes foram relacionadas a dados biodemográficos, características do trabalho, estilo de vida e aspectos do sono. A prevalência do cochilo não intencional enquanto pilotava o avião foi de 57,8%. Os fatores associados ao cochilo não intencional foram: voar por mais de 65 horas por mês, atrasos técnicos frequentes, maior necessidade de recuperação após o trabalho, capacidade para o trabalho inferior à ótima, sono insuficiente e sonolência excessiva. A ocorrência do cochilo não intencional durante a jornada de trabalho de pilotos da aviação regular está associada a fatores relacionados à organização do trabalho e à saúde.

Effects of Pentobarbital on Respiratory Functional Dynamics in Chronically Instrumented Guinea Pigs

DTIC Science & Technology

1991-01-01

inferior cerebellar peduncle; 10, inferior olive; LRN. lateral reticular nu- cleus; NSTTN. nucleus spinal tract of the trigeminal nerve ; STTN, spinal tract...reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 06 15 sodium pentobarbital; respiration; chronic single unit 06 04 recording...diaphragmatic EMG; guinea pigs 19. ABSTRACT (Continue on reverse if necessary and identify by block number) CHANG. F.-C. T. Effects of pentobarhital

Temporary Blindness after Inferior Alveolar Nerve Block.

PubMed

Barodiya, Animesh; Thukral, Rishi; Agrawal, Shaila Mahendra; Rai, Anshul; Singh, Siddharth

2017-03-01

Inferior Alveolar Nerve Block (IANB) anaesthesia is one of the common procedures in dental clinic. This procedure is safe, but complications may still occur. Ocular complications such as diplopia, loss of vision, or ophthalmoplegia are extremely rare. This case report explains an event where due to individual anatomic variation of the sympathetic vasoconstrictor nerve and maxillary and middle meningeal arteries, intravascular administration of anaesthetic agent caused unusual ocular signs and symptoms such as temporary blindness.

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery.

PubMed

Lamo-Espinosa, J M; Llombart Blanco, R; Valentí, J R

2012-01-01

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

Pseudoaneurysm of the medial inferior genicular artery after anterior cruciate ligament reconstruction.

PubMed

Mello, Wilson; de Brito, Wander Edney; Migon, Eduardo Zaniol; Borges, Alexandre

2011-03-01

We present a case of pseudoaneurysm formation of the medial inferior genicular artery after anterior cruciate ligament reconstruction. The patient presented with repeated knee hemarthrosis. He was diagnosed by means of magnetic resonance angiography and was treated by means of transluminal embolization. The patient's normal was normal after resolution of the vascular pathologic condition. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Selectivity of Local Field Potentials in Macaque Inferior Temporal Cortex

DTIC Science & Technology

2004-09-01

Selectivity of Local Field Potentials in Macaque Inferior Temporal Cortex Gabriel Kreiman , Chou Hung, Tomaso Poggio and James DiCarlo AI Memo 2004...IT. Note: Gabriel Kreiman and Chou Hung contributed equally to this work This report describes research done within the Center for Biological...separate the neuronal components of the MUA by using spike sorting algorithms (Quiroga et al., 2004; Yu and Kreiman , 1999). It will be interesting to

The mirror neuron system is more active during complementary compared with imitative action.

PubMed

Newman-Norlund, Roger D; van Schie, Hein T; van Zuijlen, Alexander M J; Bekkering, Harold

2007-07-01

We assessed the role of the human mirror neuron system (MNS) in complementary actions using functional magnetic resonance imaging while participants prepared to execute imitative or complementary actions. The BOLD signal in the right inferior frontal gyrus and bilateral inferior parietal lobes was greater during preparation of complementary than during imitative actions, suggesting that the MNS may be essential in dynamically coupling action observation to action execution.

Combat Surgery: Medical Decision Trees for Treatment of Naval Combat Casualties

DTIC Science & Technology

1991-02-01

inferior vena cava ? NO Is there a hole or tear of left atrium and/or pulmonary veins? NO l ** HEART INJURY ASSESSMENT MODULE T027 2...from holes in either superior or inferior vena cava ? YES NO See Pericardial Vena Cava Injury Module See Bleeding Into Pericardium Module T018...MODULE T018 1/1 Is blood coming from area of superior vena cava ? YES NO See Superior Vena Cava Wound

Vena caval impalement: an unusual lawn mower injury in a child.

PubMed

Muńoz-Juárez, M; Drugas, G T; Hallett, J W; Zietlow, S P

1998-06-01

Penetrating injury to the vena cava is a potentially life threatening condition that necessitates prompt recognition and immediate treatment. Herein we describe a unique lawn mower-related injury in a 4-year-old boy, resulting in the impalement of the inferior vena cava by a foreign body projectile. Relevant concepts in the management of children with lawn mower injuries are discussed, with emphasis on penetrating injury to the inferior vena cava.

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

Lee, Deok Hee; Hwang, Jae Cheol; Lim, Soo Mee

Purpose: To describe the findings of pleural and pulmonary staining of the inferior phrenic artery, which can be confused with tumor staining during transarterial chemoembolization (TACE) of hepatoma.Methods: Fifteen patients who showed pleural and pulmonary staining without relationship to hepatic masses at inferior phrenic arteriography were enrolled. The staining was noted at initial TACE (n = 8), at successive TACE (n = 5), and after hepatic surgery (n = 2). The angiographic pattern, the presence of pleural change on computed tomography (CT), and clinical history were evaluated.Results: Draining pulmonary veins were seen in all cases. The lower margin of themore » staining corresponded to the lower margin of the pleura in 10 patients. CT showed pleural and/or pulmonary abnormalities in all cases. After embolization of the inferior phrenic artery, the accumulation of iodized oil in the lung was noted.Conclusion: Understanding the CT and angiographic findings of pleural and pulmonary staining during TACE may help differentiate benign staining from tumor staining.« less

Preoperative oral use of Ibuprofen or dexamethasone may improve the anesthetic efficacy of an inferior alveolar nerve block in patients diagnosed with irreversible pulpitis.

PubMed

Nusstein, John M

2013-09-01

Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial. Shahi S, Moktari H, Rahimi S, Yavari HR, Narimani S, Abdolrahmi M, Nezafati S. J Endod 2013;39(2):160-2. John M. Nusstein, DDS, MS PURPOSE/QUESTION: To determine whether preoperative oral administration of ibuprofen (400 mg), dexamethasone (0.5 mg), or placebo (lactose) would improve the anesthetic success rate of an inferior alveolar nerve block in patients with molars diagnosed with asymptomatic irreversible pulpitis University: Dental and Periodontal Research Center of Tabriz, Tabriz University of Medical Sciences, Tabriz, Iran Randomized controlled trial Level 2: Limited-quality, patient-oriented evidence Not applicable. Copyright © 2013 Elsevier Inc. All rights reserved.

Estimation of sample size and testing power (Part 3).

PubMed

Hu, Liang-ping; Bao, Xiao-lei; Guan, Xue; Zhou, Shi-guo

2011-12-01

This article introduces the definition and sample size estimation of three special tests (namely, non-inferiority test, equivalence test and superiority test) for qualitative data with the design of one factor with two levels having a binary response variable. Non-inferiority test refers to the research design of which the objective is to verify that the efficacy of the experimental drug is not clinically inferior to that of the positive control drug. Equivalence test refers to the research design of which the objective is to verify that the experimental drug and the control drug have clinically equivalent efficacy. Superiority test refers to the research design of which the objective is to verify that the efficacy of the experimental drug is clinically superior to that of the control drug. By specific examples, this article introduces formulas of sample size estimation for the three special tests, and their SAS realization in detail.

Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis.

PubMed

Gutiérrez, Sergio; Greiwe, R Michael; Frankle, Mark A; Siegal, Steven; Lee, William E

2007-01-01

There has been renewed interest in reverse shoulder arthroplasty for the treatment of glenohumeral arthritis with concomitant rotator cuff deficiency. Failure of the prosthesis at the glenoid attachment site remains a concern. The purpose of this study was to examine glenoid component stability with regard to the angle of implantation. This investigation entailed a biomechanical analysis to evaluate forces and micromotion in glenoid components attached to 12 polyurethane blocks at -15 degrees, 0 degrees, and +15 degrees of superior and inferior tilt. The 15 degrees inferior tilt had the most uniform compressive forces and the least amount of tensile forces and micromotion when compared with the 0 degrees and 15 degrees superiorly tilted baseplate. Our results suggest that implantation with an inferior tilt will reduce the incidence of mechanical failure of the glenoid component in a reverse shoulder prosthesis.

Variations in the branching pattern of posterior division of mandibular nerve: a case report.

PubMed

Muraleedharan, Aparna; Veeramani, Raveendranath; Chand, Parkash

2014-11-01

Abnormal communications among the branches of mandibular nerve especially the posterior division are significant due to various procedures undertaken in this region. These variations are worth reporting as they pose serious implications in several interventions in this region, and may even lead to false diagnosis. During routine dissection, the mandibular nerve and its branches were dissected in the infratemporal fossa. The branches from the posterior division of the mandibular nerve namely the inferior alveolar and auriculotemporal nerves were carefully dissected, and their abnormal branching pattern was noted. There was a communicating branch between left inferior alveolar and auriculotemporal nerve. There was also a variant recurrent branch from the left inferior alveolar nerve that supplied the lateral pterygoid muscle. Such variant branches and communications between the branches of mandibular nerve as seen in this case have an embryological basis and are clinically important in this region especially for dental surgeries and anesthesia.

Situs ambiguous in a schoolchild

PubMed Central

Tortajada, Miguel; Moreno, Miriam; Gracia, Miguel; Sanchis, Amparo

2010-01-01

We report the case of a 9-year-old child with asthma, atopic dermatitis and allergic rhinoconjunctivitis due to house dust mites, in whom a routine chest x-ray identified by chance abnormal organ position, such as the stomach located on the right side. Abdominal ultrasonography indicated a centralised liver, with polysplenia on the right side and an inferior cava vein located to the left of the aorta with no interruption. Ultrasonography did not show heart defects. Magnetic resonance imaging (MRI) of the abdomen was performed that showed a short pancreas, with no neck, body and tail in it, and a left inferior vena cava with normal outlet of the renal veins, and absence of the intrahepatic part of the inferior vena cava, that was replaced by the left hemiazygos vein. Spinal cord MRI revealed dorsal syringomelia. In view of the results obtained, the diagnosis of situs ambiguous was established. PMID:22121394

Antiphospholipid Antibody Syndrome Associated with Graves’ Disease Presenting As Inferior Vena Cava Thrombosis with Bilateral Lower Limb DVT

PubMed Central

Jain, Ankur

2014-01-01

We report a case of a 60-year-old lady who presented with bilateral lower limb swelling and a thyroid swelling with clinical features consistent with thyrotoxicosis. Investigations revealed the presence of a thrombus in bilateral external, internal iliac veins, and inferior vena cava extending up to its infrahepatic part. Hormone profile and radioiodine uptake scan confirmed the diagnosis of Graves’ disease. Further workup revealed the presence of antiphospholipid antibodies (confirmed after a repeat test at 12 weeks). The patient was treated with antithyroid drugs and anticoagulants. The patient improved with normalization of thyroid function and partial recanalization of the infrahepatic part of inferior vena cava. Hyperthyroidism has been implicated as a potential hypercoagulable state; however, the association of Graves’ disease with antiphospholipid antibody syndrome is limited to isolated case reports. This case highlights a new mechanism underlying hypercoagulability associated with Graves’ disease. PMID:24812529

Life- threatening hemothorax due to the inferior pulmonary ligament injury without obvious organ injuries: a case report.

PubMed

Kim, Jae Jun; Kim, Yong Hwan; Choi, Si Young; Jeong, Seong Cheol; Moon, Seok Whan

2015-03-21

Traumatic hemothorax is usually associated with obvious organ injuries, such as rib fractures, pulmonary injuries, and other mediastinal injuries. We present a rare case in which a 42-year- old Korean man who fell off of a roof, approximately 3 meters in height, resulting in a life-threatening hemothorax without obvious injuries to the thoracic organs. Chest CT showed a large amount of hemothorax in the right side of the thoracic cavity, and an active bleeding, presumably from the posterior intercostal or the phrenic artery, with a focal aneurysmal change. The emergency thoracotomy was performed to bring the active bleeding under control. The operative findings showed there were only the inferior pulmonary ligament tears, and the active bleeding from it. The postoperative course was uneventful and the patient was discharged without any complications. We should consider the inferior pulmonary ligamental injury as one of causes for traumatic hemothorax.

Osteodiskitis of Lumbar Spine Due to Migrated Fractured Inferior Vena Cava Filter.

PubMed

Aoun, Salah G; Bedros, Nicole; El Ahmadieh, Tarek Y; Kreck, Jake; Mehta, Nikhil; Al Tamimi, Mazin

2018-05-01

Venous thromboembolism can be a significant cause of morbidity in the trauma population. Medical and surgical specialties have been pushing the indication for prophylactic filter placement. A 36-year-old man presented with axial lower back pain with a radicular right L2 component after lifting a heavy object. He had a history of penetrating brain trauma 3 years prior, with placement of a prophylactic inferior vena cava filter. His radiograph, computed tomography, and magnetic resonance imaging of the lumbar spine showed fracture of his filter, with migration of the fractured fragment through the inferior vena cava and into the L2-L3 disk space, and surrounding bony lysis and severe osteodiskitis. He was treated medically with intravenous and then oral antibiotics and improved clinically and radiographically. Conservative use of filter devices and early retrieval once their indication expires are paramount to avoid unnecessary complications. Copyright © 2018 Elsevier Inc. All rights reserved.

Cerebellar blood flow in methylmercury poisoning (Minamata disease).

PubMed

Itoh, K; Korogi, Y; Tomiguchi, S; Takahashi, M; Okajima, T; Sato, H

2001-04-01

We looked at regional cerebellar blood flow in patients with Minamata disease (MD) using technetium-99m ethyl cysteinate dimer (99m-Tc-ECD). We carried out single-photon emission computed tomography (SPECT) on 15 patients with MD (eight men, seven women, aged 51-78 years, mean 70.5 years) and 11 control subjects (eight men, three women, aged 62-80 years, mean 72.5 years). Regional blood flow was measured in the superior, middle, and inferior portions of the cerebellar hemispheres, and the frontal, temporal and occipital cerebral lobes. The degree of cerebellar atrophy was assessed on MRI. There were significant differences in regional blood flow in all parts of the cerebellum between patients and control, but no significant decrease was observed in the cerebrum. Blood flow was lower in the inferior cerebellum than in the other parts. Even in patients without cerebellar atrophy, flow was significantly decreased regional blood flow in the inferior part.

Is Consent Based on Trust Morally Inferior to Consent Based on Information?

PubMed

Kongsholm, Nana Cecilie Halmsted; Kappel, Klemens

2017-07-01

Informed consent is considered by many to be a moral imperative in medical research. However, it is increasingly acknowledged that in many actual instances of consent to participation in medical research, participants do not employ the provided information in their decision to consent, but rather consent based on the trust they hold in the researcher or research enterprise. In this article we explore whether trust-based consent is morally inferior to information-based consent. We analyse the moral values essential to valid consent - autonomy, voluntariness, non-manipulation, and non-exploitation - and assess whether these values are less protected and promoted by consent based on trust than they are by consent based on information. We find that this is not the case, and thus conclude that trust-based consent if not morally inferior to information-based consent. © 2017 John Wiley & Sons Ltd.

Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus.

PubMed

Duncumb, Joseph W; Miyagi, Kana; Forouhi, Parto; Malata, Charles M

2016-01-01

Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer.

Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

PubMed Central

Miyagi, Kana; Forouhi, Parto

2016-01-01

Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer. PMID:27651974

The use of spatial dose gradients and probability density function to evaluate the effect of internal organ motion for prostate IMRT treatment planning

NASA Astrophysics Data System (ADS)

Jiang, Runqing; Barnett, Rob B.; Chow, James C. L.; Chen, Jeff Z. Y.

2007-03-01

The aim of this study is to investigate the effects of internal organ motion on IMRT treatment planning of prostate patients using a spatial dose gradient and probability density function. Spatial dose distributions were generated from a Pinnacle3 planning system using a co-planar, five-field intensity modulated radiation therapy (IMRT) technique. Five plans were created for each patient using equally spaced beams but shifting the angular displacement of the beam by 15° increments. Dose profiles taken through the isocentre in anterior-posterior (A-P), right-left (R-L) and superior-inferior (S-I) directions for IMRT plans were analysed by exporting RTOG file data from Pinnacle. The convolution of the 'static' dose distribution D0(x, y, z) and probability density function (PDF), denoted as P(x, y, z), was used to analyse the combined effect of repositioning error and internal organ motion. Organ motion leads to an enlarged beam penumbra. The amount of percentage mean dose deviation (PMDD) depends on the dose gradient and organ motion probability density function. Organ motion dose sensitivity was defined by the rate of change in PMDD with standard deviation of motion PDF and was found to increase with the maximum dose gradient in anterior, posterior, left and right directions. Due to common inferior and superior field borders of the field segments, the sharpest dose gradient will occur in the inferior or both superior and inferior penumbrae. Thus, prostate motion in the S-I direction produces the highest dose difference. The PMDD is within 2.5% when standard deviation is less than 5 mm, but the PMDD is over 2.5% in the inferior direction when standard deviation is higher than 5 mm in the inferior direction. Verification of prostate organ motion in the inferior directions is essential. The margin of the planning target volume (PTV) significantly impacts on the confidence of tumour control probability (TCP) and level of normal tissue complication probability (NTCP). Smaller margins help to reduce the dose to normal tissues, but may compromise the dose coverage of the PTV. Lower rectal NTCP can be achieved by either a smaller margin or a steeper dose gradient between PTV and rectum. With the same DVH control points, the rectum has lower complication in the seven-beam technique used in this study because of the steeper dose gradient between the target volume and rectum. The relationship between dose gradient and rectal complication can be used to evaluate IMRT treatment planning. The dose gradient analysis is a powerful tool to improve IMRT treatment plans and can be used for QA checking of treatment plans for prostate patients.

The use of spatial dose gradients and probability density function to evaluate the effect of internal organ motion for prostate IMRT treatment planning.

PubMed

Jiang, Runqing; Barnett, Rob B; Chow, James C L; Chen, Jeff Z Y

2007-03-07

The aim of this study is to investigate the effects of internal organ motion on IMRT treatment planning of prostate patients using a spatial dose gradient and probability density function. Spatial dose distributions were generated from a Pinnacle3 planning system using a co-planar, five-field intensity modulated radiation therapy (IMRT) technique. Five plans were created for each patient using equally spaced beams but shifting the angular displacement of the beam by 15 degree increments. Dose profiles taken through the isocentre in anterior-posterior (A-P), right-left (R-L) and superior-inferior (S-I) directions for IMRT plans were analysed by exporting RTOG file data from Pinnacle. The convolution of the 'static' dose distribution D0(x, y, z) and probability density function (PDF), denoted as P(x, y, z), was used to analyse the combined effect of repositioning error and internal organ motion. Organ motion leads to an enlarged beam penumbra. The amount of percentage mean dose deviation (PMDD) depends on the dose gradient and organ motion probability density function. Organ motion dose sensitivity was defined by the rate of change in PMDD with standard deviation of motion PDF and was found to increase with the maximum dose gradient in anterior, posterior, left and right directions. Due to common inferior and superior field borders of the field segments, the sharpest dose gradient will occur in the inferior or both superior and inferior penumbrae. Thus, prostate motion in the S-I direction produces the highest dose difference. The PMDD is within 2.5% when standard deviation is less than 5 mm, but the PMDD is over 2.5% in the inferior direction when standard deviation is higher than 5 mm in the inferior direction. Verification of prostate organ motion in the inferior directions is essential. The margin of the planning target volume (PTV) significantly impacts on the confidence of tumour control probability (TCP) and level of normal tissue complication probability (NTCP). Smaller margins help to reduce the dose to normal tissues, but may compromise the dose coverage of the PTV. Lower rectal NTCP can be achieved by either a smaller margin or a steeper dose gradient between PTV and rectum. With the same DVH control points, the rectum has lower complication in the seven-beam technique used in this study because of the steeper dose gradient between the target volume and rectum. The relationship between dose gradient and rectal complication can be used to evaluate IMRT treatment planning. The dose gradient analysis is a powerful tool to improve IMRT treatment plans and can be used for QA checking of treatment plans for prostate patients.

Inventario mundial de la calidad del carbon mineral (WoCQI) [The world coal quality inventory (WoCQI)

USGS Publications Warehouse

Finkelman, R.B.; Lovern, V.S.

2001-01-01

Los oficiales encargados de la politica comercial de cada pais requieren informacion clara y precisa sobre el recurso del carbon mineral, particularmente sobre sus propiedades y caracteristicas, para tomar decisiones bien fundamentadas con respecto al mejor uso de los recursos naturales, necesidades de importacion y oportunidades de exportacion, objetivos de politica interna y externa, oportunidades de transferencia tecnologica, posibilidades de inversion externa, estudios ambientales y de salud, y asuntos relacionados con el uso de productos secundarios y su disposicion.

Disease activity guided dose reduction and withdrawal of adalimumab or etanercept compared with usual care in rheumatoid arthritis: open label, randomised controlled, non-inferiority trial.

PubMed

van Herwaarden, Noortje; van der Maas, Aatke; Minten, Michiel J M; van den Hoogen, Frank H J; Kievit, Wietske; van Vollenhoven, Ronald F; Bijlsma, Johannes W J; van den Bemt, Bart J F; den Broeder, Alfons A

2015-04-09

To evaluate whether a disease activity guided strategy of dose reduction of two tumour necrosis factor (TNF) inhibitors, adalimumab or etanercept, is non-inferior in maintaining disease control in patients with rheumatoid arthritis compared with usual care. Randomised controlled, open label, non-inferiority strategy trial. Two rheumatology outpatient clinics in the Netherlands, from December 2011 to May 2014. 180 patients with rheumatoid arthritis and low disease activity using adalimumab or etanercept; 121 allocated to the dose reduction strategy, 59 to usual care. Disease activity guided dose reduction (advice to stepwise increase the injection interval every three months, until flare of disease activity or discontinuation) or usual care (no dose reduction advice). Flare was defined as increase in DAS28-CRP (a composite score measuring disease activity) greater than 1.2, or increase greater than 0.6 and current score of at least 3.2. In the case of flare, TNF inhibitor use was restarted or escalated. Difference in proportions of patients with major flare (DAS28-CRP based flare longer than three months) between the two groups at 18 months, compared against a non-inferiority margin of 20%. Secondary outcomes included TNF inhibitor use at study end, functioning, quality of life, radiographic progression, and adverse events. Dose reduction of adalimumab or etanercept was non-inferior to usual care (proportion of patients with major flare at 18 months, 12% v 10%; difference 2%, 95% confidence interval -12% to 12%). In the dose reduction group, TNF inhibitor use could successfully be stopped in 20% (95% confidence interval 13% to 28%), the injection interval successfully increased in 43% (34% to 53%), but no dose reduction was possible in 37% (28% to 46%). Functional status, quality of life, relevant radiographic progression, and adverse events did not differ between the groups, although short lived flares (73% v 27%) and minimal radiographic progression (32% v 15%) were more frequent in dose reduction than usual care. A disease activity guided, dose reduction strategy of adalimumab or etanercept to treat rheumatoid arthritis is non-inferior to usual care with regard to major flaring, while resulting in the successful dose reduction or stopping in two thirds of patients.Trial registration Dutch trial register (www.trialregister.nl), NTR 3216. © van Herwaarden et al 2015.

Live attenuated tetravalent (G1-G4) bovine-human reassortant rotavirus vaccine (BRV-TV): Randomized, controlled phase III study in Indian infants.

PubMed

Saluja, Tarun; Palkar, Sonali; Misra, Puneet; Gupta, Madhu; Venugopal, Potula; Sood, Ashwani Kumar; Dhati, Ravi Mandyam; Shetty, Avinash; Dhaded, Sangappa Malappa; Agarkhedkar, Sharad; Choudhury, Amlan; Kumar, Ramesh; Balasubramanian, Sundaram; Babji, Sudhir; Adhikary, Lopa; Dupuy, Martin; Chadha, Sangeet Mohan; Desai, Forum; Kukian, Darshna; Patnaik, Badri Narayan; Dhingra, Mandeep Singh

2017-06-16

Rotavirus remains the leading cause of diarrhoea among children <5years. We assessed immunogenic non-inferiority of a tetravalent bovine-human reassortant rotavirus vaccine (BRV-TV) over the licensed human-bovine pentavalent rotavirus vaccine RV5. Phase III single-blind study (parents blinded) in healthy infants randomized (1:1) to receive three doses of BRV-TV or RV5 at 6-8, 10-12, and 14-16weeks of age. All concomitantly received a licensed diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b conjugate vaccine (DTwP-HepB-Hib) and oral polio vaccine (OPV). Immunogenic non-inferiority was evaluated in terms of the inter-group difference in anti-rotavirus serum IgA seroresponse (primary endpoint), and seroprotection/seroresponse rates to DTwP-HepB-Hib and OPV vaccines. Seroresponse was defined as a ≥4-fold increase in titers from baseline to D28 post-dose 3. Non-inferiority was declared if the difference between groups (based on the lower limit of the 95% confidence interval [CI]) was above -10%. Each subject was evaluated for solicited adverse events 7days and unsolicited & serious adverse events 28days following each dose of vaccination. Of 1195 infants screened, 1182 were randomized (590 to BRV-TV; 592 to RV5). Non-inferiority for rotavirus serum IgA seroresponse was not established: BRV-TV, 47.1% (95%CI: 42.8; 51.5) versus RV5, 61.2% (95%CI: 56.8; 65.5); difference between groups, -14.08% (95%CI: -20.4; -7.98). Serum IgA geometric mean concentrations at D28 post-dose 3 were 28.4 and 50.1U/ml in BRV-TV and RV5 groups, respectively. For all DTwP-HepB-Hib and OPV antigens, seroprotection/seroresponse was elicited in both groups and the -10% non-inferiority criterion between groups was met. There were 16 serious adverse events, 10 in BRV-TV group and 6 in RV5 group; none were classified as vaccine related. Both groups had similar vaccine safety profiles. BRV-TV was immunogenic but did not meet immunogenic non-inferiority criteria to RV5 when administered concomitantly with routine pediatric antigens in infants. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study.

PubMed

Choi, Chang Hyuk; Kim, Sung Guk; Lee, Jae Jun; Kwack, Byung Hoon

2017-03-01

In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; p = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; p = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B ( p = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.

Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia.

PubMed

Thiénot, Sophie; Bertheuil, Nicolas; Carloni, Raphaël; Méal, Cécile; Aillet, Sylvie; Herlin, Christian; Watier, Eric

2017-06-01

Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple-areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle. All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed. Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m 2 . In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found. We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome.

PubMed

Wolfson, Julie; Sun, Can-Lan; Wyatt, Laura; Stock, Wendy; Bhatia, Smita

2017-03-01

Background: Adolescents and young adults (AYA; 15-39 years) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on survival disparities remains unstudied. Methods: Using the Los Angeles cancer registry, we identified 1,870 ALL or AML patients between 1 and 39 years at diagnosis. Cox regression analyses assessed risk of mortality; younger age + CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. Results: ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21 years: HR = 1.9, P = 0.005; 22-29 years: HR = 2.6, P < 0.001; 30-39 years: HR = 3.0, P < 0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21 years: HR = 1.3, P = 0.3; 22-29 years: HR = 1.2, P = 0.2) but was inferior for 30- to 39-year-olds (HR = 3.4, P < 0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21 years: HR = 1.8, P = 0.02; 22-39 years: HR = 1.4, P = 0.06). Outcome at CCC/COG was comparable between children and 15- to 21-year-olds (HR = 1.3, P = 0.4) but was inferior for 22- to 39-year-olds (HR = 1.7, P = 0.05). Access: 15- to 21-year-olds were less likely to use CCC/COG than children ( P < 0.001). In 22- to 39-year-olds, public/uninsured (ALL: P = 0.004; AML<0.001), African American/Hispanics (ALL: P = 0.03), and 30- to 39-year-olds (ALL: P = 0.03) were less likely to use CCC/COG. Conclusions: Poor survival in AYAs with ALL and AML is mitigated by care at CCC/COG. Barriers to CCC/COG care include public/uninsured, and African American/Hispanic race/ethnicity. Impact: Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers. Cancer Epidemiol Biomarkers Prev; 26(3); 312-20. ©2017 AACR . ©2017 American Association for Cancer Research.

[Accidental injection of sodium hypochlorite in inferior alveolar nerve block anesthesia].

PubMed

Hongyan, Li; Jian, Xu; Baorong, Zhang; Yue, Jia; Minhua, Liu; Yilang, Luo; Jing, Zhao

2016-12-01

Sodium hypochlorite (NaClO) has been widely used in clinical practice as one of the most efficient root canal irrigants. Its properties include broad-spectrum antimicrobial activity and ability to dissolve necrotic tissues. However, when used improperly, NaClO can cause a series of adverse reactions, such as mucosal inflammation, irritation, or injury. This paper presents a case of accidental injection of NaClO in inferior alveolar nerve block anesthesia.

Inferior mesenteric vein thrombosis in Crohn`s disease: CT diagnosis

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

Coralnick, J.R.; Budin, J.A.; Sedarat, A.

1996-01-01

Mesenteric vein thrombosis has been described in association with such risk factors as coagulation disorders, postoperative dehydration, sepsis, and trauma. CT and ultrasound have greatly facilitated early diagnosis, and the features of superior mesenteric and portal vein thrombosis are well recognized. We present a case of inferior mesenteric vein thrombosis in a patient with Crohn`s disease. To our knowledge, this entity has not been reported in the radiologic literature. 7 refs., 2 figs.

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

PubMed Central

Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

2012-01-01

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

Fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve).

PubMed

Zeng, Rong; Frederick-Dyer, Katherine; Ferguson, N Lynn; Lewis, James; Fu, Yitong

2012-09-01

Fibrolipomatous hamartoma (FLH) is a rare, benign lesion of the peripheral nerves most frequently involving the median nerve and its digital branches (80 %). Pathognomonic MR features of FLH such as coaxial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes have been described by Marom and Helms, obviating the need for diagnostic biopsy. We present a case of fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve) with associated subcutaneous fat proliferation.

[Value of x-ray computed tomography in the study of the inferior vena cava in urologic practice].

PubMed

Barré, C; Vialle, M; Rieux, D; Caron-Poitreau, C; Soret, J Y; Rognon, M

1985-01-01

The CT scan provides a reliable evaluation of the inferior vena cava, especially since the development of second and third generation scanners. It can readily detect congenital malformations and obstructive anomalies complicating renal cancer and it is also able to determine the tumoral or thrombotic nature of the venous obstruction. This excellent definition of the vessel reduces the indications for caval angiography to a few exceptional cases.

Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: a rare anatomic variant.

PubMed

Perot, G; Clarençon, F; Di Maria, F; Sourour, N; Biondi, A; Cornu, P; Chiras, J

2011-10-01

Persistent trigeminal artery is a rare persistent carotid-basilar anastomosis that usually connect the infracavernous segment of the ICA with the basilar artery. Rarely, PTA may feed cerebellar artery. We describe an exceptional case of PTA terminating in postero-inferior cerebellar artery (PICA) hemispheric branch. Angiographic and CTA features are presented and hypotheses regarding developmental origin of this variation are discussed. Copyright © 2011. Published by Elsevier Masson SAS.

Cardiac Pressure Changes with Venous Gas Embolism and Decompression

DTIC Science & Technology

1994-04-01

inferior vena cava via the left femoral vein for venous access. Airway pressure was measured from a connector at the proximal end of the endotracheal...Hartley), mount- ed in a 7-9 m acrylic cuff was surgically placed around the inferior vena cava via laparotomy, approximately 1-2 cm above the renal...pressure and decreasing cardiac output which in return may cause the left atrial pressure to fall below that of the right atrium . Recent studies have

Application of an Adaptive Control Grid Interpolation Technique to Morphological Vascular Reconstruction: A Component of a Comprehensive Surgical Planning and Evaluation Tool

DTIC Science & Technology

2001-10-25

a lateral tunnel through the right atrium connecting the inferior vena cava with the RPA. The procedure results in a complete bypass of the right...IVC SVC RPA LPA SVC: superior vena cava IVC: inferior vena cava RPA: right pulmonary artery LPA: left pulmonary artery...Abstract – The total cavopulmonary connection (TCPC) is a palliative surgical repair performed on children with a single ventricle (SV

Modeling the Biodynamical Response of the Human Thorax with Body Armor from a Bullet Impact

DTIC Science & Technology

2001-03-01

inferior vena cava to the right auricle. From the right auricle, the blood is passed into the right ventricle. The right ventricle pumps the blood...the rib and vertebrae is modeled with two beam elements. To create the subcoastal angle, vertical cartilaginous connections at the inferior edge of...brachiocephalic aorta, the aorta, pulmonary arteries and veins, internal jugular veins, brachial veins, and superior vena cava . These vessels are modeled

Why can't a woman be more like a man? A renaissance perspective on the biological basis for female inferiority.

PubMed

Walton, M T; Fineman, R M; Walton, P J

1996-01-01

Western biomedical theory supported the idea of human female inferiority. The Aristotelian formulation was: Nature intends to produce the perfect male form with external genitalia; the female with internal genitalia is less than perfect and thus a defect of nature. In the Renaissance, peripubertal virilization in females was interpreted as further evidence that females were "defective" males capable of developing into the more perfect male form.

Trafficking of glucose, lactate, and amyloid-β from the inferior colliculus through perivascular routes

PubMed Central

Ball, Kelly K; Cruz, Nancy F; Mrak, Robert E; Dienel, Gerald A

2010-01-01

Metabolic brain imaging is widely used to evaluate brain function and disease, and quantitative assays require local retention of compounds used to register changes in cellular activity. As labeled metabolites of [1- and 6-14C]glucose are rapidly released in large quantities during brain activation, this study evaluated release of metabolites and proteins through perivascular fluid flow, a pathway that carries solutes from brain to peripheral lymphatic drainage sites. Assays with [3,4-14C]glucose ruled out local oxidation of glucose-derived lactate as a major contributor of label loss. Brief infusion of [1-14C]glucose and -[14C]lactate into the inferior colliculus of conscious rats during acoustic stimulation labeled the meninges, consistent with perivascular clearance of [14C]metabolites from interstitial fluid. Microinfusion of Evans blue albumin and amyloid-β1−40 (Aβ) caused perivascular labeling in the inferior colliculus, labeled the surrounding meninges, and Aβ-labeled-specific blood vessels in the caudate and olfactory bulb and was deposited in cervical lymph nodes. Efflux of extracellular glucose, lactate, and Aβ into perivascular fluid pathways is a normal route for clearance of material from the inferior colliculus that contributes to underestimates of brain energetics. Convergence of ‘watershed' drainage to common pathways may facilitate perivascular amyloid plaque formation and pathway obstruction in Alzheimer's disease. PMID:19794399

Evidence of cortical reorganization of language networks after stroke with subacute Broca's aphasia: a blood oxygenation level dependent-functional magnetic resonance imaging study

PubMed Central

Qiu, Wei-hong; Wu, Hui-xiang; Yang, Qing-lu; Kang, Zhuang; Chen, Zhao-cong; Li, Kui; Qiu, Guo-rong; Xie, Chun-qing; Wan, Gui-fang; Chen, Shao-qiong

2017-01-01

Aphasia is an acquired language disorder that is a common consequence of stroke. The pathogenesis of the disease is not fully understood, and as a result, current treatment options are not satisfactory. Here, we used blood oxygenation level-dependent functional magnetic resonance imaging to evaluate the activation of bilateral cortices in patients with Broca's aphasia 1 to 3 months after stroke. Our results showed that language expression was associated with multiple brain regions in which the right hemisphere participated in the generation of language. The activation areas in the left hemisphere of aphasia patients were significantly smaller compared with those in healthy adults. The activation frequency, volumes, and intensity in the regions related to language, such as the left inferior frontal gyrus (Broca's area), the left superior temporal gyrus, and the right inferior frontal gyrus (the mirror region of Broca's area), were lower in patients compared with healthy adults. In contrast, activation in the right superior temporal gyrus, the bilateral superior parietal lobule, and the left inferior temporal gyrus was stronger in patients compared with healthy controls. These results suggest that the right inferior frontal gyrus plays a role in the recovery of language function in the subacute stage of stroke-related aphasia by increasing the engagement of related brain areas. PMID:28250756

Assessment of turkey vehicle container microclimate on transit during summer season conditions

NASA Astrophysics Data System (ADS)

Carvalho, Rafael H.; Honorato, Danielle C. B.; Guarnieri, Paulo D.; Soares, Adriana L.; Pedrão, Mayka R.; Oba, Alexandre; Paião, Fernanda G.; Ida, Elza I.; Shimokomaki, Massami

2018-06-01

This study evaluated the formed microclimate commercial truck transport practices effects on the turkeys' welfare by measuring Dead on Arrival (DOA) index and pale, soft, and exudative (PSE-like) meat occurrence. The experimental design was entirely randomized in a 6 × 2 factorial arrangements (two truck container compartments × six water shower groups) with birds positioned at superior front (SF), inferior front (IF), superior middle (SM), inferior middle (IM), superior rear (SR), and inferior rear (IR) and two bath treatments: with water shower (WiS) and without water shower (WoS) with eight replications for each treatment. The animals were transported for 95 min' journey from the farm to the slaughterhouse under hot-humidity conditions. The results shown herein indicated the formation of a thermal core at the inferior middle and rear truck container regions, because the heat produced by the birds and the influence of developed microclimate consisting of temperature, relative humidity, and air ventilation. The IM and IR container compartments under the WoS treatment presented the highest ( P < 0.01) numbers of PSE-like meat incidence and DOA index values compared with those located at the front under WiS treatment as the consequence of the altered to birds unbearable conditions within the container microclimate in transit. The formed microclimate during the commercial transport practices under hot-humidity conditions affected the bird's welfare consequently turkey meat qualities.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Sood, Ravi; Hans, Manoj-Kumar; Shetty, Shashit

2014-12-01

This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient's subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis

PubMed Central

Sood, Ravi; Shetty, Shashit

2014-01-01

Objectives: This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Material and Methods: Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient’s subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. Results: The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Conclusions: Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis. PMID:25674319

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

PubMed Central

Juodzbalys, Gintaras

2015-01-01

ABSTRACT Objectives The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. Results A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments. PMID:25937873

The anastomosis between renal polar arteries and arteria epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis?

PubMed

Wolters, H H; Schult, M; Heidenreich, S; Chariat, M; Senninger, N; Dietl, K H

2001-12-01

Ureteral necrosis after renal transplantation is often the result of impaired perfusion due to loss of donor polar arteries. A way of preserving polar arteries is their anastomosis with the A. epigastrica inferior. In three cases (aged 49-, 58-, and 63 years), 9.3 % of 33 living donors, we detected donor polar arteries on both sides, and anastomosed the polar artery to the A. epigastrica inferior with microsurgical methods. Intraoperatively, the flow was measured by flowmeter, in the postoperative course duplexsonography and MR-angiography was performed. In all three cases we noted a bluish, ischemic parenchym mass of 10-25 % of the kidney and ureter. It recovered immediately, however, after the polar artery had been reconstructed. Intraoperative measurement showed a high flow on the polar- and the main renal artery. Duplexsonography and MR-angiography documented a good flow on the A. epigastrica anastomosis. There have been no signs of ureteral problems at all. After a mean follow-up time of 26 months, the mean creatinine level is 1.46 mg/ml. Ureteral necrosis after kidney transplantation is mostly the result of a lack of perfusion of the polar arteries of the lower kidney pole. If arteriosclerotic lesions inhibit an anastomosis with the renal artery, the anastomosis with the A. epigastrica inferior seems to be a useful alternative.

Le Fort III Distraction With Internal vs External Distractors: A Cephalometric Analysis.

PubMed

Robertson, Kevin J; Mendez, Bernardino M; Bruce, William J; McDonnell, Brendan D; Chiodo, Michael V; Patel, Parit A

2018-05-01

This study compares the change in midface position following Le Fort III advancement using either rigid external distraction (group 1) or internal distraction (group 2). We hypothesized that, with reference to right-facing cephalometry, internal distraction would result in increased clockwise rotation and inferior displacement of the midface. Le Fort III osteotomies and standardized distraction protocols were performed on 10 cadaveric specimens per group. Right-facing lateral cephalograms were traced and compared across time points to determine change in position at points orbitale, anterior nasal spine (ANS), A-point, and angle ANB. Institutional. Twenty cadaveric head specimens. Standard subcranial Le Fort III osteotomies were performed from a coronal approach and adequately mobilized. The specified distraction mechanism was applied and advanced by 15 mm. Changes of position were calculated at various skeletal landmarks: orbitale, ANS, A-point, and ANB. Group 1 demonstrated relatively uniform x-axis advancement with minimal inferior repositioning at the A-point, ANS, and orbitale. Group 2 demonstrated marked variation in x-axis advancement among the 3 points, along with a significant inferior repositioning and clockwise rotation of the midface ( P < .0001). External distraction resulted in more uniform advancement of the midface, whereas internal distraction resulted in greater clockwise rotation and inferior displacement. External distraction appears to provide increased vector control of the midface, which is important in creating a customized distraction plan based on the patient's individual occlusal and skeletal needs.

A novel method of naturally contouring the reconstructed ear: modified antihelix complex affixed to grooved base frame.

PubMed

Li, Datao; Zhang, Ruhong; Zhang, Qun; Xu, Zhicheng; Xu, Feng; Li, Yiyuan; Sun, Nan; Wang, Cheng

2014-05-01

Prior reports of ear reconstruction have cited favorable results. Although greater attention has been devoted to fabricating a more refined cartilaginous framework, many patients still complain that the contours are unnatural. The authors' aim was to offer a new technique that resolves some lingering issues. To fabricate the antihelix complex optimally, the authors modified an existing method. Rather than chiseling a sharp, Y-shaped graft of cartilage for structural prominence, the superior crus is broadened, and a gentle slope is sculpted on both aspects. Simultaneously, a groove in the base frame is carved for smooth attachment. The width of the inferior crus is limited to roughly one-third that of the superior crus, and the inferior crus is maintained in high relief. A gentle slope is shaped on the antihelix, and a groove for placement of the antihelix is carved into the base frame. Between 2011 and 2013, a total of 162 patients underwent reconstruction using this modified technique. Three such subjects have been selected to highlight the favorable results achieved. Given modifications confer natural contours to superior and inferior crura, antihelix, and surrounding structures, providing a cohesive framework for the integrity of a reconstructed ear. The antihelix complex is critical for creating a natural auricle. Harmonious integration of superior and inferior crura and antihelix enhances the overall aesthetics, increasing procedural satisfaction for patient and surgeon alike. Therapeutic, IV.