Anterior ankle arthroscopy, distraction or dorsiflexion?

PubMed

de Leeuw, Peter A J; Golanó, Pau; Clavero, Joan A; van Dijk, C Niek

2010-05-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.

Anterior ankle arthroscopy, distraction or dorsiflexion?

PubMed Central

Golanó, Pau; Clavero, Joan A.; van Dijk, C. Niek

2010-01-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7–1.5) and 0.7 cm (range 0.5–0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy. PMID:20217392

Effect of anterior capsule contraction on visual function after cataract surgery.

PubMed

Hayashi, Ken; Hayashi, Hideyuki

2007-11-01

To examine the effect of contraction of the anterior capsule opening after cataract surgery on visual acuity and contrast sensitivity. Hayashi Eye Hospital, Fukuoka, Japan. Thirty-two eyes of 32 consecutive patients who showed marked contraction of the anterior capsule opening after implantation of an intraocular lens were recruited. The area of the anterior capsule opening was measured by Scheimpflug videophotography before and after neodymium:YAG (Nd:YAG) laser anterior capsulotomy and was correlated with visual acuity and contrast sensitivity. After Nd:YAG laser anterior capsulotomy, the mean area of the anterior capsule opening increased significantly from 8.2 mm(2) to 18.0 mm(2) (P<.0001). Contrast sensitivity at most visual angles also improved significantly after Nd:YAG anterior capsulotomy, although visual acuity did not. The area of the anterior capsule opening before anterior capsulotomy was correlated significantly with contrast sensitivity but not with visual acuity, whereas there was no correlation between the opening area after anterior capsulotomy and visual acuity or contrast sensitivity. Contraction of the anterior capsule opening after cataract surgery significantly diminished contrast sensitivity in proportion to the opening area but did not markedly worsen visual acuity. Neodymium:YAG laser anterior capsulotomy improved contrast sensitivity.

Prevalence and Length of the Anterior Loop of the Inferior Alveolar Nerve in Iranians.

PubMed

Moghddam, Maryam Rastegar; Davoudmanesh, Zeinab; Azizi, Nasim; Rakhshan, Vahid; Shariati, Mahsa

2017-10-01

The anterior loop of the inferior alveolar nerve is a sensitive anatomical feature that should be taken into account during installation of dental implants anterior to the mental foramen. This study was conducted to explore the controversy regarding prevalence and length. A total of 452 mandible quadrants of 234 patients (age: 50.1 ± 13.3 years, 113 males, 121 females) were studied using cone-beam computerized tomography. After reconstructing axial, frontal, and sagittal slices, the region between the most anterior point on the mental foramen and the most anterior part of the mandibular nerve was inspected for signs of anterior loop presence. If positive, the length of the anterior loop was measured in mm as the distance between the anterior border of mental foramen and the anterior border of the loop. Prevalence and length of the anterior loop were compared statistically between sexes and age groups. The anterior loop was observed in 106 quadrants (23.5% of 451 quadrants) of 95 patients (40.6% of 234 patients), of whom 11 had bilateral anterior loops. Prevalences were similar in males (41%) and females (39%, chi-square P =.791). The mean anterior loop length was 2.77 ± 1.56 mm (95% CI: 2.5-3.1 mm), without significant sex (regression beta = -0.159, P = .134) or age (beta = -0.059, P = .578) differences. The anterior loop might exist in about 40% of patients, regardless of their gender. The mean safe anterior distance from the anterior loop is about 3 mm + (2.5-3.1 mm) = 5.5-6.1 mm, regardless of age.

Apoyo a Estudios Geodinamicos con GPS en Guatemala

NASA Astrophysics Data System (ADS)

Robles, V. R.

2013-05-01

El Instituto Geografico Nacional de Guatemala implemento 17 estaciones GNSS en el año 2009, como un proyecto de credito mixto de donacion de equipamiento del Gobierno de Suiza, el cual, este equipamiento de estaciones CORS GNSS es un sistema de recepción y transmisión de datos crudos GPS RInex que utiliza la tecnologia Spider Web de Leica, asi mismo este sistema esta sirviendo para el espablecimiento de un marco geodesico nacional de coordenadas geodesicas oficiales, el cual se calculan u obtienen las velocidades en tiempos temporales programados de las 17 Estaciones CORS. La infraestructura del marco geodesico de Guatemala esta sirviendo de base para las aplicaciones de estudios geodinamicos como el monitoreo de del desplazamiento de las placas tectonicas por medio de un estudio que se inicio en el año de 1999, llamado medicion con GPS el sistema de Fallas de los rios Polochic Motagua de Guatemala, tambien para un estudio que se implemento para deformación de corteza terrestre local en un Volcan Activo de Guatemala llamado Pacaya. Para el estudio de medicion con GPS en el sistema de falla de los Rios del polochic Motagua se implementaron 16 puntos para medir con GPS de dos frecuencias en el año de 1999, el cual, tres puntos son estaciones geodesicas CORS IGS llamados GUAT, ELEN y HUEH, despues en el año de 2003 se hizo otra medicion en un total de 20 puntos, que permitió calcular las velocidades de desplazamieinto de los puntos en mención, usando como referencia el modelo NUVEL 1A de DeMets de la placa de Norteamerica. Este estudio fue en cooperación internacional por la universidad de Nice de Francia y el IGNde Francia. Para el estudio del monitoreo con GPS del volcan activo de Guatemala, se implementaron cuatro puntos al rededor del volcan, el cual, se realizan cuatro mediciones al año, que permiten determinar axialmente la distancias entre los puntos, y rebisar estadisticamente cual es el comportamiento de las distancias en funcion del tiempo, si existen diferencias graduales crecientes o decrecientes, que nos da un indicativo del desplazamiento de la corteza terrestre al rededor del volcan.

Evaluation of novel inducible promoter/repressor systems for recombinant protein expression in Lactobacillus plantarum.

PubMed

Heiss, Silvia; Hörmann, Angelika; Tauer, Christopher; Sonnleitner, Margot; Egger, Esther; Grabherr, Reingard; Heinl, Stefan

2016-03-10

Engineering lactic acid bacteria (LAB) is of growing importance for food and feed industry as well as for in vivo vaccination or the production of recombinant proteins in food grade organisms. Often, expression of a transgene is only desired at a certain time point or period, e.g. to minimize the metabolic burden for the host cell or to control the expression time span. For this purpose, inducible expression systems are preferred, though cost and availability of the inducing agent must be feasible. We selected the plasmid free strain Lactobacillus plantarum 3NSH for testing and characterization of novel inducible promoters/repressor systems. Their feasibility in recombinant protein production was evaluated. Expression of the reporter protein mCherry was monitored with the BioLector(®) micro-fermentation system. Reporter gene mCherry expression was compared under the control of different promoter/repressor systems: PlacA (an endogenous promoter/repressor system derived from L. plantarum 3NSH), PxylA (a promoter/repressor system derived from Bacillus megaterium DSMZ 319) and PlacSynth (synthetic promoter and codon-optimized repressor gene based on the Escherichia coli lac operon). We observed that PlacA was inducible solely by lactose, but not by non-metabolizable allolactose analoga. PxylA was inducible by xylose, yet showed basal expression under non-induced conditions. Growth on galactose (as compared to exponential growth phase on glucose) reduced basal mCherry expression at non-induced conditions. PlacSynth was inducible with TMG (methyl β-D-thiogalactopyranoside) and IPTG (isopropyl β-D-1-thiogalactopyranoside), but also showed basal expression without inducer. The promoter PlacSynth was used for establishment of a dual plasmid expression system, based on T7 RNA polymerase driven expression in L. plantarum. Comparative Western blot supported BioLector(®) micro-fermentation measurements. Conclusively, overall expression levels were moderate (compared to a constitutive promoter). We evaluated different inducible promoters, as well as an orthologous expression system, for controlled gene expression in L. plantarum. Furthermore, here we provide proof of concept for a T7 RNA polymerase based expression system for L. plantarum. Thereby we expanded the molecular toolbox for an industrial relevant and generally regarded as safe (GRAS) strain.

Usefulness of oblique axial scan in magnetic resonance imaging evaluation of anterior talofibular ligament in ankle sprain.

PubMed

Kim, Jin-su; Moon, Yong-ju; Choi, Yun Sun; Park, Young Uk; Park, Seung Min; Lee, Kyung Tai

2012-01-01

The purpose of the present study was to clarify the usefulness of the oblique axial scan parallel to the course of the anterior talofibular ligament in magnetic resonance imaging of the anterior talofibular ligament in patients with chronic ankle instability. We evaluated this anterior talofibular ligament view and routine axial magnetic resonance imaging planes of 115 ankles. We diagnosed the grade of the anterior talofibular ligament injury and confirmed full-length views of the anterior talofibular ligament. Associated lesions were also checked. The subjective diagnostic convenience of associated problems was determined. The full-length view of the anterior talofibular ligament was checked in 85 (73.9%) patients in the routine axial view and 112 (97.4%) patients in the anterior talofibular ligament view. The grade of injury increased in the anterior talofibular ligament view in 26 (22.6%) patients compared with the routine axial view. There were 64 associated injuries. The anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and posterior tibialis tendinitis were more easily diagnosed on the routine axial view than on the anterior talofibular ligament view. An additional anterior talofibular ligament view is useful in the evaluation of the anterior talofibular ligament in patients with chronic ankle instability. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Anterior Cervical Spine Surgery for Degenerative Disease: A Review

PubMed Central

SUGAWARA, Taku

Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

Clinicopathological importance of anterior prostate cancer in Japanese Men.

PubMed

Sato, Shun; Takahashi, Hiroyuki; Kimura, Takahiro; Egawa, Shin; Furusato, Bungo; Ikegami, Masahiro

2017-03-01

Prostate cancer of transition zone origin or anterior location has been recognized as infrequent, smaller in size and indolent, whereas, our previous report showed that transition zone/anterior cancer was frequently experienced in Japanese men. The current study was conducted to show clinicopathological characteristics of transition zone/anterior cancer. A total of 201 radical prostatectomy specimens were categorized as cancer of anterior or posterior prostate where more than two thirds of the tumor existed in the specific area. Clinicopathological characteristics including Gleason score, pathological stage, lymph node metastasis, extraprostatic extension, surgical incision into the prostate (shown as pT2+), and surgical margin status were compared between anterior and posterior cases. Cases were divided as 83, 73, and 45 of anterior, posterior cancer, and no dominance, respectively. Anterior cancers included significant numbers of high grade tumors (13/83 cases: 15.7%), which was less than posterior cancers (28.8%: 21/73). The cases in pT2+ were significantly more frequent in anterior cases than posterior ones (22.9% vs. 4.1%). No seminal vesicle invasion was shown in anterior cases. Thus, although anterior cancers are less aggressive than posterior cancers, a significant numbers of clinically important cancers were located in the anterior portion in Japanese men. © 2017 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

Scapular kinematic and shoulder muscle activity alterations after serratus anterior muscle fatigue.

PubMed

Umehara, Jun; Kusano, Ken; Nakamura, Masatoshi; Morishita, Katsuyuki; Nishishita, Satoru; Tanaka, Hiroki; Shimizu, Itsuroh; Ichihashi, Noriaki

2018-02-23

Although the serratus anterior muscle has an important role in scapular movement, no study to date has investigated the effect of serratus anterior fatigue on scapular kinematics and shoulder muscle activity. The purpose of this study was to clarify the effect of serratus anterior fatigue on scapular movement and shoulder muscle activity. The study participants were 16 healthy men. Electrical muscle stimulation was used to fatigue the serratus anterior muscle. Shoulder muscle strength and endurance, scapular movement, and muscle activity were measured before and after the fatigue task. The muscle activity of the serratus anterior, upper and lower trapezius, anterior and middle deltoid, and infraspinatus muscles was recorded, and the median power frequency of these muscles was calculated to examine the degree of muscle fatigue. The muscle endurance and median power frequency of the serratus anterior muscle decreased after the fatigue tasks, whereas the muscle activities of the serratus anterior, upper trapezius, and infraspinatus muscles increased. External rotation of the scapula at the shoulder elevated position increased after the fatigue task. Selective serratus anterior fatigue due to electric muscle stimulation decreased the serratus anterior endurance at the flexed shoulder position. Furthermore, the muscle activities of the serratus anterior, upper trapezius, and infraspinatus increased and the scapular external rotation was greater after serratus anterior fatigue. These results suggest that the rotator cuff and scapular muscle compensated to avoid the increase in internal rotation of the scapula caused by the dysfunction of the serratus anterior muscle. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in residual poliomyelitis.

PubMed

Sung, Ki Hyuk; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Park, Moon Seok

2013-09-01

This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. Level IV, retrospective case series.

The effect of thigh muscle activity on anterior knee laxity in the uninjured and anterior cruciate ligament-injured knee.

PubMed

Barcellona, Massimo G; Morrissey, Matthew C; Milligan, Peter; Amis, Andrew A

2014-11-01

The main purpose of this study was to describe the nature of the relationship between hamstring muscle activity and anterior knee laxity. This was a cross-sectional study. Anterior knee laxity was measured at 133N and manual maximal forces using the KT2000 knee arthrometer, in 8 ACL-injured and 13 uninjured individuals. Electromyographic activity of the lateral hamstrings was measured during laxity testing. Subjects contracted the hamstrings during anterior knee laxity testing at eight predetermined levels of maximal voluntary isometric contraction. Volitional contraction of the lateral hamstrings reduced anterior knee laxity logarithmically for both the 133N and manual maximal tests in both the ACL-injured and uninjured knees. A simple linear regression model, with the log of percentage of maximum lateral hamstrings activity as the sole predictor, explained approximately 70-80% of the variation in anterior knee laxity. Both ACL-injured and uninjured subjects reduced anterior knee laxity at the same rate with increases in muscle activity. However, initial lateral hamstrings muscle activity had a greater effect on percentage anterior knee laxity scores in the ACL-injured as compared to the uninjured knee. Lateral hamstrings activity reduces anterior knee laxity in a nonlinear manner, whereby the initial lower level of activation produces the greatest change in anterior knee laxity. Therefore, hamstrings muscle activity must be monitored during anterior knee laxity testing.

Effect of repeated passive anterior loading on human knee anterior laxity.

PubMed

Vauhnik, Renata; Perme, Maja Pohar; Barcellona, Massimo G; Morrissey, Matthew C; Sevšek, France; Rugelj, Darja

2015-10-01

Increased knee anterior laxity results when the anterior cruciate ligament is injured. This increased laxity can cause knee dysfunction. Until recently this laxity was believed to be only diminished through surgery. But recent findings indicate that knee anterior laxity may be decreased with repeated loading of the knee. The purpose of this study was to test the hypothesis that regular passive anterior loading of the uninjured human knee would enhance its stiffness. Randomized controlled trial. Knee anterior laxity was tested using an arthrometer in 22 young, uninjured females before, during and after a 3 month period during which passive anterior loading was applied by a trained physiotherapist over 5 sessions per week to a randomly assigned knee. Knee anterior laxity was not affected by the passive anterior loading of the knee. Given that in this study repeated passive loading of the knee did not change knee anterior laxity, it would be easy to conclude that this training is ineffective and no further research is required. We caution against this given the relatively short duration and possibly insufficient intensity of the training and the population studied; individuals with normal joint laxity. We recommend that future research be performed that consists of individuals with lax joints who receive training for prolonged periods. Copyright © 2015 Elsevier Ltd. All rights reserved.

Causes and consequences of anterior pharyngeal pouch after total laryngectomy.

PubMed

Anderson, S; Hogan, D; Panizza, B

2014-07-01

To assess the frequency of anterior pharyngeal pouch formation after total laryngectomy, and to discuss the causes and consequences of anterior pharyngeal pouch formation. A prospective, observational study of 43 patients undergoing total laryngectomy. Data collected included laryngeal defect closure type, tumour staging and demographic information. A barium swallow was performed on day 7-14 after surgery to assess for anterior pharyngeal pouch formation and fistula formation. The incidence of anterior pharyngeal pouch formation was 47 per cent. Patients who did not have an anterior pharyngeal pouch on swallow imaging assessment were less likely to develop a pharyngo-cutaneous fistula. There was no statistically significant association between laryngeal defect closure type and anterior pharyngeal pouch formation. The anterior pharyngeal pouch is a dynamic phenomenon best investigated with a fluoroscopic swallow imaging study. Its causes are multi-factorial. Absence of an anterior pharyngeal pouch appears to confer protection against pharyngo-cutaneous fistula formation, hastening commencement of adjuvant therapy and an oral diet.

AmphiFoxQ2, a novel winged helix/forkhead gene, exclusively marks the anterior end of the amphioxus embryo

NASA Technical Reports Server (NTRS)

Yu, Jr-Kai; Holland, Nicholas D.; Holland, Linda Z.

2003-01-01

A full-length FoxQ-related gene (AmphiFoxQ2) was isolated from amphioxus. Expression is first detectable in the animal/anterior hemisphere at the mid blastula stage. The midpoint of this expression domain coincides with the anterior pole of the embryo and is offset dorsally by about 20 degrees from the animal pole. During the gastrula stage, expression is limited to the anterior ectoderm. By the early neurula stage, expression remains in the anterior ectoderm and also appears in the adjacent anterior mesendoderm. By the early larval stages, expression is detectable in the anteriormost ectoderm and in the rostral tip of the notochord. AmphiFoxQ2 is never expressed anywhere except at the anterior tip of amphioxus embryos and larvae. This is the first gene known that exclusively marks the anterior pole of chordate embryos. It may, therefore, play an important role in establishing and/or maintaining the anterior/posterior axis.

Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability.

PubMed

Lizzio, Vincent A; Meta, Fabien; Fidai, Mohsin; Makhni, Eric C

2017-12-01

The goal of this paper is to provide an overview in evaluating the patient with suspected or known anteroinferior glenohumeral instability. There is a high rate of recurrent subluxations or dislocations in young patients with history of anterior shoulder dislocation, and recurrent instability will increase likelihood of further damage to the glenohumeral joint. Proper identification and treatment of anterior shoulder instability can dramatically reduce the rate of recurrent dislocation and prevent subsequent complications. Overall, the anterior release or surprise test demonstrates the best sensitivity and specificity for clinically diagnosing anterior shoulder instability, although other tests also have favorable sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and inter-rater reliabilities. Anterior shoulder instability is a relatively common injury in the young and athletic population. The combination of history and performing apprehension, relocation, release or surprise, anterior load, and anterior drawer exam maneuvers will optimize sensitivity and specificity for accurately diagnosing anterior shoulder instability in clinical practice.

A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint.

PubMed

Phelps, Kevin D; Ming, Bryan W; Fox, Wade E; Bellamy, Nelly; Sims, Stephen H; Karunakar, Madhav A; Hsu, Joseph R

2016-06-01

To aid in surgical planning by quantifying and comparing the osseous exposure between the anterior and posterior approaches to the sacroiliac joint. Anterior and posterior approaches were performed on 12 sacroiliac joints in 6 fresh-frozen torsos. Visual and palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J. The average surface areas of exposed bone were 44 and 33 cm for the anterior and posterior approaches, respectively. The anterior iliolumbar ligament footprint could be visualized in all anterior approaches, whereas the posterior aspect could be visualized in all but one posterior approach. The anterior approach provided visual and palpable access to the anterior superior edge of the sacroiliac joint in all specimens, the posterior superior edge in 75% of specimens, and the inferior margin in 25% and 50% of specimens, respectively. The inferior sacroiliac joint was easily visualized and palpated in all posterior approaches, although access to the anterior and posterior superior edges was more limited. The anterior S1 neuroforamen was not visualized with either approach and was more consistently palpated when going posterior (33% vs. 92%). Both anterior and posterior approaches can be used for open reduction of pure sacroiliac dislocations, each with specific areas for assessing reduction. In light of current plate dimensions, fractures more than 2.5 cm lateral to the anterior iliolumbar ligament footprint are amenable to anterior plate fixation, whereas those more medial may be better addressed through a posterior approach.

Molecular Age-Related Changes in the Anterior Segment of the Eye.

PubMed

Hernandez-Zimbron, Luis Fernando; Gulias-Cañizo, Rosario; Golzarri, María F; Martínez-Báez, Blanca Elizabeth; Quiroz-Mercado, Hugo; Gonzalez-Salinas, Roberto

2017-01-01

To examine the current knowledge about the age-related processes in the anterior segment of the eye at a biological, clinical, and molecular level. We reviewed the available published literature that addresses the aging process of the anterior segment of the eye and its associated molecular and physiological events. We performed a search on PubMed, CINAHL, and Embase using the MeSH terms "eye," "anterior segment," and "age." We generated searches to account for synonyms of these keywords and MESH headings as follows: (1) "Eye" AND "ageing process" OR "anterior segment ageing" and (2) "Anterior segment" AND "ageing process" OR "anterior segment" AND "molecular changes" AND "age." Results . Among the principal causes of age-dependent alterations in the anterior segment of the eye, we found the mutation of the TGF- β gene and loss of autophagy in addition to oxidative stress, which contributes to the pathogenesis of degenerative diseases. In this review, we summarize the current knowledge regarding some of the molecular mechanisms related to aging in the anterior segment of the eye. We also introduce and propose potential roles of autophagy, an important mechanism responsible for maintaining homeostasis and proteostasis under stress conditions in the anterior segment during aging.

Clinical Outcomes and Return to Sport After Arthroscopic Anterior, Posterior, and Combined Shoulder Stabilization

PubMed Central

Kraeutler, Matthew J.; Aberle, Nicholas S.; Brown, Colin C.; Ptasinski, Joseph J.; McCarty, Eric C.

2018-01-01

Background: Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups. Purpose: To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur’geons (ASES) score, and Shoulder Activity Scale. Results: A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; P = .28), SANE (anterior: 87; posterior: 85; combined: 87; P = .79), ASES (anterior: 88; posterior: 83; combined: 91; P = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; P = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; P = .84). Conclusion: Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups. PMID:29637085

Trypan blue staining of the anterior capsule under an air bubble with a modified cannula.

PubMed

Toprak, Ahmet Baris; Erkin, Esin Fatma; Guler, Cenap

2003-01-01

To attain good visibility of the anterior capsule in the advanced or white cataract, trypan blue 0.1% is used to stain the anterior capsule. The dye is usually injected under an air bubble. However, it is difficult to inject the dye properly due to capillary forces. An ordinary anterior chamber cannula was modified and its coverage area increased to facilitate the staining of the anterior capsule under an air bubble. The anterior capsule was stained properly by using the modified cannula in all of the cases.

Posterior medial meniscus-femoral insertion into the anterior cruciate ligament. A case report.

PubMed

Bhargava, A; Ferrari, D A

1998-03-01

Medial meniscal anomalies are rare. The anterior horn insertion into the anterior cruciate ligament is the most common. In the course of an arthroscopy for torn lateral meniscus, an anomalous band in continuity with the posterior horn of the medial meniscus was observed to insert into the anterior cruciate ligament. Although the tibial portion of the anterior cruciate was redundant, the anomalous band provided tension to the anterior cruciate ligament and a negative pivot shift. A previously unreported posterior medial meniscal femoral insertion is described.

Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

PubMed

Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

2014-11-01

Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player.

PubMed

Tonogai, Ichiro; Matsuura, Tetsuya; Iwame, Toshiyuki; Wada, Keizo; Takasago, Tomoya; Goto, Tomohiro; Hamada, Daisuke; Kawatani, Yohei; Fujimoto, Eiki; Kitagawa, Tetsuya; Takao, Shyoichiro; Iwamoto, Seiji; Yamanaka, Moriaki; Harada, Masafumi; Sairyo, Koichi

2017-01-01

Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.

Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player

PubMed Central

Iwame, Toshiyuki; Hamada, Daisuke; Fujimoto, Eiki; Kitagawa, Tetsuya; Takao, Shyoichiro; Iwamoto, Seiji; Yamanaka, Moriaki; Harada, Masafumi

2017-01-01

Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy. PMID:28607785

The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture

PubMed Central

Fukui, Shinji; Aoki, Katsuya; Kaneko, Yoshiteru; Samma, Shoji; Fujimoto, Kiyohide

2014-01-01

A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously. PMID:26955558

The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture.

PubMed

Fukui, Shinji; Aoki, Katsuya; Kaneko, Yoshiteru; Samma, Shoji; Fujimoto, Kiyohide

2014-05-01

A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously.

Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes.

PubMed

Cruz, Alexandre Santa; de Hollanda, João Paris Buarque; Duarte, Aires; Hungria Neto, José Soares

2013-06-01

The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. There were no infection, non-union, malunion or anterior knee pain complications. Anterior tibial tension band plating leads to prompt fracture consolidation and is a good alternative for the treatment of anterior tibial cortex stress fractures. Bone grafts were shown to be unnecessary.

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.

Age-related differences in early novelty processing: Using PCA to parse the overlapping anterior P2 and N2 components

PubMed Central

Daffner, Kirk R.; Alperin, Brittany R.; Mott, Katherine K.; Tusch, Erich; Holcomb, Phillip J.

2015-01-01

Previous work demonstrated age-associated increases in the anterior P2 and age-related decreases in the anterior N2 in response to novel stimuli. Principal component analysis (PCA) was used to determine if the inverse relationship between these components was due to their temporal and spatial overlap. PCA revealed an early anterior P2, sensitive to task relevance, and a late anterior P2, responsive to novelty, both exhibiting age-related amplitude increases. A PCA factor representing the anterior N2, sensitive to novelty, exhibited age-related amplitude decreases. The late P2 and N2 to novels inversely correlated. Larger late P2 amplitude to novels was associated with better behavioral performance. Age-related differences in the anterior P2 and N2 to novel stimuli likely represent age-associated changes in independent cognitive operations. Enhanced anterior P2 activity (indexing augmentation in motivational salience) may be a compensatory mechanism for diminished anterior N2 activity (indexing reduced ability of older adults to process ambiguous representations). PMID:25596483

Lenticonus diagnosis in Alport's syndrome: Anterior capsule apical angle calculation using Scheimpflug imagery.

PubMed

Jarrín, E; Jarrín, I; Arnalich-Montiel, F

2015-08-01

We describe a simplified method to detect anterior lenticonus. Three eyes of 2 patients with anterior lenticonus, plus 16 eyes from 16 healthy controls underwent Scheimpflug imaging of their anterior segment with Pentacam. The anterior capsule apex angle was manually identified and automatically measured by AutoCAD. The mean angle was 173.06° (SD: 1.91) in healthy subjects, and 158.33° (SD: 3.05) in anterior lenticonus eyes. The angle obtained from patients was more than 3 SD steeper than those from healthy subjects. The apical angle calculation method seems to discriminate well between normal eyes and eyes suspected of having anterior lenticonus. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

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

PubMed

Ochoa-Escudero, Martin; Juliano, Amy F

2016-10-01

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

The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study.

PubMed

Schwartz, Daniel G; Kang, Sang Hoon; Lynch, T Sean; Edwards, Sara; Nuber, Gordon; Zhang, Li-Qun; Saltzman, Matthew

2013-03-01

Frequently, patients who are candidates for reverse shoulder arthroplasty have had prior surgery that may compromise the anterior deltoid muscle. There have been conflicting reports on the necessity of the anterior deltoid thus it is unclear whether a dysfunctional anterior deltoid muscle is a contraindication to reverse shoulder arthroplasty. The purpose of this study was to determine the 3-dimensional (3D) moment arms for all 6 deltoid segments, and determine the biomechanical significance of the anterior deltoid before and after reverse shoulder arthroplasty. Eight cadaveric shoulders were evaluated with a 6-axis force/torque sensor to assess the direction of rotation and 3D moment arms for all 6 segments of the deltoid both before and after placement of a reverse shoulder prosthesis. The 2 segments of anterior deltoid were unloaded sequentially to determine their functional role. The 3D moment arms of the deltoid were significantly altered by placement of the reverse shoulder prosthesis. The anterior and middle deltoid abduction moment arms significantly increased after placement of the reverse prosthesis (P < .05). Furthermore, the loss of the anterior deltoid resulted in a significant decrease in both abduction and flexion moments (P < .05). The anterior deltoid is important biomechanically for balanced function after a reverse total shoulder arthroplasty. Losing 1 segment of the anterior deltoid may still allow abduction; however, losing both segments of the anterior deltoid may disrupt balanced abduction. Surgeons should be cautious about performing reverse shoulder arthroplasty in patients who do not have a functioning anterior deltoid muscle. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Anterior Diabetic Retinopathy Studied by Ultra-widefield Angiography.

PubMed

Bae, Kunho; Lee, Ju Yeon; Kim, Tae Hyup; Cho, Ga Eun; Ahn, Jeeyun; Kim, Sang Jin; Kim, Jae Hyun; Kang, Se Woong

2016-10-01

To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence. A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated. Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients ( p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis ( p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients ( p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients ( p = 0.010). Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles.

Anterior Cervical Discectomy and Fusion (ACDF): Comparison Between Zero Profile Implants and Anterior Cervical Plate and Spacer.

PubMed

Alimi, Marjan; Njoku, Innocent; Hofstetter, Christoph P; Tsiouris, Apostolos J; Kesavabhotla, Kartik; Boockvar, John; Navarro-Ramirez, Rodrigo; Härtl, Roger

2016-04-17

Interposition grafts combined with anterior plating currently remain the gold standard for anterior cervical discectomy and fusion. The use of anterior plates increases fusion rates but may be associated with higher rates of postoperative dysphagia. The aim of the current study was to determine the clinical and radiological outcomes following anterior cervical discectomy and fusion (ACDF) using zero-profile anchored spacers versus standard interposition grafts with anterior plating. This was a retrospective case series. A total of 53 male and 51 female consecutive patients (164 total operated levels) who underwent ACDF between 2007 and 2011 were included. The mean clinical follow-up was 15.7 ± 1.2 (SEM) months for patients with zero-profile implants and 14.8 ± 2.1 months for patients with conventional ACDF with anterior plating. Patient demographics, operative details, clinical outcomes, complications, and radiographic imaging were reviewed. Dysphagia was determined using the Bazaz criteria. Clinical outcome scores improved in both groups as measured by the modified Japanese Orthopedic Association and Nurick scores. Zero-profile constructs gave rise to significantly less prevertebral soft tissue swelling compared to constructs with anterior plates postoperatively (15.74 ± 0.52 as compared to 20.48 ± 0.85 mm, p < 0.001) and at the latest follow-up (10.88 ± 0.39 mm vs. 13.72 ± 0.67 mm, p < 0.001). There was a significant difference in the incidence of dysphagia at the latest follow-up (1.5% vs. 20%, p=0.001, zero-profile vs. anterior plate, respectively). Zero-profile implants lead to functional outcomes similar to standard anterior plate constructs. Avoiding the use of an anterior locking plate may decrease the risk of persistent postoperative dysphagia.

The effect of anterior proton beams in the setting of a prostate-rectum spacer

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

Christodouleas, John P., E-mail: christojo@uphs.upenn.edu; Tang, Shikui; Susil, Robert C.

2013-10-01

Studies suggest that anterior beams with in vivo range verification would improve rectal dosimetry in proton therapy for prostate cancer. We investigated whether prostate-rectum spacers would enhance or diminish the benefits of anterior proton beams in these treatments. Twenty milliliters of hydrogel was injected between the prostate and rectum of a cadaver using a transperineal approach. Computed tomography (CT) and magnetic resonance (MR) images were used to generate 7 uniform scanning (US) and 7 single-field uniform dose pencil-beam scanning (PBS) plans with different beam arrangements. Pearson correlations were calculated between rectal, bladder, and femoral head dosimetric outcomes and beam arrangementmore » anterior scores, which characterize the degree to which dose is delivered anteriorly. The overall quality of each plan was compared using a virtual dose-escalation study. For US plans, rectal mean dose was inversely correlated with anterior score, but for PBS plans there was no association between rectal mean dose and anterior score. For both US and PBS plans, full bladder and empty bladder mean doses were correlated with anterior scores. For both US and PBS plans, femoral head mean doses were inversely correlated with anterior score. For US plans and a full bladder, 4 beam arrangements that included an anterior beam tied for the highest maximum prescription dose (MPD). For US plans and an empty bladder, the arrangement with 1 anterior and 2 anterior oblique beams achieved the highest MPD in the virtual dose-escalation study. The dose-escalation study did not differentiate beam arrangements for PBS. All arrangements in the dose-escalation study were limited by bladder constraints except for the arrangement with 2 posterior oblique beams. The benefits of anterior proton beams in the setting of prostate-rectum spacers appear to be proton modality dependent and may not extend to PBS.« less

The effect of anterior proton beams in the setting of a prostate-rectum spacer

PubMed Central

Christodouleas, John P.; Tang, Shikui; Susil, Robert C.; McNutt, Todd R.; Song, Danny Y.; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha; DeWeese, Theodore L.; Lu, Hsiao-Ming; Both, Stefan

2014-01-01

Studies suggest that anterior beams with in vivo range verification would improve rectal dosimetry in proton therapy for prostate cancer. We investigated whether prostate-rectum spacers would enhance or diminish the benefits of anterior proton beams in these treatments. Twenty milliliters of hydrogel was injected between the prostate and rectum of a cadaver using a transperineal approach. Computed tomography (CT) and magnetic resonance (MR) images were used to generate 7 uniform scanning (US) and 7 single-field uniform dose pencil-beam scanning (PBS) plans with different beam arrangements. Pearson correlations were calculated between rectal, bladder, and femoral head dosimetric outcomes and beam arrangement anterior scores, which characterize the degree to which dose is delivered anteriorly. The overall quality of each plan was compared using a virtual dose-escalation study. For US plans, rectal mean dose was inversely correlated with anterior score, but for PBS plans there was no association between rectal mean dose and anterior score. For both US and PBS plans, full bladder and empty bladder mean doses were correlated with anterior scores. For both US and PBS plans, femoral head mean doses were inversely correlated with anterior score. For US plans and a full bladder, 4 beam arrangements that included an anterior beam tied for the highest maximum prescription dose (MPD). For US plans and an empty bladder, the arrangement with 1 anterior and 2 anterior oblique beams achieved the highest MPD in the virtual dose-escalation study. The dose-escalation study did not differentiate beam arrangements for PBS. All arrangements in the dose-escalation study were limited by bladder constraints except for the arrangement with 2 posterior oblique beams. The benefits of anterior proton beams in the setting of prostate-rectum spacers appear to be proton modality dependent and may not extend to PBS. PMID:23578497

Anterior Urethral Advancement as a Single-Stage Technique for Repair of Anterior Hypospadias: Our Experience.

PubMed

Gite, Venkat A; Nikose, Jayant V; Bote, Sachin M; Patil, Saurabh R

2017-07-02

Many techniques have been described to correct anterior hypospadias with variable results. Anterior urethral advancement as one stage technique was first described by Ti Chang Shing in 1984. It was also used for the repair of strictures and urethrocutaneous fistulae involving distal urethra. We report our experience of using this technique with some modification for the repair of anterior hypospadias. In the period between 2013-2015, 20 cases with anterior hypospadias including 2 cases of glanular, 3 cases of coronal, 12 cases of subcoronal and 3 cases of distal penile hypospadias were treated with anterior urethral advancement technique. Patients' age groups ranged from 18 months to 10 years. Postoperatively, patients were passing urine from tip of neomeatus with satisfactory stream during follow up period of 6 months to 2 years. There were no major complications in any of our patients except in one patient who developed meatal stenosis which was treated by periodic dilatation. Three fold urethral mobilization was sufficient in all cases. Anterior urethral advancement technique is a single-stage procedure with good cosmetic results and least complications for anterior hypospadias repair in properly selected cases.

[Two cases of Vogt-Koyanagi-Harada disease presenting shallow anterior chamber].

PubMed

Takemoto, Daisuke; Ijiri, Shigeyuki; Shimizu, Michiharu; Higashide, Tomomi; Sugiyama, Kazuhisa

2015-05-01

We report two cases of Vogt-Koyanagi-Harada disease (VKH) in which shallow anterior chambers were improved after steroid pulse therapy. The patients were women aged 65 and 72. They had headaches, decreased visual acuity and shallow anterior chamber in both eyes. There was no inflammation in the anterior chamber. Ultrasound biomicroscopy (UBM) showed ciliary edema, ciliochoroidal detachment, and angle closure. One case showed high intraocular pressure (IOP), and a diagnosis of acute primary angle closure was made. Although cataract surgery was performed in the left eye, postoperative optical coherence tomography (OCT) revealed serous retinal detachment in both eyes. The shallow anterior chamber and UBM findings were improved and serous retinal detachment disappeared after steroid pulse therapy in both cases. VKH may cause shallow anterior chamber and angle closure. The inflammatory changes of VKH in the anterior segment, i. e. ciliary edema and ciliochoroidal detachment, may exacerbate the shallow anterior chambers and narrow angles and result in an acute increase in IOP in eyes with short axial length. VKH associated with shallow anterior chamber may be misdiagnosed as acute primary angle closure. For differential diagnosis, examinations of the ocular fundus including OCT are useful.

Varus alignment leads to increased forces in the anterior cruciate ligament.

PubMed

van de Pol, Gerrit Jan; Arnold, Markus P; Verdonschot, Nico; van Kampen, Albert

2009-03-01

Varus thrust of the knee is a dynamic increase of an often preexisting varus angle and it is suspected to be a major reason for failure of anterior cruciate ligament reconstructions. However, it is not known if a direct relationship exists between varus thrust and forces in the anterior cruciate ligament. Forces in the anterior cruciate ligament increase with increasing varus alignment, and consequently an anterior cruciate ligament deficiency in a varus-aligned leg leads to more lateral tibiofemoral joint opening. Controlled laboratory study. Six human cadaver legs were axially loaded with 3 different weightbearing lines--a neutral weightbearing line, a weightbearing line that passes through the middle of the medial tibial plateau (50% varus), and a line passing the edge of the medial tibial plateau (100% varus)--that were used to create a varus moment. The resulting lateral tibiofemoral joint opening and corresponding anterior cruciate ligament tension were measured. The tests were repeated with and without the anterior cruciate ligament in place. In the neutral aligned legs, there was no apparent lateral joint opening, and no anterior cruciate ligament tension change was noted. The lateral joint opening increased when the weightbearing line increased from 0% to 50% to 100%. The lateral joint opening was significantly higher in 10 degrees of knee flexion compared with knee extension. In the 100% varus weightbearing line, the anterior cruciate ligament tension was significantly higher (53.9 N) compared with neutral (31 N) or the 50% weightbearing line (37.9 N). A thrust could only be observed in the 100% weightbearing line tests. In the absence of an anterior cruciate ligament, there was more lateral joint opening, although this was only significant in the 100% weightbearing line. There is a direct relationship between varus alignment and anterior cruciate ligament tension. In the absence of an anterior cruciate ligament, the amount of lateral opening tends to increase. With increasing lateral opening, a thrust can sometimes be experimentally observed. A varus alignment in an anterior cruciate ligament-deficient knee does not necessarily lead to a varus thrust and therefore does not always need operative varus alignment correction. However, in an unstable anterior cruciate ligament-deficient knee with a varus thrust, it might be safer to perform a high valgus tibial osteotomy to minimize the risk of an anterior cruciate ligament reconstruction failure.

38 CFR 3.379 - Anterior poliomyelitis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

38 CFR 3.379 - Anterior poliomyelitis.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

38 CFR 3.379 - Anterior poliomyelitis.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

38 CFR 3.379 - Anterior poliomyelitis.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

38 CFR 3.379 - Anterior poliomyelitis.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is...

Molecular Age-Related Changes in the Anterior Segment of the Eye

PubMed Central

Gulias-Cañizo, Rosario; Martínez-Báez, Blanca Elizabeth; Quiroz-Mercado, Hugo

2017-01-01

Purpose To examine the current knowledge about the age-related processes in the anterior segment of the eye at a biological, clinical, and molecular level. Methods We reviewed the available published literature that addresses the aging process of the anterior segment of the eye and its associated molecular and physiological events. We performed a search on PubMed, CINAHL, and Embase using the MeSH terms “eye,” “anterior segment,” and “age.” We generated searches to account for synonyms of these keywords and MESH headings as follows: (1) “Eye” AND “ageing process” OR “anterior segment ageing” and (2) “Anterior segment” AND “ageing process” OR “anterior segment” AND “molecular changes” AND “age.” Results. Among the principal causes of age-dependent alterations in the anterior segment of the eye, we found the mutation of the TGF-β gene and loss of autophagy in addition to oxidative stress, which contributes to the pathogenesis of degenerative diseases. Conclusions In this review, we summarize the current knowledge regarding some of the molecular mechanisms related to aging in the anterior segment of the eye. We also introduce and propose potential roles of autophagy, an important mechanism responsible for maintaining homeostasis and proteostasis under stress conditions in the anterior segment during aging. PMID:29147580

Atypical anterior wall fracture of the acetabulum: case series of anterior acetabular rim fracture without involvement of the pelvic brim.

PubMed

Lenarz, Christopher J; Moed, Berton R

2007-09-01

The purpose of this study was to describe a form of anterior wall acetabular fracture, which has been inadequately defined in the literature. Retrospective analysis of consecutive patients. Level 1 trauma center. A retrospective analysis of consecutive acetabulum patients treated by a single surgeon between 1999 and 2005 identified 6 patients with a form of anterior wall fracture without involvement of the pelvic brim. All fractures were treated operatively. Open reduction and internal fixation through an anterior surgical approach. Final radiographic appearance and modified Merle d'Aubigne score. All 6 cases demonstrated characteristics of an atypical fracture of the anterior wall, involving the anterior rim of the acetabulum similar in nature to those described for the posterior wall, rather than the standard anterior wall fracture type described by Letournel. Of the 6 cases that were identified, 5 had follow-up 1 year or greater with a mean modified Merle d'Aubigne Score of 17 (range: 17-18). A form of anterior wall acetabular fracture exists, which involves the anterior acetabular rim without involvement of the pelvic brim. It can occur in young patients with high-energy mechanisms of injury, as well as in the elderly with low-energy trauma. With appropriate surgical management, using a modified Smith-Peterson approach, good to excellent clinical outcomes should be expected.

A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability – diagnostics using a posterior approach

PubMed Central

Kielar, Maciej

2016-01-01

Aim The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency. PMID:27679732

Scheimpflug imaging in anterior megalophthalmos

PubMed Central

Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo

2013-01-01

We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment. PMID:23275220

Scheimpflug imaging in anterior megalophthalmos.

PubMed

Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo

2013-01-01

We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment.

A Rare Case of Neglected Traumatic Anterior Dislocation of Hip in a Child.

PubMed

Mootha, Aditya Krishna; Mogali, Kasi Viswanadam

2016-01-01

Post traumatic hip dislocations are very rare in children. Neglected anterior hip dislocations in children are not described in literature so far. Here, we present a case of 6 weeks old anterior hip dislocation successfully managed by open reduction. A 9-year-old male child presented with neglected anterior hip dislocation on left side. Open reduction carried out through direct anterior approach to hip. Congruent reduction is achieved. At final follow up of 1 year, the child had unrestricted activities of daily living and no radiological signs of osteonecrosis or any joint space reduction. There is paucity of literature over neglected post traumatic anterior hip dislocations in children. The treatment options vary from closed reduction after heavy traction to sub trochanteric osteotomy. However, we feel that open reduction through direct anterior approach is the preferred mode of management whenever considered possible.

Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis

PubMed Central

Yeon, Howard B.; Weinberg, Jacob; Arlet, Vincent; Ouelett, Jean A.

2007-01-01

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5–7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4. PMID:17464517

A blind area of origins of epistaxis: technical or cognitive?

PubMed

Wei, Wei; Lai, Yuting; Zang, Chaoping; Luo, Jiqin; Zhu, Bijun; Liu, Quan; Liu, Ying

2018-04-24

To investigate common origins and features of anterior epistaxis. Patients (168) with anterior nose bleed were studied from May to October 2013. Endoscopic examination with angled endoscope and then subsequent management (radiofrequency, selective packing,) was performed. Under thorough nasal endoscopy, anterior nasal bleeding origin was ranked in turn as follows: the anterior nasal septum (NS 83.3%), the small area of anterior lateral wall of nasal cavity corresponding to the nasal back (NB 7.1%), the anterior end of the inferior turbinate (IT 5.4%), and the nasal part of the nasal cavity roof (NR 4.2%). Arterial lesion and hypertension led to large instant quantity of bleeding; hypertension and negligible bleeding origin prolonged bleeding duration. Bleeding was successfully controlled with nasal endoscopy and radiofrequency or selective packing. The arterial bleeding small area of anterior lateral wall of nasal cavity corresponding to the nasal back and the nasal part of the nasal cavity roof accounted for more than 10% of anterior epistaxis and a thorough endoscopic examination should include these area with angled endoscope. Then radiofrequency and selective packing will sharply reduce the bleeding duration.

Wnt6 maintains anterior escort cells as an integral component of the germline stem cell niche

PubMed Central

2018-01-01

ABSTRACT Stem cells reside in a niche, a local environment whose cellular and molecular complexity is still being elucidated. In Drosophila ovaries, germline stem cells depend on cap cells for self-renewing signals and physical attachment. Germline stem cells also contact the anterior escort cells, and here we report that anterior escort cells are absolutely required for germline stem cell maintenance. When escort cells die from impaired Wnt signaling or hid expression, the loss of anterior escort cells causes loss of germline stem cells. Anterior escort cells function as an integral niche component by promoting DE-cadherin anchorage and by transiently expressing the Dpp ligand to promote full-strength BMP signaling in germline stem cells. Anterior escort cells are maintained by Wnt6 ligands produced by cap cells; without Wnt6 signaling, anterior escort cells die leaving vacancies in the niche, leading to loss of germline stem cells. Our data identify anterior escort cells as constituents of the germline stem cell niche, maintained by a cap cell-produced Wnt6 survival signal. PMID:29361569

Wnt6 maintains anterior escort cells as an integral component of the germline stem cell niche.

PubMed

Wang, Xiaoxi; Page-McCaw, Andrea

2018-02-07

Stem cells reside in a niche, a local environment whose cellular and molecular complexity is still being elucidated. In Drosophila ovaries, germline stem cells depend on cap cells for self-renewing signals and physical attachment. Germline stem cells also contact the anterior escort cells, and here we report that anterior escort cells are absolutely required for germline stem cell maintenance. When escort cells die from impaired Wnt signaling or hid expression, the loss of anterior escort cells causes loss of germline stem cells. Anterior escort cells function as an integral niche component by promoting DE-cadherin anchorage and by transiently expressing the Dpp ligand to promote full-strength BMP signaling in germline stem cells. Anterior escort cells are maintained by Wnt6 ligands produced by cap cells; without Wnt6 signaling, anterior escort cells die leaving vacancies in the niche, leading to loss of germline stem cells. Our data identify anterior escort cells as constituents of the germline stem cell niche, maintained by a cap cell-produced Wnt6 survival signal. © 2018. Published by The Company of Biologists Ltd.

Flexibility and fatigue evaluation of oblique as compared with anterior lumbar interbody cages with integrated endplate fixation.

PubMed

Freeman, Andrew L; Camisa, William J; Buttermann, Glenn R; Malcolm, James R

2016-01-01

This study was undertaken to quantify the in vitro range of motion (ROM) of oblique as compared with anterior lumbar interbody devices, pullout resistance, and subsidence in fatigue. Anterior and oblique cages with integrated plate fixation (IPF) were tested using lumbar motion segments. Flexibility tests were conducted on the intact segments, cage, cage + IPF, and cage + IPF + pedicle screws (6 anterior, 7 oblique). Pullout tests were then performed on the cage + IPF. Fatigue testing was conducted on the cage + IPF specimens for 30,000 cycles. No ROM differences were observed in any test group between anterior and oblique cage constructs. The greatest reduction in ROM was with supplemental pedicle screw fixation. Peak pullout forces were 637 ± 192 N and 651 ± 127 N for the anterior and oblique implants, respectively. The median cage subsidence was 0.8 mm and 1.4 mm for the anterior and oblique cages, respectively. Anterior and oblique cages similarly reduced ROM in flexibility testing, and the integrated fixation prevented device displacement. Subsidence was minimal during fatigue testing, most of which occurred in the first 2500 cycles.

Intraarticular arthrofibrosis of the knee alters patellofemoral contact biomechanics.

PubMed

Mikula, Jacob D; Slette, Erik L; Dahl, Kimi D; Montgomery, Scott R; Dornan, Grant J; O'Brien, Luke; Turnbull, Travis Lee; Hackett, Thomas R

2017-12-19

Arthrofibrosis in the suprapatellar pouch and anterior interval can develop after knee injury or surgery, resulting in anterior knee pain. These adhesions have not been biomechanically characterized. The biomechanical effects of adhesions in the suprapatellar pouch and anterior interval during simulated quadriceps muscle contraction from 0 to 90° of knee flexion were assessed. Adhesions of the suprapatellar pouch and anterior interval were hypothesized to alter the patellofemoral contact biomechanics and increase the patellofemoral contact force compared to no adhesions. Across all flexion angles, suprapatellar adhesions increased the patellofemoral contact force compared to no adhesions by a mean of 80 N. Similarly, anterior interval adhesions increased the contact force by a mean of 36 N. Combined suprapatellar and anterior interval adhesions increased the mean patellofemoral contact force by 120 N. Suprapatellar adhesions resulted in a proximally translated patella from 0 to 60°, and anterior interval adhesions resulted in a distally translated patella at all flexion angles other than 15° (p < 0.05). The most important finding in this study was that patellofemoral contact forces were significantly increased by simulated adhesions in the suprapatellar pouch and anterior interval. Anterior knee pain and osteoarthritis may result from an increase in patellofemoral contact force due to patellar and quadriceps tendon adhesions. For these patients, arthroscopic lysis of adhesions may be beneficial.

Finite element analysis and cadaveric cinematic analysis of fixation options for anteriorly implanted trabecular metal interbody cages.

PubMed

Berjano, Pedro; Blanco, Juan Francisco; Rendon, Diego; Villafañe, Jorge Hugo; Pescador, David; Atienza, Carlos Manuel

2015-11-01

To assess, with finite element analysis and an in vitro biomechanical study in cadaver, whether the implementation of an anterior interbody cage made of hedrocel with nitinol shape memory staples in compression increases the stiffness of the stand-alone interbody cage and to compare these constructs' stiffness to other constructs common in clinical practice. A biomechanical study with a finite element analysis and cadaveric testing assessed the stiffness of different fixation modes for the L4-L5 functional spinal unit: intact spine, destabilized spine with discectomy, posterior pedicle-screw fixation, anterior stand-alone interbody cage, anterior interbody cage with bilateral pedicle screws and anterior interbody cage with two shape memory staples in compression. These modalities of vertebral fixation were compared in four loading modes (flexion, extension, lateral bending, and axial rotation). The L4-L5 spinal unit with an anterior interbody cage and two staples was stiffer than the stand-alone cage. The construct stiffness was similar to that of a model of posterior pedicular stabilization. The stiffness was lower than that of the anterior cage plus bilateral pedicle-screw fixation. The use of an anterior interbody implant with shape memory staples in compression may be an alternative to isolated posterior fixation and to anterior isolated implants, with increased stiffness.

Biomechanical differences of the anterior and posterior bands of the ulnar collateral ligament of the elbow.

PubMed

Jackson, Timothy J; Jarrell, Shelby E; Adamson, Gregory J; Chung, Kyung Chil; Lee, Thay Q

2016-07-01

The main purpose of this study was to examine the functional characteristics of the anterior and posterior bands of the anterior bundle of the ulnar collateral ligament (UCL). Six cadaveric elbows were tested using a digital tracking system to measure the strain in the anterior band and posterior band of the anterior bundle of the UCL throughout a flexion/extension arc. The specimens were then placed in an Instron materials testing machine and loaded to failure to determine yield load and ultimate load of the UCL. The posterior band showed a linear increase in strain with increasing degrees of elbow flexion while the anterior band showed minimal change in strain throughout. The bands showed similar strain at yield load and ultimate load, demonstrating similar intrinsic properties. The anterior band of the anterior bundle of the UCL shows an isometric strain pattern through elbow range of motion, while the posterior band shows an increasing strain pattern in higher degrees of elbow flexion. Both bands show similar strain in a load to failure model, indicating insertion point, not intrinsic differences, of the bands determine the function of the anterior bundle of the UCL. This demonstrates a biomechanical rationale for UCL reconstructions using single point anatomical insertion points.

An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients.

PubMed

Oliveira, Dauro Douglas; Bartolomeo, Flávia Uchôa Costa; Cardinal, Lucas; Figueiredo, Daniel Santos Fonseca; Palomo, Juan Martin; Andrade, Ildeu

2014-11-01

Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.

OCT-based crystalline lens topography in accommodating eyes.

PubMed

Pérez-Merino, Pablo; Velasco-Ocana, Miriam; Martinez-Enriquez, Eduardo; Marcos, Susana

2015-12-01

Custom Spectral Domain Optical Coherence Tomography (SD-OCT) provided with automatic quantification and distortion correction algorithms was used to measure anterior and posterior crystalline lens surface elevation in accommodating eyes and to evaluate relationships between anterior segment surfaces. Nine young eyes were measured at different accommodative demands. Anterior and posterior lens radii of curvature decreased at a rate of 0.78 ± 0.18 and 0.13 ± 0.07 mm/D, anterior chamber depth decreased at 0.04 ± 0.01 mm/D and lens thickness increased at 0.04 ± 0.01 mm/D with accommodation. Three-dimensional surface elevations were estimated by subtracting best fitting spheres. In the relaxed state, the spherical term accounted for most of the surface irregularity in the anterior lens (47%) and astigmatism (70%) in the posterior lens. However, in accommodated lenses astigmatism was the predominant surface irregularity (90%) in the anterior lens. The RMS of high-order irregularities of the posterior lens surface was statistically significantly higher than that of the anterior lens surface (x2.02, p<0.0001). There was significant negative correlation in vertical coma (Z3 (-1)) and oblique trefoil (Z3 (-3)) between lens surfaces. The astigmatic angle showed high degree of alignment between corneal surfaces, moderate between corneal and anterior lens surface (~27 deg), but differed by ~80 deg between the anterior and posterior lens surfaces (including relative anterior/posterior lens astigmatic angle shifts (10-20 deg).

OCT-based crystalline lens topography in accommodating eyes

PubMed Central

Pérez-Merino, Pablo; Velasco-Ocana, Miriam; Martinez-Enriquez, Eduardo; Marcos, Susana

2015-01-01

Custom Spectral Domain Optical Coherence Tomography (SD-OCT) provided with automatic quantification and distortion correction algorithms was used to measure anterior and posterior crystalline lens surface elevation in accommodating eyes and to evaluate relationships between anterior segment surfaces. Nine young eyes were measured at different accommodative demands. Anterior and posterior lens radii of curvature decreased at a rate of 0.78 ± 0.18 and 0.13 ± 0.07 mm/D, anterior chamber depth decreased at 0.04 ± 0.01 mm/D and lens thickness increased at 0.04 ± 0.01 mm/D with accommodation. Three-dimensional surface elevations were estimated by subtracting best fitting spheres. In the relaxed state, the spherical term accounted for most of the surface irregularity in the anterior lens (47%) and astigmatism (70%) in the posterior lens. However, in accommodated lenses astigmatism was the predominant surface irregularity (90%) in the anterior lens. The RMS of high-order irregularities of the posterior lens surface was statistically significantly higher than that of the anterior lens surface (x2.02, p<0.0001). There was significant negative correlation in vertical coma (Z3−1) and oblique trefoil (Z3−3) between lens surfaces. The astigmatic angle showed high degree of alignment between corneal surfaces, moderate between corneal and anterior lens surface (~27 deg), but differed by ~80 deg between the anterior and posterior lens surfaces (including relative anterior/posterior lens astigmatic angle shifts (10-20 deg). PMID:26713216

Comparison of the intervertebral disc spaces between axial and anterior lean cervical traction.

PubMed

Chung, Chin-Teng; Tsai, Sen-Wei; Chen, Chun-Jung; Wu, Ting-Chung; Wang, David; Lan, Haw-Chang H; Wu, Shyi-Kuen

2009-11-01

The insufficient investigations on the changes of spinal structures during traction prevent further exploring the possible therapeutic mechanism of cervical traction. A blind randomized crossover-design study was conducted to quantitatively compare the intervertebral disc spaces between axial and anterior lean cervical traction in sitting position. A total of 96 radiographic images from the baseline measurements, axial and anterior lean tractions in 32 asymptomatic subjects were digitized for further analysis. The intra- and inter-examiner reliabilities for measuring the intervertebral disc spaces were in good ranges (ICCs = 0.928-0.942). With the application of anterior lean traction, the statistical increases were detected both in anterior and in posterior disc spaces compared to the baseline (0.29 mm and 0.24 mm; both P < 0.01) and axial traction (0.16 mm and 0.35 mm; both P < 0.01). The greater intervertebral disc spaces obtained during anterior lean traction might be associated with the more even distribution of traction forces over the anterior and posterior neck structures. The neck extension moment through mandible that generally occurred in the axial traction could be counteracted by the downward force of head weight during anterior lean traction. This study quantitatively demonstrated that anterior lean traction in sitting position provided more intervertebral disc space enlargements in both anterior and posterior aspects than axial traction did. These findings may serve as a therapeutic reference when cervical traction is suggested.

Reliability of the anterior drawer test, the pivot shift test, and the Lachman test.

PubMed

Kim, S J; Kim, H K

1995-08-01

In 147 patients with arthroscopically proved chronic injuries of the anterior cruciate ligament, the anterior drawer test, the Lachman test, and the pivot shift test were done before operation under general or spinal anesthesia. Results of the anterior drawer test were positive in 79.6% of the patients, in 98.6% patients having the Lachman test, and in 89.8% of patients having the pivot shift test. In 19 cases (12.9%), arthroscopic examination showed reattachment of the proximally torn end of the anterior cruciate ligament to the posterior cruciate ligament. In these cases, results of the anterior drawer test were positive in 13 patients (68.4%), in 17 (89.5%) patients having the Lachman test, and in 12 patients (63.2%) having the pivot shift test. In 15 cases with a false negative pivot shift test, arthroscopy showed blockage of anterior subluxation of the lateral tibial condyle by a partially functioning portion of the anterior cruciate ligament, which was reattached to the posterior cruciate ligament in 7 cases. In 2 cases with a false negative Lachman test, there was firm reattachment of the torn end of the anterior cruciate ligament to the proximal portion of the posterior cruciate ligament combined with a bucket handle tear of the medial meniscus. The Lachman test was most sensitive in diagnosing chronic injuries of the anterior cruciate ligament. The pivot shift test was also sensitive but was influenced by many factors.

Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome.

PubMed

Eftaiha, S M; Balachandran, B; Marecik, S J; Mellgren, A; Nordenstam, J; Melich, G; Prasad, L M; Park, J J

2017-10-01

Sacral nerve stimulation has become a preferred method for the treatment of faecal incontinence in patients who fail conservative (non-operative) therapy. In previous small studies, sacral nerve stimulation has demonstrated improvement of faecal incontinence and quality of life in a majority of patients with low anterior resection syndrome. We evaluated the efficacy of sacral nerve stimulation in the treatment of low anterior resection syndrome using a recently developed and validated low anterior resection syndrome instrument to quantify symptoms. A retrospective review of consecutive patients undergoing sacral nerve stimulation for the treatment of low anterior resection syndrome was performed. Procedures took place in the Division of Colon and Rectal Surgery at two academic tertiary medical centres. Pre- and post-treatment Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores were assessed. Twelve patients (50% men) suffering from low anterior resection syndrome with a mean age of 67.8 (±10.8) years underwent sacral nerve test stimulation. Ten patients (83%) proceeded to permanent implantation. Median time from anterior resection to stimulator implant was 16 (range 5-108) months. At a median follow-up of 19.5 (range 4-42) months, there were significant improvements in Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores (P < 0.001). Sacral nerve stimulation improved symptoms in patients suffering from low anterior resection syndrome and may therefore be a viable treatment option. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Modeling the drug transport in the anterior segment of the eye.

PubMed

Avtar, Ram; Tandon, Deepti

2008-10-02

The aim of the present work is the development of a simple mathematical model for the time course concentration profile of topically administered drugs in the anterior chamber aqueous humor and investigation of the effects of various model parameters on the aqueous humor concentration of lipophilic and hydrophilic drugs. A simple pharmacokinetic model for the transient drug transport in the anterior segment has been developed by using the conservation of mass in the precorneal tear film, Fick's law of diffusion and Michaelis-Menten kinetics of drug metabolism in cornea, and the conservation of mass in the anterior chamber. An analytical solution describing the drug concentration in the anterior chamber has been obtained. The model predicts that an increase in the drug metabolic (consumption) rate in the corneal epithelium reduces the drug concentration in the anterior chamber for both lipophilic and hydrophilic molecules. A decrease in the clearance rate and distribution volume of the drug in the anterior chamber raises the aqueous humor concentration significantly. It is also observed that decay rate of drug concentration in the anterior chamber is higher for lipophilic molecules than that for hydrophilic molecules. The bioavailability of drugs applied topically to the eye may be improved by a rise in the precorneal tear volume, diffusion coefficient in corneal epithelium and distribution coefficient across the endothelium anterior chamber interface, and by reducing the drug metabolism, drug clearance rate and distribution volume in anterior chamber.

Subgenual anterior cingulate-insula resting-state connectivity as a neural correlate to trait and state stress resilience.

PubMed

Shao, Robin; Lau, Way K W; Leung, Mei-Kei; Lee, Tatia M C

2018-07-01

Accumulating evidence indicates important roles of the subgenual anterior cingulate cortex and rostral limbic regions such as the anterior insula, in regulating stress-related affective responses and negative affect states in general. However, research is lacking in simultaneously assessing the inter-relations between trait and state affective responses to stress, and the functional connectivity between the subgenual anterior cingulate and anterior insula. This preliminary research involved matched healthy participants with high (N = 10) and low (N = 10) self-reported trait stress resilience, and assessed their affective and subgenual anterior cingulate-anterior insula resting-state functional connectivity patterns before and after a psychosocial stress task. We found that while the low-resilience group displayed higher trait negative affect and perceived greater task-related stress, only the high-resilience group showed increase of negative affect, along with greater decrease of left subgenual anterior cingulate-right anterior insula connectivity, following stress induction. Moreover, the functional connectivity change mediated group difference in affect change following stress task. We speculate that the contingent increase of negative affect, and the associated temporary decoupling of subgenual anterior cingulate-insula circuitry, may represent a normative and adaptive stress response underpinned by adaptive and dynamic interplay between the default mode and salience networks. Such findings, if consolidated, have important implications for promoting stress resilience and reducing risk for stress-related affective disorders. Copyright © 2018. Published by Elsevier Inc.

Neural connectivity of the anterior body of the fornix in the human brain: diffusion tensor imaging study.

PubMed

Jang, Sung Ho; Kwon, Hyeok Gyu

2014-01-24

A few studies have reported on the neural connectivity of the fornix in the human brain, however, little is known about the neural connectivity of the anterior body of the fornix. In this study, we used diffusion tensor imaging in investigation of the neural connectivity of the anterior body of the fornix in normal subjects. Forty healthy subjects were recruited for this study. A seed region of interest was placed on the anterior body of the fornix using the FMRIB Software Library. Connectivity was defined as the incidence of connection between the anterior body of the fornix and any neural structure of the brain at the threshold of 5, 25, and 50 streamlines. In all subjects, the anterior body of the fornix showed 100% connectivity to the anterior commissure and hypothalamus at thresholds of 5, 25, and 50. On the other hand, regarding the thresholds of 5, 25, and 50, the anterior body of the fornix showed connectivity to the septal forebrain region (53.8, 23.8, and 15.0%), frontal lobe via anterior commissure (41.3,12.5, and 10.0%), medial temporal lobe (85.0,66.3, and 62.5%), lateral temporal lobe (75.0, 56.3, and 35.0%), occipital lobe (21.3, 5.0, and 1.3%), frontal lobe via septum pellucidum (28.8, 13.8, and 8.8%), tegmentum of midbrain (7.5, 5.0, and 0%), tectum of midbrain (2.5,0, and 0%), and tegmentum of pons (5.0,0, and 0%). The anterior body of the fornix showed high connectivity with the anterior commissure and hypothalamus, and brain areas relevant to cholinergic nuclei (the septal forebrain region and brainstem) and memory function (the medial temporal lobe). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Maxillary anterior en masse retraction using different antero-posterior position of mini screw: a 3D finite element study.

PubMed

Hedayati, Zohreh; Shomali, Mehrdad

2016-12-01

Nowadays, mini screws are used in orthodontic tooth movement to obtain maximum or absolute anchorage. They have gained popularity among orthodontists for en masse retraction of anterior teeth after first premolar extraction in maximum anchorage cases. The purpose of this study was to determine the type of anterior tooth movement during the time when force was applied from different mini screw placements to the anterior power arm with various heights. A finite element method was used for modeling maxillary teeth and bone structure. Brackets, wire, and hooks were also designed for modeling. Two appropriate positions for mini screw in the mesial and distal of the second premolar were designed as fixed nodes. Forces were applied from the mini screw to four different levels of anterior hook height: 0, 3, 6, and 9 mm. Initial tooth movement in eight different conditions was analyzed and calculated with ANSYS software. Rotation of anterior dentition was decreased with a longer anterior power arm and the mesial placement of the mini screw. Bodily movements occurred with the 9-mm height of the power arm in both mini screw positions. Intrusion or extrusion of the anterior teeth segment depended on the level of the mini screw and the edge of the power arm on the Z axis. According to the findings of this study, the best control in the sagittal plane during anterior en masse retraction was achieved by mesial placement of the mini screw and the 9-mm height of the anterior power arm. Where control in the vertical plane was concerned, distal placement of the mini screw with the 6-mm power arm height had minimum adverse effect on anterior dentition.

Profiles of muscularity in junior Olympic weight lifters.

PubMed

Kanehisa, H; Funato, K; Abe, T; Fukunaga, T

2005-03-01

This study aimed to investigate the muscularity of strength-trained junior athletes. Muscle thickness (Mt) values at 10 sites (anterior forearm, anterior upper arm, posterior upper arm, chest, abdomen, back, anterior thigh, posterior thigh, anterior lower leg, and posterior lower leg) were determined in junior Olympic weight lifters (OWL, n=7, 15.1+/-0.3 y, mean+/-SD) and non-athletes (CON, n=13, 15.1+/-0.3 y) using a brightness mode ultrasonography. Skeletal age assessed with the Tanner-Whitehouse II method (20 hand-wrist bones) was similar in OWL (16.4+/-0.7 y) and CON (16.3+/-0.6 y). At the 6 sites (anterior forearm, anterior upper arm, posterior upper arm, chest, back and anterior thigh), OWL showed significantly greater Mt values than CON even in terms of Mt relative to body mass(1/3) Mt x BM(-1/3). On the other hand, there were no significant differences between the 2 groups in the Mt ratios of the anterior to posterior site in the upper arm, thigh and lower leg and those of the back to either the chest or abdomen in the trunk. For OWL only, skeletal age was significantly correlated to Mt x BM(-1/3) at the abdomen (r=0.869, p<0.05) and anterior thigh (r=0.883, p<0.05). The findings here indicate that 1) as compared to adolescent non-athletes, junior Olympic weight lifters show a greater muscularity in the upper body and anterior thigh without predominant development in either of anterior and posterior sites within the same body segment, 2) for junior Olympic weight lifters, the muscularity of abdominal and knee extensor muscles is influenced by the biological maturation.

Tensile properties of a morphologically split supraspinatus tendon.

PubMed

Matsuhashi, Tomoya; Hooke, Alexander W; Zhao, Kristin D; Goto, Akira; Sperling, John W; Steinmann, Scott P; An, Kai-Nan

2014-07-01

The supraspinatus tendon consists morphologically of two sub-regions, anterior and posterior. The anterior sub-region is thick and tubular while the posterior is thin and strap-like. The purpose of this study was to compare the structural and mechanical properties of the anterior and posterior sub-regions of the supraspinatus tendon. The supraspinatus tendons from seven human cadaveric shoulders were morphologically divided into the anterior and posterior sub-regions. Length, width, and thickness were measured. A servo-hydraulic testing machine (MTS Systems Corporation, Minneapolis, MN) was used for tensile testing. The maximal load at failure, modulus of elasticity and ultimate tendon stress were calculated. Repeated measures were used for statistical comparisons. The mean anterior tendon cross-sectional area was 47.3 mm(2) and the posterior was 32.1 mm(2) . Failure occurred most often at the insertion site: anterior (5/7) and posterior (6/7). All parameters of the anterior sub-region were significantly greater than those of the posterior sub-region. The moduli of elasticity at the insertion site were 592.4 MPa in the anterior sub-region and 217.7 MPa in the posterior (P = 0.01). The ultimate failure loads were 779.2 N in the anterior sub-region and 335.6 N in the posterior (P = 0.003). The ultimate stresses were 22.1 MPa in the anterior sub-region and 11.6 MPa in the posterior (P = 0.008). We recognized that the anterior and posterior sub-regions of the SSP tendon have significantly different mechanical properties. In a future study, we need to evaluate how best to repair an SSP tendon considering these region-specific properties. Copyright © 2013 Wiley Periodicals, Inc.

The function of the left anterior temporal pole: evidence from acute stroke and infarct volume

PubMed Central

Tsapkini, Kyrana; Frangakis, Constantine E.

2011-01-01

The role of the anterior temporal lobes in cognition and language has been much debated in the literature over the last few years. Most prevailing theories argue for an important role of the anterior temporal lobe as a semantic hub or a place for the representation of unique entities such as proper names of peoples and places. Lately, a few studies have investigated the role of the most anterior part of the left anterior temporal lobe, the left temporal pole in particular, and argued that the left anterior temporal pole is the area responsible for mapping meaning on to sound through evidence from tasks such as object naming. However, another recent study indicates that bilateral anterior temporal damage is required to cause a clinically significant semantic impairment. In the present study, we tested these hypotheses by evaluating patients with acute stroke before reorganization of structure–function relationships. We compared a group of 20 patients with acute stroke with anterior temporal pole damage to a group of 28 without anterior temporal pole damage matched for infarct volume. We calculated the average percent error in auditory comprehension and naming tasks as a function of infarct volume using a non-parametric regression method. We found that infarct volume was the only predictive variable in the production of semantic errors in both auditory comprehension and object naming tasks. This finding favours the hypothesis that left unilateral anterior temporal pole lesions, even acutely, are unlikely to cause significant deficits in mapping meaning to sound by themselves, although they contribute to networks underlying both naming and comprehension of objects. Therefore, the anterior temporal lobe may be a semantic hub for object meaning, but its role must be represented bilaterally and perhaps redundantly. PMID:21685458

The Central Bright Spot Sign: A Potential New MR Imaging Sign for the Early Diagnosis of Anterior Ischemic Optic Neuropathy due to Giant Cell Arteritis.

PubMed

Remond, P; Attyé, A; Lecler, A; Lamalle, L; Boudiaf, N; Aptel, F; Krainik, A; Chiquet, C

2017-07-01

A rapid identification of the etiology of anterior ischemic optic neuropathy is crucial because it determines therapeutic management. Our aim was to assess MR imaging to study the optic nerve head in patients referred with anterior ischemic optic neuropathy, due to either giant cell arteritis or the nonarteritic form of the disease, compared with healthy subjects. Fifteen patients with giant cell arteritis-related anterior ischemic optic neuropathy and 15 patients with nonarteritic anterior ischemic optic neuropathy from 2 medical centers were prospectively included in our study between August 2015 and May 2016. Fifteen healthy subjects and patients had undergone contrast-enhanced, flow-compensated, 3D T1-weighted MR imaging. The bright spot sign was defined as optic nerve head enhancement with a 3-grade ranking system. Two radiologists and 1 ophthalmologist independently performed blinded evaluations of MR imaging sequences with this scale. Statistical analysis included interobserver agreement. MR imaging scores were significantly higher in patients with giant cell arteritis-related anterior ischemic optic neuropathy than in patients with nonarteritic anterior ischemic optic neuropathy ( P ≤ .05). All patients with giant cell arteritis-related anterior ischemic optic neuropathy (15/15) and 7/15 patients with nonarteritic anterior ischemic optic neuropathy presented with the bright spot sign. No healthy subjects exhibited enhancement of the anterior part of the optic nerve. There was a significant relationship between the side of the bright spot and the side of the anterior ischemic optic neuropathy ( P ≤ .001). Interreader agreement was good for observers (κ = 0.815). Here, we provide evidence of a new MR imaging sign that identifies the acute stage of giant cell arteritis-related anterior ischemic optic neuropathy; patients without this central bright spot sign always had a nonarteritic pathophysiology and therefore did not require emergency corticosteroid therapy. © 2017 by American Journal of Neuroradiology.

N-terminal prolactin-derived fragments, vasoinhibins, are proapoptoptic and antiproliferative in the anterior pituitary.

PubMed

Ferraris, Jimena; Radl, Daniela Betiana; Zárate, Sandra; Jaita, Gabriela; Eijo, Guadalupe; Zaldivar, Verónica; Clapp, Carmen; Seilicovich, Adriana; Pisera, Daniel

2011-01-01

The anterior pituitary is under a constant cell turnover modulated by gonadal steroids. In the rat, an increase in the rate of apoptosis occurs at proestrus whereas a peak of proliferation takes place at estrus. At proestrus, concomitant with the maximum rate of apoptosis, a peak in circulating levels of prolactin is observed. Prolactin can be cleaved to different N-terminal fragments, vasoinhibins, which are proapoptotic and antiproliferative factors for endothelial cells. It was reported that a 16 kDa vasoinhibin is produced in the rat anterior pituitary by cathepsin D. In the present study we investigated the anterior pituitary production of N-terminal prolactin-derived fragments along the estrous cycle and the involvement of estrogens in this process. In addition, we studied the effects of a recombinant vasoinhibin, 16 kDa prolactin, on anterior pituitary apoptosis and proliferation. We observed by Western Blot that N-terminal prolactin-derived fragments production in the anterior pituitary was higher at proestrus with respect to diestrus and that the content and release of these prolactin forms from anterior pituitary cells in culture were increased by estradiol. A recombinant preparation of 16 kDa prolactin induced apoptosis (determined by TUNEL assay and flow cytometry) of cultured anterior pituitary cells and lactotropes from ovariectomized rats only in the presence of estradiol, as previously reported for other proapoptotic factors in the anterior pituitary. In addition, 16 kDa prolactin decreased forskolin-induced proliferation (evaluated by BrdU incorporation) of rat total anterior pituitary cells and lactotropes in culture and decreased the proportion of cells in S-phase of the cell cycle (determined by flow cytometry). In conclusion, our study indicates that the anterior pituitary production of 16 kDa prolactin is variable along the estrous cycle and increased by estrogens. The antiproliferative and estradiol-dependent proapoptotic actions of this vasoinhibin may be involved in the control of anterior pituitary cell renewal.

N-Terminal Prolactin-Derived Fragments, Vasoinhibins, Are Proapoptoptic and Antiproliferative in the Anterior Pituitary

PubMed Central

Ferraris, Jimena; Radl, Daniela Betiana; Zárate, Sandra; Jaita, Gabriela; Eijo, Guadalupe; Zaldivar, Verónica; Clapp, Carmen; Seilicovich, Adriana; Pisera, Daniel

2011-01-01

The anterior pituitary is under a constant cell turnover modulated by gonadal steroids. In the rat, an increase in the rate of apoptosis occurs at proestrus whereas a peak of proliferation takes place at estrus. At proestrus, concomitant with the maximum rate of apoptosis, a peak in circulating levels of prolactin is observed. Prolactin can be cleaved to different N-terminal fragments, vasoinhibins, which are proapoptotic and antiproliferative factors for endothelial cells. It was reported that a 16 kDa vasoinhibin is produced in the rat anterior pituitary by cathepsin D. In the present study we investigated the anterior pituitary production of N-terminal prolactin-derived fragments along the estrous cycle and the involvement of estrogens in this process. In addition, we studied the effects of a recombinant vasoinhibin, 16 kDa prolactin, on anterior pituitary apoptosis and proliferation. We observed by Western Blot that N-terminal prolactin-derived fragments production in the anterior pituitary was higher at proestrus with respect to diestrus and that the content and release of these prolactin forms from anterior pituitary cells in culture were increased by estradiol. A recombinant preparation of 16 kDa prolactin induced apoptosis (determined by TUNEL assay and flow cytometry) of cultured anterior pituitary cells and lactotropes from ovariectomized rats only in the presence of estradiol, as previously reported for other proapoptotic factors in the anterior pituitary. In addition, 16 kDa prolactin decreased forskolin-induced proliferation (evaluated by BrdU incorporation) of rat total anterior pituitary cells and lactotropes in culture and decreased the proportion of cells in S-phase of the cell cycle (determined by flow cytometry). In conclusion, our study indicates that the anterior pituitary production of 16 kDa prolactin is variable along the estrous cycle and increased by estrogens. The antiproliferative and estradiol-dependent proapoptotic actions of this vasoinhibin may be involved in the control of anterior pituitary cell renewal. PMID:21760910

The TALE Class Homeobox Gene Smed-prep Defines the Anterior Compartment for Head Regeneration

PubMed Central

Felix, Daniel A.; Aboobaker, A. Aziz

2010-01-01

Planaria continue to blossom as a model system for understanding all aspects of regeneration. They provide an opportunity to understand how the replacement of missing tissues from preexisting adult tissue is orchestrated at the molecular level. When amputated along any plane, planaria are capable of regenerating all missing tissue and rescaling all structures to the new size of the animal. Recently, rapid progress has been made in understanding the developmental pathways that control planarian regeneration. In particular Wnt/beta-catenin signaling is central in promoting posterior fates and inhibiting anterior identity. Currently the mechanisms that actively promote anterior identity remain unknown. Here, Smed-prep, encoding a TALE class homeodomain, is described as the first gene necessary for correct anterior fate and patterning during planarian regeneration. Smed-prep is expressed at high levels in the anterior portion of whole animals, and Smed-prep(RNAi) leads to loss of the whole brain during anterior regeneration, but not during lateral regeneration or homeostasis in intact worms. Expression of markers of different anterior fated cells are greatly reduced or lost in Smed-prep(RNAi) animals. We find that the ectopic anterior structures induced by abrogation of Wnt signaling also require Smed-prep to form. We use double knockdown experiments with the S. mediterranea ortholog of nou-darake (that when knocked down induces ectopic brain formation) to show that Smed-prep defines an anterior fated compartment within which stem cells are permitted to assume brain fate, but is not required directly for this differentiation process. Smed-prep is the first gene clearly implicated as being necessary for promoting anterior fate and the first homeobox gene implicated in establishing positional identity during regeneration. Together our results suggest that Smed-prep is required in stem cell progeny as they form the anterior regenerative blastema and is required for specifying anterior cell fates and correct patterning. PMID:20422023

Combining Classical and Molecular Approaches Elaborates on the Complexity of Mechanisms Underpinning Anterior Regeneration

PubMed Central

Evans, Deborah J.; Owlarn, Suthira; Tejada Romero, Belen; Chen, Chen; Aboobaker, A. Aziz

2011-01-01

The current model of planarian anterior regeneration evokes the establishment of low levels of Wnt signalling at anterior wounds, promoting anterior polarity and subsequent elaboration of anterior fate through the action of the TALE class homeodomain PREP. The classical observation that decapitations positioned anteriorly will regenerate heads more rapidly than posteriorly positioned decapitations was among the first to lead to the proposal of gradients along an anteroposterior (AP) axis in a developmental context. An explicit understanding of this phenomenon is not included in the current model of anterior regeneration. This raises the question what the underlying molecular and cellular basis of this temporal gradient is, whether it can be explained by current models and whether understanding the gradient will shed light on regenerative events. Differences in anterior regeneration rate are established very early after amputation and this gradient is dependent on the activity of Hedgehog (Hh) signalling. Animals induced to produce two tails by either Smed-APC-1(RNAi) or Smed-ptc(RNAi) lose anterior fate but form previously described ectopic anterior brain structures. Later these animals form peri-pharyngeal brain structures, which in Smed-ptc(RNAi) grow out of the body establishing a new A/P axis. Combining double amputation and hydroxyurea treatment with RNAi experiments indicates that early ectopic brain structures are formed by uncommitted stem cells that have progressed through S-phase of the cell cycle at the time of amputation. Our results elaborate on the current simplistic model of both AP axis and brain regeneration. We find evidence of a gradient of hedgehog signalling that promotes posterior fate and temporarily inhibits anterior regeneration. Our data supports a model for anterior brain regeneration with distinct early and later phases of regeneration. Together these insights start to delineate the interplay between discrete existing, new, and then later homeostatic signals in AP axis regeneration. PMID:22125640

Combining classical and molecular approaches elaborates on the complexity of mechanisms underpinning anterior regeneration.

PubMed

Evans, Deborah J; Owlarn, Suthira; Tejada Romero, Belen; Chen, Chen; Aboobaker, A Aziz

2011-01-01

The current model of planarian anterior regeneration evokes the establishment of low levels of Wnt signalling at anterior wounds, promoting anterior polarity and subsequent elaboration of anterior fate through the action of the TALE class homeodomain PREP. The classical observation that decapitations positioned anteriorly will regenerate heads more rapidly than posteriorly positioned decapitations was among the first to lead to the proposal of gradients along an anteroposterior (AP) axis in a developmental context. An explicit understanding of this phenomenon is not included in the current model of anterior regeneration. This raises the question what the underlying molecular and cellular basis of this temporal gradient is, whether it can be explained by current models and whether understanding the gradient will shed light on regenerative events. Differences in anterior regeneration rate are established very early after amputation and this gradient is dependent on the activity of Hedgehog (Hh) signalling. Animals induced to produce two tails by either Smed-APC-1(RNAi) or Smed-ptc(RNAi) lose anterior fate but form previously described ectopic anterior brain structures. Later these animals form peri-pharyngeal brain structures, which in Smed-ptc(RNAi) grow out of the body establishing a new A/P axis. Combining double amputation and hydroxyurea treatment with RNAi experiments indicates that early ectopic brain structures are formed by uncommitted stem cells that have progressed through S-phase of the cell cycle at the time of amputation. Our results elaborate on the current simplistic model of both AP axis and brain regeneration. We find evidence of a gradient of hedgehog signalling that promotes posterior fate and temporarily inhibits anterior regeneration. Our data supports a model for anterior brain regeneration with distinct early and later phases of regeneration. Together these insights start to delineate the interplay between discrete existing, new, and then later homeostatic signals in AP axis regeneration.

The TALE class homeobox gene Smed-prep defines the anterior compartment for head regeneration.

PubMed

Felix, Daniel A; Aboobaker, A Aziz

2010-04-22

Planaria continue to blossom as a model system for understanding all aspects of regeneration. They provide an opportunity to understand how the replacement of missing tissues from preexisting adult tissue is orchestrated at the molecular level. When amputated along any plane, planaria are capable of regenerating all missing tissue and rescaling all structures to the new size of the animal. Recently, rapid progress has been made in understanding the developmental pathways that control planarian regeneration. In particular Wnt/beta-catenin signaling is central in promoting posterior fates and inhibiting anterior identity. Currently the mechanisms that actively promote anterior identity remain unknown. Here, Smed-prep, encoding a TALE class homeodomain, is described as the first gene necessary for correct anterior fate and patterning during planarian regeneration. Smed-prep is expressed at high levels in the anterior portion of whole animals, and Smed-prep(RNAi) leads to loss of the whole brain during anterior regeneration, but not during lateral regeneration or homeostasis in intact worms. Expression of markers of different anterior fated cells are greatly reduced or lost in Smed-prep(RNAi) animals. We find that the ectopic anterior structures induced by abrogation of Wnt signaling also require Smed-prep to form. We use double knockdown experiments with the S. mediterranea ortholog of nou-darake (that when knocked down induces ectopic brain formation) to show that Smed-prep defines an anterior fated compartment within which stem cells are permitted to assume brain fate, but is not required directly for this differentiation process. Smed-prep is the first gene clearly implicated as being necessary for promoting anterior fate and the first homeobox gene implicated in establishing positional identity during regeneration. Together our results suggest that Smed-prep is required in stem cell progeny as they form the anterior regenerative blastema and is required for specifying anterior cell fates and correct patterning.

Anterior Diabetic Retinopathy Studied by Ultra-widefield Angiography

PubMed Central

Bae, Kunho; Lee, Ju Yeon; Kim, Tae Hyup; Cho, Ga Eun; Ahn, Jeeyun; Kim, Sang Jin; Kim, Jae Hyun

2016-01-01

Purpose To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence. Methods A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated. Results Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients (p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis (p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients (p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients (p = 0.010). Conclusions Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles. PMID:27729754

Anterior Versus Posterior Approach for Multilevel Degenerative Cervical Disease: A Retrospective Propensity Score-Matched Study of the MarketScan Database.

PubMed

Cole, Tyler; Veeravagu, Anand; Zhang, Michael; Azad, Tej D; Desai, Atman; Ratliff, John K

2015-07-01

Retrospective 2:1 propensity score-matched analysis on a national longitudinal database between 2006 and 2010. To compare rates of adverse events, revisions procedure rates, and payment differences in anterior cervical fusion procedures compared with posterior laminectomy and fusion procedures with at least 3 levels of instrumentation. The comparative benefits of anterior versus posterior approach to multilevel degenerative cervical disease remain controversial. Recent systematic reviews have reached conflicting conclusions. We demonstrate the comparative economic and clinical outcomes of anterior and posterior approaches for multilevel cervical degenerative disk disease. We identified 13,662 patients in a national billing claims database who underwent anterior or posterior cervical fusion procedures with 3 or more levels of instrumentation. Cohorts were balanced using 2:1 propensity score matching and outcomes were compared using bivariate analysis. With the exception of dysphagia (6.4% in anterior and 1.4% in posterior), overall 30-day complication rates were lower in the anterior approach group. The rate of any complication excluding dysphagia with anterior approaches was 12.3%, significantly lower (P < 0.0001) than that of posterior approaches, 17.8%. Anterior approaches resulted in lower hospital ($18,346 vs. $23,638) and total payments ($28,963 vs. $33,526). Patients receiving an anterior surgical approach demonstrated significantly lower rate of 30-day readmission (5.1% vs. 9.9%, P < 0.0001), were less likely to require revision surgery (12.8% vs. 18.1%, P < 0.0001), and had a shorter length of stay by 1.5 nights (P < 0.0001). Anterior approaches in the surgical management of multilevel degenerative cervical disease provide clinical advantages over posterior approaches, including lower overall complication rates, revision procedure rates, and decreased length of stay. Anterior approach procedures are also associated with decreased overall payments. These findings must be interpreted in light of limitations inherent to retrospective longitudinal studies including absence of subjective and radiographical outcomes. 3.

PITX2 and NODAL expression during axis formation in the early rabbit embryo.

PubMed

Plöger, Ruben; Viebahn, Christoph

2018-04-26

Attaining molecular and morphological axial polarity during gastrulation is a fundamental early requirement for normal development of the embryo. In mammals, the first morphological sign of the anterior-posterior axis appears anteriorly in the form of the anterior marginal crescent (or anterior visceral endoderm) while in the avian the first such sign is the Koller's sickle at the posterior pole of the embryonic disc. Despite this inverse mode of axis formation many genes and molecular pathways involved in various steps of this process seem to be evolutionary conserved amongst amniotes, the nodal gene being a well-known example with its functional involvement prior and during gastrulation. The pitx2 gene, however, is a new candidate described in the chick as an early marker for anterior-posterior polarity and as regulator of axis formation including twinning. To find out whether pitx2 has retained its inductive and early marker function during the evolution of mammals, this study analyzes pitx2 and nodal expression at parallel stages during formation of the anterior-posterior polarity in the early rabbit embryo using whole-mount in situ hybridization and serial light-microscopical sections. At a late pre-gastrulation stage a localized reduction of nodal expression presages the position of the anterior pole of the embryonic disc and thus serves as the earliest molecular marker of anterior-posterior polarity known so far. pitx2 is expressed in a polarized manner in the anterior marginal crescent and in the posterior half of the embryonic disc during further development only while nodal expression in the anterior segment of the posterior pitx2 expression domain helps to define the so-called anterior streak domain (ASD), a novel progenitor region of the anterior half of the primitive streak. The expression patterns of both genes thus serve as signs of a conserved involvement in early axis formation in amniotes and, possibly, in twinning in mammals as well. Copyright © 2018 Elsevier GmbH. All rights reserved.

Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device.

PubMed

Raz, E; Shapiro, M; Becske, T; Zumofen, D W; Tanweer, O; Potts, M B; Riina, H A; Nelson, P K

2015-05-01

Endoluminal reconstruction with the Pipeline Embolization Device is an effective treatment option for select intracranial aneurysms. However, concerns for the patency of eloquent branch arteries covered by the Pipeline Embolization Device have been raised. We aimed to examine the patency of the anterior choroidal artery and clinical sequelae after ICA aneurysm treatment. We prospectively analyzed all patients among our first 157 patients with ICA aneurysms treated by the Pipeline Embolization Device who required placement of at least 1 device across the ostium of the anterior choroidal artery. The primary outcome measure was angiographic patency of the anterior choroidal artery at last follow-up. Age, sex, type of aneurysm, neurologic examination data, number of Pipeline Embolization Devices used, relationship of the anterior choroidal artery to the aneurysm, and completeness of aneurysm occlusion on follow-up angiograms were also analyzed. Twenty-nine aneurysms requiring placement of at least 1 Pipeline Embolization Device (median = 1, range = 1-3) across the anterior choroidal artery ostium were identified. At angiographic follow-up (mean = 15.1 months; range = 12-39 months), the anterior choroidal artery remained patent, with antegrade flow in 28/29 aneurysms (96.5%), while 24/29 (82.7%) of the target aneurysms were angiographically occluded by 1-year follow-up angiography. Anterior choroidal artery occlusion, with retrograde reconstitution of the vessel, was noted in a single case. A significant correlation between the origin of the anterior choroidal artery from the aneurysm dome and failure of the aneurysms to occlude following treatment was found. After placement of 36 Pipeline Embolization Devices across 29 anterior choroidal arteries (median = 1 device, range = 1-3 devices), 1 of 29 anterior choroidal arteries was found occluded on angiographic follow-up. The vessel occlusion did not result in persistent clinical sequelae. Coverage of the anterior choroidal artery origin with the Pipeline Embolization Device, hence, may be considered reasonably safe when deemed necessary for aneurysm treatment. © 2015 by American Journal of Neuroradiology.

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.

PubMed

Singalavanija, Tassapol; Ausayakhun, Somsanguan; Tangmonkongvoragul, Chulaluck

2018-01-01

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients.

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study

PubMed Central

Ausayakhun, Somsanguan

2018-01-01

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients. PMID:29466424

Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment.

PubMed

Notten, K J B; Essers, B A; Weemhoff, M; Rutten, A G H; Donners, J J A E; van Gestel, I; Kruitwagen, R F P M; Roovers, J P W R; Dirksen, C D

2015-05-01

We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse. Labelled discrete choice experiment. Three Dutch teaching hospitals. Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or more, indicated for anterior colporrhaphy (n = 100). Discrete choice experiments are an attribute-based survey method for measuring preferences. In this experiment, women were asked to choose between two treatment scenarios, mesh surgery or anterior colporrhaphy. These surgical treatments differed in four treatment attributes: (i) recurrence rate, (ii) exposure rate, (iii) infection rate, (iv) dyspareunia. Data were analysed using a multinomial logit model. Women's preferences for anterior colporrhaphy or mesh surgery for the repair of vaginal wall prolapse. All treatment attributes, i.e. recurrence, exposure, infection and dyspareunia, proved to be significant in the woman's decision to choose mesh surgery (P < 0.001), while only two attributes out of three, recurrence and infection, were significant for anterior colporrhaphy (P < 0.001). The relative importance data showed that with regards to the four statistically significant attributes for mesh, dyspareunia was the most important attribute, and of the two significant attributes for anterior colporrhaphy, the risk of infection. Based on the attributes and levels in our discrete choice experiment, anterior colporrhaphy was preferred in 74% as a primary correction of anterior vaginal wall prolapse, followed by a preference for mesh in 26% of all choices. This study showed that next to the risk of recurrence, other aspects like risk of infection, dyspareunia and exposure play a role in the woman's preference for a surgical treatment. In addition, our results indicate that anterior colporrhaphy is preferred in the majority of the choices, followed by a preference for mesh surgery in a quarter of all choice sets. However, these results represent the average preference of a sample of women and cannot be taken as the preference of each individual. In the medical decision-making context, information from the current study should be personalised to fit patient's unique circumstances. For patients to construct their own, individual preferences, they should be well informed about the existence and magnitude of the potential benefits and risks related to either anterior colporrhaphy or mesh surgery. © 2014 Royal College of Obstetricians and Gynaecologists.

Anterior capsule tear after laser iridotomy complicating phacoemulsification

PubMed Central

Vivien Cherng Hui, Yip; Sanjay, Srinivasan; Benjamin Chong-Ming, Chang

2011-01-01

A 70-year-old Indian lady had a history of bilateral laser peripheral iridotomy (LPI) for primary angle closure. Subsequently she developed cataract in both the eyes. Right eye cataract surgery was complicated by an anterior capsule rupture, which was discovered intra-operatively at the site of the LPI. Trypan blue was used to stain the anterior capsule to delineate the anterior capsule defect. An attempt at continuous curvilinear capsulorhexis was unsuccessful, and the anterior capsulotomy was completed with scissors. To the best of our knowledge the surgical management of cataract in the presence of anterior capsule rupture as a result of LPI has not been reported. Awareness of this potential complication of LPI will aid in planning for successful phacoemulsification cataract surgery. PMID:23960943

Calcium translocations during the moulting cycle of the semiterrestrial isopod Ligia hawaiiensis (Oniscidea, Crustacea).

PubMed

Ziegler, Andreas; Hagedorn, Monica; Ahearn, Gregory A; Carefoot, Thomas H

2007-01-01

Terrestrial isopods moult first the posterior and then the anterior half of the body. During the moulting cycle they retain a significant fraction of cuticular calcium partly by storing it in sternal CaCO(3) deposits. We analysed the calcium content in whole Ligia hawaiiensis and the calcium distribution between the posterior, the anterior ventral, and the anterior dorsal cuticle during four stages of the moulting cycle. The results indicate that: (1) overall, about 80% of the calcium is retained and 20% is lost with the exuviae, (2) in premoult 68% of the calcium in the posterior cuticle is resorbed (23% moved to the anterior ventral cuticle, 17% to the anterior dorsal cuticle, and the remaining 28% to internal tissues), (3) after the posterior moult 83% of the calcium in the anterior cuticle is shifted to the posterior cuticle and possibly to internal storage sites, (4) following the anterior moult up to 54% of the calcium in the posterior cuticle is resorbed and used to mineralise the new anterior cuticle. (45)Ca-uptake experiments suggest that up to 80% of calcium lost with the anterior exuviae may be regained after its ingestion. Whole body calcium of Ligia hawaiiensis is only 0.7 times that of the fully terrestrial isopods. These terrestrial species can retain only 48% of whole body calcium, suggesting that the amount of calcium that can be retained by shifting it between the anterior and posterior integument is limited. We propose that fully terrestrial Oniscidea rely to a larger degree on other calcium sources like internal stores and uptake from the ingested exuviae.

Age-related, interindividual, and right/left differences in anterior-posterior foot pressure ratio in preschool children

PubMed Central

2013-01-01

Background This study aimed to examine age-related, interindividual, and right/left differences in anterior-posterior foot pressure ratio in 764 preschool children (364 boys and 400 girls) aged 3.5-6.5 years. Methods Subjects maintained an upright standing posture for 10 seconds on the Footview Clinic, an instrument designed to calculate the anterior-posterior foot pressure ratio. The ratio of anterior foot pressure in each subject’s right and left feet was selected as a variable, and the mean of a 10 s measurement was used for analysis. Results The ratio of anterior foot pressure was significantly larger in the right foot than in the left foot. With regard to age, the ratio of anterior foot pressure was significantly larger in children aged over 4.5 years than in children aged 3.5 years. It was also larger in children aged 6 and 6.5 years than in children aged 4 years. Interindividual differences in variables were large, and coefficients of variance were highest in children aged 3.5 years and lowest in children aged 6.5 years. Conclusions In conclusion, anterior foot pressure increases with age in preschool children. Interindividual differences in anterior foot pressure are large and tend to decrease with age. Furthermore, the anterior foot pressure is slightly higher in the right foot than in the left foot. These results will be useful for various studies, such as examining relationships between the anterior-posterior foot pressure ratio and factors, such as untouched toes, physical fitness, and level of exercise. PMID:23601375

Occipital Nerve Field Transcranial Direct Current Stimulation Normalizes Imbalance Between Pain Detecting and Pain Inhibitory Pathways in Fibromyalgia.

PubMed

De Ridder, Dirk; Vanneste, Sven

2017-04-01

Occipital nerve field (OCF) stimulation with subcutaneously implanted electrodes is used to treat headaches, more generalized pain, and even failed back surgery syndrome via unknown mechanisms. Transcranial direct current stimulation (tDCS) can predict the efficacy of implanted electrodes. The purpose of this study is to unravel the neural mechanisms involved in global pain suppression, mediated by occipital nerve field stimulation, within the realm of fibromyalgia. Nineteen patients with fibromyalgia underwent a placebo-controlled OCF tDCS. Electroencephalograms were recorded at baseline after active and sham stimulation. In comparison with healthy controls, patients with fibromyalgia demonstrate increased dorsal anterior cingulate cortex, increased premotor/dorsolateral prefrontal cortex activity, and an imbalance between pain-detecting dorsal anterior cingulate cortex and pain-suppressing pregenual anterior cingulate cortex activity, which is normalized after active tDCS but not sham stimulation associated with increased pregenual anterior cingulate cortex activation. The imbalance improvement between the pregenual anterior cingulate cortex and the dorsal anterior cingulate cortex is related to clinical changes. An imbalance assumes these areas communicate and, indeed, abnormal functional connectivity between the dorsal anterior cingulate cortex and pregenual anterior cingulate cortex is noted to be caused by a dysfunctional effective connectivity from the pregenual anterior cingulate cortex to the dorsal anterior cingulate cortex, which improves and normalizes after real tDCS but not sham tDCS. In conclusion, OCF tDCS exerts its effect via activation of the descending pain inhibitory pathway and de-activation of the salience network, both of which are abnormal in fibromyalgia.

Clinical characteristics, treatment and ocular complications of HLA-B27-related anterior uveitis and HLA-B27-non related anterior uveitis.

PubMed

Valls Pascual, Elia; Fontanilla Ortega, Pablo; Vicens Bernabeu, Elvira; Martínez-Costa, Lucía; Blanco Alonso, Ricardo

2016-01-01

Anterior uveitis is the most common type of intraocular inflammation. Those associated to HLA-B27 represent 18 to 32% of all anterior uveitis cases. To describe clinical characteristics, systemic treatment need, and frequency and type of ocular complications in a cohort of patients diagnosed with HLAB27-related anterior uveitis and in a cohort of patients diagnosed with HLA-B27 non-related anterior uveitis. To establish if statistically significant differences between both cohorts exist. We performed a retrospective cohort study including patients with non infectious anterior uveitis related and not related to the antigen HLA-B27. 162 patients were included, 58 diagnosed with HLA-B27-related anterior uveitis (cohort HLA-B27+1) and 104 diagnosed with HLA-B27- non related anterior uveitis (cohort HLA-B27-). No statistically significant differences were found regarding clinical characteristics between both cohorts with the exception of a higher frequency of recurrences in cohort HLA-B27+ and a higher frequency of chronic uveitis in cohort HLA-B27-. No differences were found regarding systemic treatment use nor development of ocular complications. In contrast to previous studies, we neither found higher male gender predominance in the cohort of patients with HLA-B27-related anterior uveitis, Nor did we find differences regarding average age, laterality, development of complications nor use of systemic corticosteroids. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Biomechanical comparison of anterior cervical plating and combined anterior/lateral mass plating.

PubMed

Adams, M S; Crawford, N R; Chamberlain, R H; Bse; Sonntag, V K; Dickman, C A

2001-01-01

Previous studies showed anterior plates of older design to be inadequate for stabilizing the cervical spine in all loading directions. No studies have investigated enhancement in stability obtained by combining anterior and posterior plates. To determine which modes of loading are stabilized by anterior plating after a cervical burst fracture and to determine whether adding posterior plating further significantly stabilizes the construct. A repeated-measures in vitro biomechanical flexibility experiment was performed to investigate how surgical destabilization and subsequent addition of hardware components alter spinal stability. Six human cadaveric specimens were studied. Angular range of motion (ROM) and neutral zone (NZ) were quantified during flexion, extension, lateral bending, and axial rotation. Nonconstraining, nondestructive torques were applied while recording three-dimensional motion optoelectronically. Specimens were tested intact, destabilized by simulated burst fracture with posterior distraction, plated anteriorly with a unicortical locking system, and plated with a combined anterior/posterior construct. The anterior plate significantly (p<.05) reduced the ROM relative to normal in all modes of loading and significantly reduced the NZ in flexion and extension. Addition of the posterior plates further significantly reduced the ROM in all modes of loading and reduced the NZ in lateral bending. Anterior plating systems are capable of substantially stabilizing the cervical spine in all modes of loading after a burst fracture. The combined approach adds significant stability over anterior plating alone in treating this injury but may be unnecessary clinically. Further study is needed to assess the added clinical benefits of the combined approach and associated risks.

Protraction of mandibular second and third molars into missing first molar spaces for a patient with an anterior open bite and anterior spacing.

PubMed

Baik, Un-Bong; Chun, Youn-Sic; Jung, Min-Ho; Sugawara, Junji

2012-06-01

In a young woman, aged 18 years 8 months, who had an anterior open bite and anterior spacing, the right and left mandibular first molar extraction spaces were closed by protraction of the second and third molars without reciprocal retraction of the incisors and the premolars. The amounts of protraction for the second molars were 12 mm on the right side and 11 mm on the left side. Two miniscrews were inserted into the mesiobuccal side of the edentulous spaces, and 2 more screws were inserted into the anterior sites after removing previous miniscrews. In addition, 4 miniscrews were inserted into the buccal and palatal sides between the first and second maxillary molars to intrude the maxillary posterior teeth, which had extruded into the missing mandibular spaces. Careful biomechanical consideration was used to prevent extrusion of the molars and worsening of the anterior open bite from protraction of the posterior teeth. Ultimately, the anterior open bite was corrected by both intrusion of the maxillary molars and extrusion of the maxillary anterior teeth. Excellent occlusion and correction of the anterior open bite were achieved without tipping, rotation of the posterior teeth, or other problems. The right mandibular third molar, which had been impacted at the beginning of treatment, erupted into the second molar space and functioned properly. At the 1-year follow-up examination, the patient had a slight anterior open bite, but closure of the first molar extraction spaces was well maintained. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Wide Linear Corticotomy and Anterior Segmental Osteotomy Under Local Anesthesia Combined Corticision for Correcting Severe Anterior Protrusion With Insufficient Alveolar Housing.

PubMed

Noh, Min-Ki; Lee, Baek-Soo; Kim, Shin-Yeop; Jeon, Hyeran Helen; Kim, Seong-Hun; Nelson, Gerald

2017-11-01

This article presents an alternate surgical treatment method to correct a severe anterior protrusion in an adult patient with an extremely thin alveolus. To accomplish an effective and efficient anterior segmental retraction without periodontal complications, the authors performed, under local anesthesia, a wide linear corticotomy and corticision in the maxilla and an anterior segmental osteotomy in mandible. In the maxilla, a wide linear corticotomy was performed under local anesthesia. In the maxillary first premolar area, a wide section of cortical bone was removed. Retraction forces were applied buccolingually with the aid of temporary skeletal anchorage devices. Corticision was later performed to close residual extraction space. In the mandible, an anterior segmental osteotomy was performed and the first premolars were extracted under local anesthesia. In the maxilla, a wide linear corticotomy facilitated a bony block movement with temporary skeletal anchorage devices, without complications. The remaining extraction space after the bony block movement was closed effectively, accelerated by corticision. In the mandible, anterior segmental retraction was facilitated by an anterior segmental osteotomy performed under local anesthesia. Corticision was later employed to accelerate individual tooth movements. A wide linear corticotomy and an anterior segmental osteotomy combined with corticision can be an effective and efficient alternative to conventional orthodontic treatment in the bialveolar protrusion patient with an extremely thin alveolar housing.

Objective evaluation of the changes in the crystalline lens during accommodation in young and presbyopic populations using Pentacam HR system.

PubMed

Ni, Yao; Liu, Xia-Lin; Wu, Ming-Xing; Lin, Ying; Sun, Yu-Ying; He, Chang; Liu, Yi-Zhi

2011-01-01

To quantify the changes in the lens profile with accommodation in different age groups. The Pentacam HR system was used to obtain the images of the anterior eye segment from 23 young and 15 presbyopic emmetropic subjects in unaccommodated (with an accommodation stimulus of 0.0D) and accommodated (with an accommodation stimulus of 5.0D for the young group and 1.0D for the presbyopic group) states. The phakic crystalline lens shape, including curvature of crystalline lens and central lens thickness (CLT), and the measurements of anterior segment length (ASL), central anterior chamber depth (CACD) were investigated. The anterior chamber volume (ACV) was also measured. The reduction of CACD and ACV were significant in both groups after accommodation stimulus. From the profile of anterior eye segment, a significant decrease in anterior crystalline lens radii of curvature (-2.52mm) and a mean increase in CLT (0.222mm) and ASL (0.108mm) were found in the young group with an accommodation stimulus of 5.0D. However, no statistically significant changes of CLT, ASL, or crystalline lens radii of curvature were found in the presbyopic group. Our data showed that the shallowing of anterior chamber during accommodation was caused by the forward bulging of the anterior lens surface, rather than by anterior shifting of lens position in either young or presbyopic subjects.

Factors associated with anterior open bite in children with developmental disabilities.

PubMed

de Castilho, Lia Silva; Abreu, Mauro Henrique Nogueira Guimarães; Pires E Souza, Luiz Gustavo de Almeida; Romualdo, Leiliane Teresinha de Almeida; Souza E Silva, Maria Elisa; Resende, Vera Lúcia Silva

2018-01-01

To investigate factors associated with anterior open bite in individuals aged from 2 to 33 years with developmental disabilities. This is a cross-sectional study. A total of 271 dental records were examined. The anterior open bite analyzed was determined based on clinic exam. These variables were also analyzed: gender, age, education level of mother, International Code of Diseases (ICD), mouth breathing, use of anticonvulsant drugs, hyperkinesis, pacifier use, thumb sucking, seizure, and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without anterior open bite. Variables with a p-value of < 0.25 in the bivariate analysis were incorporated into the logistic regression models. Mouth breathers had a 2.60-fold (95% CI: 1.35-5.01) greater chance of exhibiting anterior open bite than nasal breathers. Pacifier users are more likely to have an anterior open bite (3.32-fold, 95% CI: 1.62-6.77). Individuals with reported involuntary movements had a 2.66-fold (95% CI: 1.26-5.63) greater chance of exhibiting anterior open bite. Users of anticonvulsants drugs had a 3.05 (95% CI: 1.57-5.92) greater chance of showing anterior open bite. Involuntary movements, mouth breathing, using anticonvulsant drugs, and using pacifier are factors associated with anterior open bite in patients with developmental disabilities. © 2017 Special Care Dentistry Association and Wiley Periodicals, Inc.

Bilateral spinal anterior horn lesions in acute motor axonal neuropathy.

PubMed

Sawada, Daisuke; Fujii, Katsunori; Misawa, Sonoko; Shiohama, Tadashi; Fukuhara, Tomoyuki; Fujita, Mayuko; Kuwabara, Satoshi; Shimojo, Naoki

2018-05-28

Guillain-Barré syndrome is an acute immune-mediated peripheral polyneuropathy. Neuroimaging findings from patients with this syndrome have revealed gadolinium enhancement in the cauda equina and in the anterior and posterior nerve roots, but intra-spinal lesions have never been described. Herein, we report, for the first time, bilateral spinal anterior horn lesions in a patient with an acute motor axonal neuropathy form of Guillain-Barré syndrome. The patient was a previously healthy 13-year-old Japanese girl, who exhibited acute-onset flaccid tetraplegia and loss of tendon reflexes. Nerve conduction studies revealed motor axonal damage, leading to the diagnosis of acute motor axonal neuropathy. Notably, spinal magnetic resonance imaging revealed bilateral anterior horn lesions on T2-weighted imaging at the Th11-12 levels, as well as gadolinium enhancement of the cauda equina and anterior and posterior nerve roots. The anterior horn lesions were most prominent on day 18, and their signal intensity declined thereafter. Although intravenous treatment with immunoglobulins was immediately administered, the motor function was not completely regained. We propose that anterior spinal lesions might be responsible for the prolonged neurological disability of patients with Guillain-Barré syndrome, possibly produced by retrograde progression from the affected anterior nerve roots to the intramedullary roots, and the anterior horn motor neurons. Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Estudio ab initio del mecanismo de la reacción HSO + O3

NASA Astrophysics Data System (ADS)

Nebot Gil, I.

La reacción entre el radical HSO y el ozono ha sido ampliamente estudiada desde el punto de vista experimental debido a la importancia que tiene el radical HSO en la oxidación de los compuestos de azufre reductores y a que puede contribuir a la producción de H2SO4 [1-4]. Se realizaron diversos estudios teóricos sobre la cinética de la reacción entre el radical HSO y el ozono. La reacción del HSO con el ozono presenta tres canales diferentes : HSO + O3 &rightarrow &HSO2 + O2 &rightarrow &HS + 2 O2 &rightarrow &SO + OH + O2 La controversia existente entre los grupos experimentales sobre cuál de las tres vías es la predominante, se ha resuelto mediante un estudio teórico de todas ellas utilizando métodos ab initio. La estructura de todos los reactivos, productos, intermedios y estados de transición ha sido optimizada a nivel ab initio utilizando los métodos UMP2 /6-31G** y QCISD/6-31G**.

A forkhead Transcription Factor Is Wound-Induced at the Planarian Midline and Required for Anterior Pole Regeneration

PubMed Central

Scimone, M. Lucila; Lapan, Sylvain W.; Reddien, Peter W.

2014-01-01

Planarian regeneration requires positional information to specify the identity of tissues to be replaced as well as pluripotent neoblasts capable of differentiating into new cell types. We found that wounding elicits rapid expression of a gene encoding a Forkhead-family transcription factor, FoxD. Wound-induced FoxD expression is specific to the ventral midline, is regulated by Hedgehog signaling, and is neoblast-independent. FoxD is subsequently expressed within a medial subpopulation of neoblasts at wounds involving head regeneration. Ultimately, FoxD is co-expressed with multiple anterior markers at the anterior pole. Inhibition of FoxD with RNA interference (RNAi) results in the failure to specify neoblasts expressing anterior markers (notum and prep) and in anterior pole formation defects. FoxD(RNAi) animals fail to regenerate a new midline and to properly pattern the anterior blastema, consistent with a role for the anterior pole in organizing pattern of the regenerating head. Our results suggest that wound signaling activates a forkhead transcription factor at the midline and, if the head is absent, FoxD promotes specification of neoblasts at the prior midline for anterior pole regeneration. PMID:24415944

Severe fixed cervical kyphosis treated with circumferential osteotomy and pedicle screw fixation using an anterior-posterior-anterior surgical sequence.

PubMed

Yoshihara, Hiroyuki; Abumi, Kuniyoshi; Ito, Manabu; Kotani, Yoshihisa; Sudo, Hideki; Takahata, Masahiko

2013-11-01

Surgical treatment for severe circumferentially fixed cervical kyphosis has been challenging. Both anterior and posterior releases are necessary to provide the cervical mobility necessary for fusion in a corrected position. In two case reports, we describe the circumferential osteotomy of anterior-posterior-anterior surgical sequence, and the efficacy of this technique when cervical pedicle screw fixation for severe fixed cervical kyphosis is used. Etiology of fixed cervical kyphosis was unknown in one patient and neurofibromatosis in one patient. Both patients had severe fixed cervical kyphosis as determined by cervical radiographs and underwent circumferential osteotomy and fixation via an anterior-posterior-anterior surgical sequence and correction of kyphosis by pedicle screw fixation. Severe fixed cervical kyphosis was treated successfully by the use of circumferential osteotomy and pedicle screw fixation. The surgical sequence described in this report is a reasonable approach for severe circumferentially fixed cervical kyphosis and short segment fixation can be achieved using pedicle screws. Copyright © 2013 Elsevier Inc. All rights reserved.

Reduced anterior cingulate glutamate in pediatric major depression: a magnetic resonance spectroscopy study.

PubMed

Rosenberg, David R; Macmaster, Frank P; Mirza, Yousha; Smith, Janet M; Easter, Phillip C; Banerjee, S Preeya; Bhandari, Rashmi; Boyd, Courtney; Lynch, Michelle; Rose, Michelle; Ivey, Jennifer; Villafuerte, Rosemond A; Moore, Gregory J; Renshaw, Perry

2005-11-01

Anterior cingulate cortex has been implicated in the pathogenesis of major depressive disorder (MDD). With single voxel proton magnetic resonance spectroscopy, we reported reductions in anterior cingulate glutamatergic concentrations (grouped value of glutamate and glutamine) in 14 pediatric MDD patients versus 14 case-matched healthy control subjects. These changes might reflect a change in glutamate, glutamine, or their combination. Fitting to individually quantify anterior cingulate glutamate and glutamine was performed in these subjects with a new basis set created from data acquired on a 1.5 Tesla General Electric Signa (GE Healthcare, Waukesha, Wisconsin) magnetic resonance imaging scanner with LCModel (Version 6.1-0; Max-Planck-Institute, Gottingen, Germany). Reduced anterior cingulate glutamate was observed in MDD patients versus control subjects (8.79 +/- 1.68 vs. 11.46 +/- 1.55, respectively, p = .0002; 23% decrease). Anterior cingulate glutamine did not differ significantly between patients with MDD and control subjects. These findings provide confirmatory evidence of anterior cingulate glutamate alterations in pediatric MDD.

Acute shallowing of the anterior chamber.

PubMed Central

Mapstone, R

1981-01-01

In aging eyes phenylephrine drops have no significant effect on the depth of the anterior chamber, whereas pilocarpine drops produce a significant shallowing. If both drugs are instilled simultaneously, a significantly greater decrease in anterior chamber depth occurs. The effect is seen in normal, glaucomatous, and hypertensive eyes, and in eyes with shallow anterior chambers. It did not occur in eyes that had had an iridectomy. During the course of a positive provocative test an acute reduction in anterior depth occurs which is reversed when the angle opens and pressure returns to normal levels. It is concluded that the depth of the anterior chamber is not a static dimension but that changes can occur which are rapid and transient. The mechanism of shallowing and deepening depends on an increase or a decrease in the pupil block force. It is a necessary consequence too that eyes with nonshallow anterior chambers can get closed-angle glaucoma and that this possibility cannot be detected by a conventional gonioscopic approach. PMID:6455153

Anterior Eye Imaging with Optical Coherence Tomography

NASA Astrophysics Data System (ADS)

Huang, David; Li, Yan; Tang, Maolong

The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

The Relationship Between High-Order Aberration and Anterior Ocular Biometry During Accommodation in Young Healthy Adults

PubMed Central

Ke, Bilian; Mao, Xinjie; Jiang, Hong; He, Jichang; Liu, Che; Li, Min; Yuan, Ying

2017-01-01

Purpose This study investigated the anterior ocular anatomic origin of high-order aberration (HOA) components using optical coherence tomography and a Shack-Hartmann wavefront sensor. Methods A customized system was built to simultaneously capture images of ocular wavefront aberrations and anterior ocular biometry. Relaxed, 2-diopter (D) and 4-D accommodative states were repeatedly measured in 30 young subjects. Custom software was used to correct optical distortions and measure biometric parameters from the images. Results The anterior ocular biometry changed during 2-D accommodation, in which central lens thickness, ciliary muscle thicknesses at 1 mm posterior to the scleral spur (CMT1), and the maximum value of ciliary muscle thickness increased significantly, whereas anterior chamber depth, CMT3, radius of anterior lens surface curvature (RAL), and radius of posterior lens surface curvature (RPL) decreased significantly. The changes in the anterior ocular parameters during 4-D accommodation were similar to those for the 2-D accommodation. \\begin{document}\

Long anterior zonules and pigment dispersion.

PubMed

Moroi, Sayoko E; Lark, Kurt K; Sieving, Paul A; Nouri-Mahdavi, Kouros; Schlötzer-Schrehardt, Ursula; Katz, Gregory J; Ritch, Robert

2003-12-01

To describe pigment dispersion associated with long anterior zonules. Multicenter observational case series. Fifteen patients, seven of whom were treated for glaucoma or ocular hypertension, were identified with long anterior zonules and pigment dispersion. Transmission electron microscopy was performed on one anterior capsule specimen. All patients had anterior zonules that inserted centrally on the lens capsule. Signs of pigment dispersion included corneal endothelial pigmentation, loss of the pupillary ruff, and variable trabecular meshwork pigmentation. Ultrasound biomicroscopy verified the lack of posterior iris insertion and concavity. There was no exfoliation material. Transmission electron microscopy showed zonular lamellae with adherent pigment granules, and no exfoliation material. Long anterior zonules inserted onto the central lens capsule may cause mechanical disruption of the pigment epithelium at the pupillary ruff and central iris leading to pigment dispersion.

Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing

PubMed Central

Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

2014-01-01

Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N of applied anterior shear load produced a mean peak anterior tibial translation of 3.1 ± 1.1 mm and a mean peak ACL strain of 4.9% ± 4.3%. Anterior shear load was a significant determinant of anterior tibial translation (P <.0005) and peak ACL strain (P = .04). A significant correlation (r = 0.52, P <.0005) was observed between anterior tibial translation and ACL strain. Cadaveric simulations of landing produced a mean axial impact load of 4070 ± 732 N. Simulated landing significantly increased the mean peak anterior tibial translation to 10.4 ± 3.5 mm and the mean peak ACL strain to 6.8% ± 2.8% (P <.0005) compared with the prelanding condition. Significant correlations were observed between peak ACL strain during simulated landing and anterior tibial translation quantified by knee arthrometry. Conclusion Our first hypothesis is supported by a significant correlation between arthrometry displacement collected during laxity tests and concurrent ACL strain calculated from DVRT measurements. Experimental findings also support our second hypothesis that instrumented measures of anterior knee laxity predict peak ACL strain during landing, while specimens with greater knee laxity demonstrated higher levels of peak ACL strain during landing. Clinical Relevance The current findings highlight the importance of instrumented anterior knee laxity assessments as a potential indicator of the risk of ACL injuries in addition to its clinical utility in the evaluation of ACL integrity. PMID:24275863

The "Floating Labrum": Bankart Lesion Repair With Anterior Capsular Extension Using 2 Anterior Working Portals.

PubMed

Rao, Allison J; Verma, Nikhil N; Trenhaile, Scott W

2017-10-01

Surgical repair of a Bankart lesion requires thorough recognition of the capsulolabral attachment and adequate visualization for suture anchor repair. The glenoid labrum usually detaches from its capsule and bony attachment anteriorly and inferiorly; however, the labral and capsule detachment can sometimes extend beyond this zone of injury. Identification and repair may require additional viewing and working portals to allow for ease of suture passage and anchor placement. This technique guide describes a case scenario of a Bankart lesion with anterior extension of the capsular tear, repaired with use of 2 anterior working portals.

Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model.

PubMed

Battaglia, Michael J; Lenhoff, Mark W; Ehteshami, John R; Lyman, Stephen; Provencher, Matthew T; Wickiewicz, Thomas L; Warren, Russell F

2009-02-01

Numerous studies have documented the effect of complete medial collateral ligament injury on anterior cruciate ligament loads; few have addressed how partial medial collateral ligament disruption affects knee kinematics. To determine knee kinematics and subsequent change in anterior cruciate ligament load in a partial and complete medial collateral ligament injury model. Controlled laboratory study. Ten human cadaveric knees were sequentially tested by a robot with the medial collateral ligament intact, in a partial injury model, and in a complete injury model with a universal force-moment sensor measuring system. Tibial translation, rotation, and anterior cruciate ligament load were measured under 3 conditions: anterior load (125 N), valgus load (10 N x m), and internal-external rotation torque (4 N x m; all at 0 degrees and 30 degrees of flexion). Anterior and posterior translation did not statistically increase with a partial or complete medial collateral ligament injury at 0 degrees and 30 degrees of flexion. In response to a 125 N anterior load, at 0 degrees , the anterior cruciate ligament load increased 8.7% (from 99.5 to 108.2 N; P = .006) in the partial injury and 18.3% (117.7 N; P < .001) in the complete injury; at 30 degrees , anterior cruciate ligament load was increased 12.3% (from 101.7 to 114.2 N; P = .001) in the partial injury and 20.6% (122.7 N; P < .001) in the complete injury. In response to valgus torque (10 N x m) at 30 degrees , anterior cruciate ligament load was increased 55.3% (30.4 to 47.2 N; P = .044) in the partial injury model and 185% (86.8 N; P = .001) in the complete injury model. In response to internal rotation torque (4 N.m) at 30 degrees , anterior cruciate ligament load was increased 29.3% (27.6 to 35.7 N; P = .001) in the partial injury model and 65.2% (45.6 N; P < .001) in the complete injury model. The amount of internal rotation at 30 degrees of flexion was significantly increased in the complete injury model (22.8 degrees ) versus the intact state (19.5 degrees ; P < .001). Partial and complete medial collateral ligament tears significantly increased the load on the anterior cruciate ligament. In a partial tear, the resultant load on the anterior cruciate ligament was increased at 30 degrees of flexion and with valgus load and internal rotation torque. Patients may need to be protected from valgus and internal rotation forces after anterior cruciate ligament reconstruction in the setting of a concomitant partial medial collateral ligament tear. This information may help clinicians understand the importance of partial injuries of the medial collateral ligament with a combined anterior cruciate ligament injury complex.

Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study.

PubMed

Pizanis, Antonius; Holstein, Jörg H; Vossen, Felix; Burkhardt, Markus; Pohlemann, Tim

2013-08-26

Anterior bone grafts are used as struts to reconstruct the anterior column of the spine in kyphosis or following injury. An incomplete fusion can lead to later correction losses and compromise further healing. Despite the different stabilizing techniques that have evolved, from posterior or anterior fixating implants to combined anterior/posterior instrumentation, graft pseudarthrosis rates remain an important concern. Furthermore, the need for additional anterior implant fixation is still controversial. In this bench-top study, we focused on the graft-bone interface under various conditions, using two simulated spinal injury models and common surgical fixation techniques to investigate the effect of implant-mediated compression and contact on the anterior graft. Calf spines were stabilised with posterior internal fixators. The wooden blocks as substitutes for strut grafts were impacted using a "pressfit" technique and pressure-sensitive films placed at the interface between the vertebral bone and the graft to record the compression force and the contact area with various stabilization techniques. Compression was achieved either with posterior internal fixator alone or with an additional anterior implant. The importance of concomitant ligament damage was also considered using two simulated injury models: pure compression Magerl/AO fracture type A or rotation/translation fracture type C models. In type A injury models, 1 mm-oversized grafts for impaction grafting provided good compression and fair contact areas that were both markedly increased by the use of additional compressing anterior rods or by shortening the posterior fixator construct. Anterior instrumentation by itself had similar effects. For type C injuries, dramatic differences were observed between the techniques, as there was a net decrease in compression and an inadequate contact on the graft occurred in this model. Under these circumstances, both compression and the contact area on graft could only be maintained at high levels with the use of additional anterior rods. Under experimental conditions, we observed that ligamentous injury following type C fracture has a negative influence on the compression and contact area of anterior interbody bone grafts when only an internal fixator is used for stabilization. Because of the loss of tension banding effects in type C injuries, an additional anterior compressing implant can be beneficial to restore both compression to and contact on the strut graft.

Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament.

PubMed

Markolf, K L; Kochan, A; Amstutz, H C

1984-02-01

Thirty-five patients with documented absence of the anterior cruciate ligament were tested on the University of California, Los Angeles, instrumented clinical knee-testing apparatus and we measured the response curves for the following testing modes: anterior-posterior force versus displacement at full extension and at 20 and 90 degrees of flexion; varus-valgus moment versus angulation at full extension and 20 degrees of flexion; and tibial torque versus rotation at 20 degrees of flexion. Absolute values of stiffness and laxity and right-left differences for these injured knees were compared with identical quantities measured previously for a control population of forty-nine normal subjects with no history of treatment for injury to the knee. For both the uninjured knees and the knees without an anterior cruciate ligament, at 20 and 90 degrees of flexion the anterior-posterior laxity was greatest at approximately 15 degrees of external rotation of the foot. The injured knees demonstrated significantly increased total anterior-posterior laxity and decreased anterior stiffness when compared with the uninjured knees in all tested positions of the foot and knee. The mean increase in paired anterior-posterior laxity for the injured knees in this group of patients at +/- 200 newtons of applied anterior-posterior force was 3.1 millimeters (+39 per cent) at full extension, 5.5 millimeters (+57 per cent) at 20 degrees of flexion, and 2.5 millimeters (+34 per cent) at 90 degrees of flexion. The mean reduction in anterior stiffness for injured knees was also greatest (-54 per cent) at 20 degrees of knee flexion. Only slight reduction in posterior stiffness (-16 per cent) was measured at 20 degrees of flexion, and this probably reflected the presence of associated capsular and meniscal injuries. In the group of anterior cruciate-deficient knees, the patients with an absent medial meniscus showed greater total anterior-posterior laxity in all three positions of knee flexion than did the patients with an intact or torn meniscus. Varus-valgus laxity at full extension increased an average of 1.7 degrees (+36 per cent) for the injured knees, while varus and valgus stiffness decreased 21 per cent and 24 per cent. Absence of the medial meniscus (in a knee with absence of the anterior cruciate ligament) increased varus-valgus laxity at zero and 20 degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS)

Multidisciplinary approach to restoring anterior maxillary partial edentulous area using an IPS Empress 2 fixed partial denture: a clinical report.

PubMed

Dundar, Mine; Gungor, M Ali; Cal, Ebru

2003-04-01

Esthetics is a major concern during restoration of anterior partial edentulous areas. All-ceramic fixed partial dentures may provide better esthetics and biocompatibility in the restoration of anterior teeth. This clinic report describes a multidisciplinary approach and treatment procedures with an IPS Empress 2 fixed partial denture to restore missing anterior teeth.

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

2016-01-01

Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport. PMID:20702858

EGL-20/Wnt and MAB-5/Hox Act Sequentially to Inhibit Anterior Migration of Neuroblasts in C. elegans

PubMed Central

Josephson, Matthew P.; Chai, Yongping; Ou, Guangshuo; Lundquist, Erik A.

2016-01-01

Directed neuroblast and neuronal migration is important in the proper development of nervous systems. In C. elegans the bilateral Q neuroblasts QR (on the right) and QL (on the left) undergo an identical pattern of cell division and differentiation but migrate in opposite directions (QR and descendants anteriorly and QL and descendants posteriorly). EGL-20/Wnt, via canonical Wnt signaling, drives the expression of MAB-5/Hox in QL but not QR. MAB-5 acts as a determinant of posterior migration, and mab-5 and egl-20 mutants display anterior QL descendant migrations. Here we analyze the behaviors of QR and QL descendants as they begin their anterior and posterior migrations, and the effects of EGL-20 and MAB-5 on these behaviors. The anterior and posterior daughters of QR (QR.a/p) after the first division immediately polarize and begin anterior migration, whereas QL.a/p remain rounded and non-migratory. After ~1 hour, QL.a migrates posteriorly over QL.p. We find that in egl-20/Wnt, bar-1/β-catenin, and mab-5/Hox mutants, QL.a/p polarize and migrate anteriorly, indicating that these molecules normally inhibit anterior migration of QL.a/p. In egl-20/Wnt mutants, QL.a/p immediately polarize and begin migration, whereas in bar-1/β-catenin and mab-5/Hox, the cells transiently retain a rounded, non-migratory morphology before anterior migration. Thus, EGL-20/Wnt mediates an acute inhibition of anterior migration independently of BAR-1/β-catenin and MAB-5/Hox, and a later, possible transcriptional response mediated by BAR-1/β-catenin and MAB-5/Hox. In addition to inhibiting anterior migration, MAB-5/Hox also cell-autonomously promotes posterior migration of QL.a (and QR.a in a mab-5 gain-of-function). PMID:26863303

Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy

PubMed Central

Balakrishna, Nagalla

2017-01-01

Aim To evaluate the configuration of the anterior chamber angle quantitatively and study the morphological changes in the eye with ultrasound biomicroscopy (UBM) in primary angle closure glaucoma (PACG) patients after laser peripheral iridotomy (LPI). Materials and methods A total of 185 eyes of 185 PACG patients post-LPI and 126 eyes of 126 normal subjects were included in this prospective study. All subjects underwent complete ophthalmic evaluation, A-scan biometry, and UBM. The anterior segment and angle parameters were measured quantitatively and compared in both groups using Student’s t-test. Results The PACG patients had shorter axial length, shallower central anterior chamber depth anterior chamber depth (ACD), and anteriorly located lens when compared with normal subjects. Trabecular iris angle (TIA) was significantly narrow (5.73 ± 7.76°) in patients with PACG when compared with normal subjects (23.75 ± 9.38°). The angle opening distance at 500 pm from scleral spur (AOD 500), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), and iris-zonule distance (IZD) were significantly shorter in patients with PACG than in normal subjects (p < 0.0001). The iris lens angle (ILA), scleral-iris angle (SIA), and scleral-ciliary process angle (SCPA) were significantly narrower in patients with PACG than in normal subjects (p < 0.0001). The iris-lens contact distance (ILCD) was greater in PACG group than in normal (p = 0.001). Plateau iris was seen in 57/185 (30.8%) of the eyes. Anterior positioned ciliary processes were seen in 130/185 eyes (70.3%) of eyes. Conclusion In PACG patients, persistent apposition angle closure is common even after LPI, which could be due to anterior rotation of ciliary body and plateau iris and overcrowding of anterior segment due to shorter axial length and relative anterior lens position. How to cite this article: Mansoori T, Balakrishna N. Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy. J Curr Glaucoma Pract 2017;11(3):86-91. PMID:29151682

A comparison of anterior and posterior approaches for the surgical treatment of pancreatic pseudocyst using laparoscopic cystogastrostomy.

PubMed

Barragan, Barnard; Love, Lance; Wachtel, Mitchell; Griswold, John A; Frezza, Eldo E

2005-12-01

Laparoscopic treatment of pancreatic pseudocyst allows for definitive drainage with faster recovery. Although many groups have reported their experience with an anterior approach, only a few have done so with a posterior approach. This paper compares the approaches, analyzing their potential benefits and pitfalls. Seven females and one male underwent laparoscopic cystgastrostomy to treat pancreatic pseudocysts. The anterior approach was performed by opening the stomach anteriorly, localizing the pseudocyst ultrasonographically, draining the cyst with a needle and, via the same opening, using a stapler to form a cystgastrostomy. The posterior approach was performed by directly visualizing the posterior gastric wall and the pseudocyst, opening and draining the cyst with a needle, and using a stapler and running sutures for closure. All patients had gallstone pancreatitis. Cystgastrostomy via the anterior approach was used in 4 patients and via the posterior approach in 4 patients. Dense adhesions required one attempted posterior cystgastrostomy to be converted to an anterior approach. The mean age of the anterior group was 38 years (range, 18-58 years) and hospital stay was 6 days (range, 4-8 days): for the posterior group, mean age was 42 years (range, 40-44 years) and length of stay was 3 days (range, 2-4 days). Although both approaches had good results with no complications and short hospital stays, the posterior approach is safer, with a more precise cyst visualization and dissection that permits more tissue to be sent for histopathologic examination. Furthermore, the posterior approach?s larger anastomosis would seem to yield fewer occlusions, which are commonly seen with the anterior approach. The anterior approach is easier to learn, but it requires the opening of the anterior stomach and the use of ultrasound.

Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

PubMed Central

Kato, Fumihiko; Ito, Keigo; Nakashima, Hiroaki; Machino, Masaaki

2009-01-01

Anterior procedures in the cervical spine are feasible in cases having anterior aetiologies such as anterior neural compression and/or severe kyphosis. Halo vests or anterior plates are used concurrently for cases with long segmental fixation. Halo vests are bothersome and anterior plate fixation is not adequately durable. We developed a new anterior pedicle screw (APS) and plate fixation procedure that can be used with fluoroscope-assisted pedicle axis view imaging. Six patients (3 men and 3 women; mean age, 54 years) with anterior multisegmental aetiology were included in this study. Their original diagnoses comprised cervical myelopathy and/or radiculopathy (n = 4), posterior longitudinal ligament ossification (n = 1) and post-traumatic kyphosis (n = 1). All patients underwent anterior decompression and strut grafting with APS and plate fixation. Mean operative time was 192 min and average blood loss was 73 ml. Patients were permitted to ambulate the next day with a cervical collar. Local sagittal alignment was characterised by 3.5° of kyphosis preoperatively, which improved to 6.8° of lordosis postoperatively and 5.2° of lordosis at final follow-up. Postoperative improvement and early bony union were observed in all cases. There was no serious complication except for two cases of dysphagia. Postoperative imaging demonstrated screw exposure in one screw, but no pedicle perforation. APS and plate fixation is useful in selected cases of multisegmental anterior reconstruction of cervical spine. However, the adequate familiarity and experience with both cervical pedicle screw fixation and the imaging technique used for visualising the pedicle during surgery are crucial for this procedure. PMID:19343377

Slit-lamp Needling of the Anterior Capsule for Aqueous Misdirection After Hyaloido-zonulectomy and Iridectomy.

PubMed

Mardelli, Pierre G; Mardelli, Marc E

2018-04-01

We present a case of persistent aqueous misdirection, after Ahmed glaucoma valve surgery, despite undergoing an anterior vitrectomy with hyaloido-zonulectomy and iridectomy. A 73-year-old female patient, 4 months after phacotrabeculectomy, was referred with persistent high intraocular pressure (IOP). Postoperatively, she developed aqueous misdirection with a flat anterior chamber (AC) but with an IOP of 15 mm Hg. On presentation, her AC was shallow with peripheral iris-cornea touch, and her IOP was 39 mm Hg. Posterior Nd:Yag capsulotomy with disruption of anterior hyaloid face partially deepened the AC. With failure of the trabeculectomy and high IOP, an Ahmed valve was placed. On the first operative day the AC was deep with an IOP of 10 mm Hg. On day 6 the patient presented with pain, flat AC, and an IOP of 10 mm Hg. Fundus examination revealed no choroidal effusion. Despite repeated reformation with viscoelastic, the AC failed to deepen. An anterior vitrectomy with hyaloido-zonulectomy was performed. Initially, the AC was deep, but, a few days later, it was flat. Multiple reformations and vitreous tap failed to keep the AC deep. A 30-G needle was passed at the slit lamp across the temporal cornea, iris, and anterior capsule into the anterior vitreous cavity. The needle was then partially withdrawn and used to create a space between the intraocular lens and anterior capsule. This immediately deepened the AC and remained so for the duration of follow-up (4 mo). Slit-lamp needling of the anterior lens capsule can be successfully performed to help resolve a persistent case of aqueous misdirection after anterior vitrectomy.

Evaluation of anterior lenticonus in alport syndrome using tracey wavefront aberrometry and transmission electron microscopy.

PubMed

Kim, Kwan Soo; Kim, Mo Sae; Kim, Joon Mo; Choi, Chul Young

2010-01-01

To evaluate the efficacy of Tracey wavefront aberrometry (Tracey Technologies, Houston, TX) and transmission electron microscopy for the detection of anterior lenticonus in Alport syndrome. Tracey wavefront aberrometry was used to treat a patient with bilateral anterior lenticonus who had a history of Alport syndrome. For transmission electron microscopic examination, anterior lens capsules were obtained during clear lens phacoemulsification and intraocular lens implantation. Spherical aberrations were the predominant higher-order aberrations in the internal optics of both eyes. The Tracey wavefront aberrometer showed that most of the irregular astigmatism originated from the lenticular portion. Transmission electron microscopy of the specimens showed anterior lens capsules with decreased thickness and multiple dehiscences. Tracey wavefront aberrometry and transmission electron microscopy are effective tools for evaluation of anterior lenticonus in Alport syndrome. Copyright 2010, SLACK Incorporated.

Role of the right dorsal anterior insula in the urge to tic in Tourette syndrome.

PubMed

Tinaz, Sule; Malone, Patrick; Hallett, Mark; Horovitz, Silvina G

2015-08-01

The mid-posterior part of the insula is involved in processing bodily sensations and urges and is activated during tic generation in Tourette syndrome. The dorsal anterior part of the insula, however, integrates sensory and emotional information with cognitive valuation and is implicated in interoception. The right dorsal anterior insula also participates in urge suppression in healthy subjects. This study examined the role of the right dorsal anterior insula in the urge to tic in Tourette syndrome. Resting-state functional magnetic resonance imaging was performed in 13 adult Tourette patients and 13 matched controls. The role of the right dorsal anterior insula within the urge-tic network was investigated using graph theory-based neural network analysis. The functional connectivity of the right dorsal anterior insula was also correlated with urge and tic severity. Even though the patients did not exhibit any overt tics, the right dorsal anterior insula demonstrated higher connectivity, especially with the frontostriatal nodes of the urge-tic network in patients compared with controls. The functional connectivity between the right dorsal anterior insula and bilateral supplementary motor area also correlated positively with urge severity in patients. These results suggest that the right dorsal anterior insula is part of the urge-tic network and could influence the urge- and tic-related cortico-striato-thalamic regions even during rest in Tourette syndrome. It might be responsible for heightened awareness of bodily sensations generating premonitory urges in Tourette syndrome. © 2015 International Parkinson and Movement Disorder Society.

Histological Analysis of the Tibial Anterior Cruciate Ligament Insertion

PubMed Central

Siebold, Rainer; Oka, Shinya; Traut, Ulrike; Schuhmacher, Peter; Kirsch, Joachim

2017-01-01

Objective: To describe the morphology of the tibial ACL insertion by histological assessment in the sagittal plane. Methods: For histology the native (undissected) tibial ACL insertion of 6 fresh-frozen cadaveric knees was cut into 4 sagittal sections parallel to the long axis of the medial tibial spine. The slices were stained with hematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analyzed at a magnification of ×20. Results: From medial to lateral the anterior-posterior lengths of the ACL insertion were an average of 10.2, 9.3, 7.6 and 5.8 mm. The anterior margin of the tibial ACL insertion raised from an anterior ridge. The most medial ACL fibers rose along with a peak of the anterior part of the medial tibial spine in which the direct insertion was adjacent to the articular cartilage. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact to the lateral ACL insertion. A small fat pad was located just posterior to the tibial ACL insertion. There were no central or posterolateral inserting ACL fibers in the area intercondylaris anterior. Conclusion: The functional intraligamentous midsubstance ACL fibers arose from the most posterior part of its bony tibial insertion in a flat and “C-shape” way. The anterior border of this functional ACL started from a bony ‘anterior ridge’ and the medial border was along with a peak of the medial tibial spine.

Anterior segment photography in pediatric eyes using the Lytro light field handheld noncontact camera.

PubMed

Marcus, Inna; Tung, Irene T; Dosunmu, Eniolami O; Thiamthat, Warakorn; Freedman, Sharon F

2013-12-01

To compare anterior segment findings identified in young children using digital photographic images from the Lytro light field camera to those observed clinically. This was a prospective study of children <9 years of age with an anterior segment abnormality. Clinically observed anterior segment examination findings for each child were recorded and several digital images of the anterior segment of each eye captured with the Lytro camera. The images were later reviewed by a masked examiner. Sensitivity of abnormal examination findings on Lytro imaging was calculated and compared to the clinical examination as the gold standard. A total of 157 eyes of 80 children (mean age, 4.4 years; range, 0.1-8.9) were included. Clinical examination revealed 206 anterior segment abnormalities altogether: lids/lashes (n = 21 eyes), conjunctiva/sclera (n = 28 eyes), cornea (n = 71 eyes), anterior chamber (n = 14 eyes), iris (n = 43 eyes), and lens (n = 29 eyes). Review of Lytro photographs of eyes with clinically diagnosed anterior segment abnormality correctly identified 133 of 206 (65%) of all abnormalities. Additionally, 185 abnormalities in 50 children were documented at examination under anesthesia. The Lytro camera was able to document most abnormal anterior segment findings in un-sedated young children. Its unique ability to allow focus change after image capture is a significant improvement on prior technology. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Sampling of the anterior apical region results in increased cancer detection and upgrading in transrectal repeat saturation biopsy of the prostate.

PubMed

Seles, Maximilian; Gutschi, Thomas; Mayrhofer, Katrin; Fischereder, Katja; Ehrlich, Georg; Gallé, Guenter; Gutschi, Stefan; Pachernegg, Oliver; Pummer, Karl; Augustin, Herbert

2016-04-01

To evaluate whether biopsy cores taken via a transrectal approach from the anterior apical region of the prostate in a repeat-biopsy population can result in an increased overall cancer detection rate and in more accurate assessment of the Gleason score. The study was a prospective, randomised (end-fire vs side-fire ultrasound probe) evaluation of 288 men by repeat transrectal saturation biopsy with 28 cores taken from the transition zone, base, mid-lobar, anterior and the anterior apical region located ventro-laterally to the urethra of the peripheral zone. The overall prostate cancer detection rate was 44.4%. Improvement of the overall detection rate by 7.8% could be achieved with additional biopsies of the anterior apical region. Two tumours featuring a Gleason score 7 could only be detected in the anterior apical region. In three cases (2.34%) Gleason score upgrading was achieved by separate analysis of each positive core of the anterior apical region. A five-fold higher cancer detection rate in the anterior apical region compared with the transition zone could be shown. Sampling of the anterior apical region results in higher overall cancer detection rate in repeat transrectal saturation biopsies of the prostate. Specimens from this region can detect clinically significant cancer, improve accuracy of the Gleason Scoring and therefore may alter therapy. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Assessing the validity of surface electromyography for recording muscle activation patterns from serratus anterior.

PubMed

Hackett, Lucien; Reed, Darren; Halaki, Mark; Ginn, Karen A

2014-04-01

No direct evidence exists to support the validity of using surface electrodes to record muscle activity from serratus anterior, an important and commonly investigated shoulder muscle. The aims of this study were to determine the validity of examining muscle activation patterns in serratus anterior using surface electromyography and to determine whether intramuscular electromyography is representative of serratus anterior muscle activity. Seven asymptomatic subjects performed dynamic and isometric shoulder flexion, extension, abduction, adduction and dynamic bench press plus tests. Surface electrodes were placed over serratus anterior and around intramuscular electrodes in serratus anterior. Load was ramped during isometric tests from 0% to 100% maximum load and dynamic tests were performed at 70% maximum load. EMG signals were normalised using five standard maximum voluntary contraction tests. Surface electrodes significantly underestimated serratus anterior muscle activity compared with the intramuscular electrodes during dynamic flexion, dynamic abduction, isometric flexion, isometric abduction and bench press plus tests. All other test conditions showed no significant differences including the flexion normalisation test where maximum activation was recorded from both electrode types. Low correlation between signals was recorded using surface and intramuscular electrodes during concentric phases of dynamic abduction and flexion. It is not valid to use surface electromyography to assess muscle activation levels in serratus anterior during isometric exercises where the electrodes are not placed at the angle of testing and dynamic exercises. Intramuscular electrodes are as representative of the serratus anterior muscle activity as surface electrodes. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Microsurgical anatomy importance of A1-anterior communicating artery complex].

PubMed

Monroy-Sosa, Alejandro; Pérez-Cruz, Julio César; Reyes-Soto, Gervith; Delgado-Hernández, Carlos; Macías-Duvignau, Mario Alberto; Delgado-Reyes, Luis

2013-01-01

The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

Gait perturbation response in chronic anterior cruciate ligament deficiency and repair.

PubMed

Ferber, Reed; Osternig, Louis R; Woollacott, Marjorie H; Wasielewski, Noah J; Lee, Ji Hang

2003-02-01

To determine how chronic anterior cruciate ligament deficient and surgically repaired subjects react to unexpected forward perturbations during gait as compared to healthy controls. Gait testing of 10 chronic anterior cruciate ligament deficient subjects prior to and three months following reconstructive surgery, and 10 uninjured controls. The ability of an anterior cruciate ligament injured individual to react and maintain equilibrium during gait perturbations is critical for the prevention of reinjury. No studies have investigated how these individuals respond to unexpected perturbations during normal gait. An unexpected forward perturbation was induced upon heel strike using a force plate capable of translational movement. Prior to surgery, the anterior cruciate ligament subjects exhibited a greater knee extensor moment in response to the perturbation compared to healthy controls. Following surgery, the anterior cruciate ligament injured subjects exhibited a static knee position and a sustained knee extensor moment throughout stance in response to the perturbation as compared to controls. These data suggest that chronic anterior cruciate ligament deficient subjects rely heavily on knee extensor musculature to prevent collapse in response to an unexpected perturbation. This same reactive response was more pronounced 3 months following surgery. The results suggest that, prior to and following surgery, chronic anterior cruciate ligament injured subjects respond differently than healthy controls to an unexpected perturbation during gait. Anterior cruciate ligament injured or repaired subjects do not reduce or avoid vigorous contraction of the quadriceps muscles when responding to gait perturbations.

Can a knee brace reduce the strain in the anterior cruciate ligament? A study using combined in vivo/in vitro method.

PubMed

Hangalur, Gajendra; Brenneman, Elora; Nicholls, Micah; Bakker, Ryan; Laing, Andrew; Chandrashekar, Naveen

2016-06-01

It is unknown whether prophylactic knee braces can reduce the strain in the anterior cruciate ligament during dynamic activities. An athlete, who had characteristics of high anterior cruciate ligament injury risk, was chosen. A motion capture system (Optotrak Certus; Northern Digital, Waterloo, ON, Canada) was used to record dynamic trials during drop-landing activity of this subject with and without the knee brace being worn. A musculoskeletal model was used to estimate the muscle forces during this activity. A dynamic knee simulator then applied kinematics and muscle forces on a cadaver knee with and without the brace mounted on it. The anterior cruciate ligament strain was measured. The peak strain in the anterior cruciate ligament was substantially lower for the braced (7%) versus unbraced (20%) conditions. Functional knee braces could decrease the strain in the anterior cruciate ligament during dynamic activities in a high-risk subject. However, the reduction seems to be a result of altered muscle firing pattern due to the brace. Prophylactic knee brace could reduce the strain in the anterior cruciate ligament of high-risk subjects during drop-landing through altered muscle firing pattern associated with brace wear. This could help reduce the anterior cruciate ligament injury risk. © The International Society for Prosthetics and Orthotics 2015.

Chromium VI administration induces oxidative stress in hypothalamus and anterior pituitary gland from male rats.

PubMed

Nudler, Silvana I; Quinteros, Fernanda A; Miler, Eliana A; Cabilla, Jimena P; Ronchetti, Sonia A; Duvilanski, Beatriz H

2009-03-28

Hexavalent chromium (Cr VI)-containing compounds are known carcinogens which are present in industrial settings and in the environment. The major route of chromium exposure for the general population is oral intake. Previously we have observed that Cr VI affects anterior pituitary secretion and causes oxidative stress in vitro. The aim of the present work was to investigate if in vivo Cr VI treatment (100 ppm of Cr VI in drinking water for up 30 days) causes oxidative stress in hypothalamus and anterior pituitary gland from male rats. This treatment produced a 4-fold increase of chromium content in hypothalamus and 10-fold increase in anterior pituitary gland. Lipid peroxidation showed a significant increase in hypothalamus and anterior pituitary. Cr VI augmented superoxide dismutase activity in anterior pituitary gland and glutathione reductase activity in hypothalamus, but glutathione peroxidase and catalase activities remained unchanged in both tissues. Heme oxygenase-1 mRNA expression significantly rose in both tissues. Metallothionein 1 mRNA content increased in anterior pituitary and metallothionein 3 mRNA increased in hypothalamus. These results show, for the first time, that oral chronic administration of Cr VI produces oxidative stress on the hypothalamus and anterior pituitary gland which may affect normal endocrine function.

Clonal and molecular analysis of the prospective anterior neural boundary in the mouse embryo

PubMed Central

Cajal, Marieke; Lawson, Kirstie A.; Hill, Bill; Moreau, Anne; Rao, Jianguo; Ross, Allyson; Collignon, Jérôme; Camus, Anne

2012-01-01

In the mouse embryo the anterior ectoderm undergoes extensive growth and morphogenesis to form the forebrain and cephalic non-neural ectoderm. We traced descendants of single ectoderm cells to study cell fate choice and cell behaviour at late gastrulation. In addition, we provide a comprehensive spatiotemporal atlas of anterior gene expression at stages crucial for anterior ectoderm regionalisation and neural plate formation. Our results show that, at late gastrulation stage, expression patterns of anterior ectoderm genes overlap significantly and correlate with areas of distinct prospective fates but do not define lineages. The fate map delineates a rostral limit to forebrain contribution. However, no early subdivision of the presumptive forebrain territory can be detected. Lineage analysis at single-cell resolution revealed that precursors of the anterior neural ridge (ANR), a signalling centre involved in forebrain development and patterning, are clonally related to neural ectoderm. The prospective ANR and the forebrain neuroectoderm arise from cells scattered within the same broad area of anterior ectoderm. This study establishes that although the segregation between non-neural and neural precursors in the anterior midline ectoderm is not complete at late gastrulation stage, this tissue already harbours elements of regionalisation that prefigure the later organisation of the head. PMID:22186731

Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study.

PubMed

Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

2014-10-01

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.

Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study.

PubMed

Kim, Hyun-Min Mike; Chacon, Alexander C; Andrews, Seth H; Roush, Evan P; Cho, Edward; Conaway, William K; Kunselman, Allen R; Lewis, Gregory S

2016-04-01

Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Simultaneous Bilateral Anterior and Posterior Lenticonus in Alport Syndrome.

PubMed

Bamotra, Ravi Kant; Meenakshi; Kesarwani, Prem Chandra; Qayum, Shazia

2017-08-01

Alport syndrome is an inherited disease characterized by progressive renal failure, hearing loss, and ocular abnormalities like anterior lenticonus, corneal opacities, cataract, central perimacular and peripheral coalescing fleck retinopathies, and temporal retinal thinning. Although anterior lenticonus is common in Alport syndrome, simultaneous anterior and posterior lenticonus is a rare presentation. We report a case of a 22-year-old female with simultaneous anterior and posterior lenticonus presentation in which ocular examination lead to the detection of Alport syndrome. The patient had sensorineural deafness as well as microscopic haematuria. Clear lens extraction was performed in both eyes to eliminate lenticular irregular astigmatism for visual rehabilitation.

[Anterior infarction of the left ventricle and infarct of the posterior wall of the right ventricle caused by thrombosis of the anterior interventricular artery].

PubMed

Penther, P; Boschat, J; Etienne, Y; Le Potier, J

1988-01-01

The association: anterior infarction of the left ventricle-posterior infarction of the right ventricle, is a rare entity. The authors report the case of a 64 year-old woman, who died on the fifth day of an extended anterior myocardial infarction, present on electrocardiograms; there were however immediate signs of right heart failure unexplained by a pericardial effusion. At the autopsy, the unusual length and distribution of the anterior interventricular artery which was completely obstructed near its origin by a thrombosis occurring on a severe atheromatous and calcified stenosis, explain this association.

Electron microscopic examination of the anterior lens capsule in a case of Alport's syndrome.

PubMed

Citirik, Mehmet; Batman, Cosar; Men, Gamze; Tuncel, Murvet; Zilelioglu, Orhan

2007-09-01

To report a case of Alport's syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. A 21-year-old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. The course of Alport's syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport's syndrome.

Why do lesions in the rodent anterior thalamic nuclei cause such severe spatial deficits?

PubMed Central

Aggleton, John P.; Nelson, Andrew J.D.

2015-01-01

Lesions of the rodent anterior thalamic nuclei cause severe deficits to multiple spatial learning tasks. Possible explanations for these effects are examined, with particular reference to T-maze alternation. Anterior thalamic lesions not only impair allocentric place learning but also disrupt other spatial processes, including direction learning, path integration, and relative length discriminations, as well as aspects of nonspatial learning, e.g., temporal discriminations. Working memory tasks, such as T-maze alternation, appear particularly sensitive as they combine an array of these spatial and nonspatial demands. This sensitivity partly reflects the different functions supported by individual anterior thalamic nuclei, though it is argued that anterior thalamic lesion effects also arise from covert pathology in sites distal to the thalamus, most critically in the retrosplenial cortex and hippocampus. This two-level account, involving both local and distal lesion effects, explains the range and severity of the spatial deficits following anterior thalamic lesions. These findings highlight how the anterior thalamic nuclei form a key component in a series of interdependent systems that support multiple spatial functions. PMID:25195980

Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report.

PubMed

Niro, A; Sborgia, G; Sborgia, A; Alessio, G

2018-01-17

The incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy. A 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia. Hyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.

Bilateral spontaneous crystalline lens dislocation to the anterior chamber: a case report.

PubMed

Jovanović, Milos

2013-01-01

There are various reasons for the lens dislocation. Spontaneous dislocation of a clear lens is extremely rare, especially its dislocation to the anterior chamber. The author presents a case of spontaneous clear lens dislocation to the anterior chamber in both eyes in a patient without the history of any trauma. Dislocation occurred spontaneously, first in the left eye, along with a sudden decrease of vision. The ophthalmologist found a clear lens in the anterior chamber, without any sign of an elevated intraocular pressure, as should have been expected. The dislocated lens was removed surgically (intracapsular extraction) with the preventive basal iridectomy. Two years later, the same happened in the right eye: clear lens moved spontaneously to the anterior chamber, with a decrease of vision, but again without any rise of intraocular pressure and/or any pain. Intracapsular extraction of the lens with basal iridectomy was done again. The presented case demonstrates that spontaneous dislocation of the transparent lens to the eye anterior chamber can occur in both eyes at different time intervals. We suggest the removal of dislocated lens in the anterior chamber by the intracapsular extraction.

The Palatal Approach to Distraction Osteogenesis of the Anterior Maxillary Alveolus.

PubMed

Bell, Robert E

2015-07-01

This report describes the palatal approach to gain access for osteodistraction of the anterior maxilla to improve the vector of force during distraction. This case report illustrates a novel approach to anterior maxillary osteodistraction. The palatal approach allows the maxillary segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the palatal tissue creates a vector of force toward the palate. The vascular pedicle for the transport segment is the labial mucosa and musculature. In the present case, the alveolar segment was advanced 3.6 mm anteriorly and 12.2 mm inferiorly as measured by pre- and postoperative computed tomograms. This patient with a large vertical alveolar defect and high smile line had successful restoration with dental implants. The result has been stable for 14 months. In this case, the palatal approach to the anterior maxillary osteotomy was shown to be an effective method of reconstructing a large vertical anterior defect. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Laparoscopic anterior resection and total mesorectal excision for rectal cancer: a prospective nonrandomized study.

PubMed

Palanivelu, C; Sendhilkumar, K; Jani, Kalpesh; Rajan, P S; Maheshkumar, G S; Shetty, Roshan; Parthasarthi, R

2007-04-01

The purpose of this study was to present our experience of laparoscopic total mesorectal resection, including ultralow resection and coloanal anastomosis. Between 1993 and 2005, patients fit for general anesthesia, with resectable cancers, and with lower edge of tumor beyond 5 cm of the anal verge were subjected to laparoscopic anterior resection with sphincter preservation. Double stapling technique is used to establish bowel continuity. A total of 170 patients, 88 males and 82 females, were subjected to successful laparoscopic anterior resection, which included high anterior resection (n=90), low anterior resection (n=52), ultralow anterior resection (n=20), and coloanal anastomosis (n=8). The average age of patients was 58.4 years (12-90 years). Mean operating time was 130 min and mean hospital stay was 7 days. The morbidity was 13.5% with nil mortality. With an average follow-up of 49 months (range 9 years to 3 months), 9 patients developed local recurrence and 45 patients developed distant metastasis. In selected cases, laparoscopic anterior resection is possible for all levels of rectal tumors, allowing sphincter preservation and maintaining oncological safety.

Structural and Dynamical Aspects of Electrodeposition

DTIC Science & Technology

1993-05-01

Lfquido Utilizando Ondas Estacionarias de Rayos X " Investigaci6n y Ciencia (Scientific American in Spanish) (invited and submitted) 10. Bommarito, G. M...investigations researchers have emphasized the underpotential deposition of metal mono and multilayers employing electrochemical, x -ray based and ultra high...of adsorbate employed. 2. The underpotential deposition of copper on an iodine covered platinum surface by x -ray based techniques with emphasis on: a

Method for measuring anterior chamber volume by image analysis

NASA Astrophysics Data System (ADS)

Zhai, Gaoshou; Zhang, Junhong; Wang, Ruichang; Wang, Bingsong; Wang, Ningli

2007-12-01

Anterior chamber volume (ACV) is very important for an oculist to make rational pathological diagnosis as to patients who have some optic diseases such as glaucoma and etc., yet it is always difficult to be measured accurately. In this paper, a method is devised to measure anterior chamber volumes based on JPEG-formatted image files that have been transformed from medical images using the anterior-chamber optical coherence tomographer (AC-OCT) and corresponding image-processing software. The corresponding algorithms for image analysis and ACV calculation are implemented in VC++ and a series of anterior chamber images of typical patients are analyzed, while anterior chamber volumes are calculated and are verified that they are in accord with clinical observation. It shows that the measurement method is effective and feasible and it has potential to improve accuracy of ACV calculation. Meanwhile, some measures should be taken to simplify the handcraft preprocess working as to images.

Relative Frequencies of Arteritic and Nonarteritic Anterior Ischemic Optic Neuropathy in an Arab Population.

PubMed

Gruener, Anna M; Chang, Jessica R; Bosley, Thomas M; Al-Sadah, Zakeya M; Kum, Clarissa; McCulley, Timothy J

2017-12-01

To evaluate the relative frequencies of arteritic and nonarteritic anterior ischemic optic neuropathy (AION) in an Arab population and to compare and contrast these findings with known epidemiological data from Caucasian populations. A retrospective review of the medical records of all patients diagnosed with AION at the King Khaled Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia, between 1997 and 2012. Of 171 patients with AION, 4 had biopsy-proven giant-cell arteritis (GCA). The relative frequencies of arteritic anterior ischemic optic neuropathy (AAION) and nonarteritic anterior ischemic optic neuropathy (NAION) in this Arab cohort were 2.3% and 97.7%, respectively. The relative frequencies of arteritic anterior ischemic optic neuropathy and nonarteritic anterior ischemic optic neuropathy differ between Arab and North American clinic-based populations, with giant-cell arteritis-related ischemia being much less frequent in Saudi Arabia.

Cell life and death in the anterior pituitary gland: role of oestrogens.

PubMed

Seilicovich, A

2010-07-01

Apoptotic processes play an important role in the maintenance of cell numbers in the anterior pituitary gland during physiological endocrine events. In this review, we summarise the regulation of apoptosis of anterior pituitary cells, particularly lactotrophs, somatotrophs and gonadotrophs, and analyse the possible mechanisms involved in oestrogen-induced apoptosis in anterior pituitary cells. Oestrogens exert apoptotic actions in several cell types and act as modulators of pituitary cell renewal, sensitising cells to both mitogenic and apoptotic signals. Local synthesis of growth factors and cytokines induced by oestradiol as well as changes in phenotypic features that enhance the responsiveness of anterior pituitary cells to pro-apoptotic factors may account for cyclical apoptotic activity in anterior pituitary cells during the oestrous cycle. Considering that tissue homeostasis results from a balance between cell proliferation and death and that mechanisms involved in apoptosis are tightly regulated, defects in cell death processes could have a considerable physiopathological impact.

Comparison of Gait Aspects According to FES Stimulation Position Applied to Stroke Patients

PubMed Central

Mun, Byeong-mu; Kim, Tae-ho; Lee, Jin-hwan; Lim, Jin-youg; Seo, Dong-kwon; Lee, Dong-jin

2014-01-01

[Purpose] This study sought to identify the gait aspects according to the FES stimulation position in stroke patients during gait training. [Subjects and Methods] To perform gait analysis, ten stroke patients were grouped based on 4 types of gait conditions: gait without FES stimulation (non-FES), gait with FES stimulation on the tibialis anterior (Ta), gait with FES stimulation on the tibialis anterior and quadriceps (TaQ), and gait with FES stimulation on the tibialis anterior and gluteus medius (TaGm). [Results] Based on repeated measures analysis of variance of measurements of gait aspects comprised of gait speed, gait cycle, and step length according to the FES stimulation position, the FES stimulation significantly affected gait aspects. [Conclusion] In conclusion, stimulating the tibialis anterior and quadriceps and stimulating the tibialis anterior and gluteus medius are much more effective than stimulating only the tibialis anterior during gait training in stroke patients using FES. PMID:24764634

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network.

PubMed

Takenaka, Shota; Aono, Hiroyuki

2017-03-01

Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery of this symptom have been investigated using univariate or/and multivariate analyses. However, the conclusions have been somewhat controversial. Bayesian network models, which are graphic and intuitive to the clinician, may facilitate understanding of the prognosis of drop foot resulting from degenerative lumbar diseases. (1) To show a layered correlation among predictors of recovery from drop foot resulting from degenerative lumbar diseases; and (2) to develop support tools for clinical decisions to treat drop foot resulting from lumbar degenerative diseases. Between 1993 and 2013, we treated 141 patients with decompressive lumbar spine surgery who presented with drop foot attributable to degenerative diseases. Of those, 102 (72%) were included in this retrospective study because they had drop foot of recent development and had no diseases develop that affect evaluation of drop foot after surgery. Specifically, 28 (20%) patients could not be analyzed because their records were not available at a minimum of 2 years followup after surgery and 11 (8%) were lost owing to postoperative conditions that affect the muscle strength evaluation. Eight candidate variables were sex, age, herniated soft disc, duration of the neurologic injury (duration), preoperative tibialis anterior muscle strength (pretibialis anterior), leg pain, cauda equina syndrome, and number of involved levels. Manual muscle testing was used to assess the tibialis anterior muscle strength. Drop foot was defined as a tibialis anterior muscle strength score of less than 3 of 5 (5 = movement against gravity and full resistance, 4 = movement against gravity and moderate resistance, 3 = movement against gravity through full ROM, 3- = movement against gravity through partial ROM, 2 = movement with gravity eliminated through full ROM, 1 = slight contraction but no movement, and 0 = no contraction). The two outcomes of interest were postoperative tibialis anterior muscle strength (posttibialis anterior) of 3 or greater and posttibialis anterior strength of 4 or greater at 2 years after surgery. We developed two separate Bayesian network models with outcomes of interest for posttibialis anterior strength of 3 or greater and posttibialis anterior strength of 4 or greater. The two outcomes correspond to "good" and "excellent" results based on previous reports, respectively. Direct predictors are defined as variables that have the tail of the arrow connecting the outcome of interest, whereas indirect predictors are defined as variables that have the tail of the arrow connecting either direct predictors or other indirect predictors that have the tail of the arrow connecting direct predictors. Sevenfold cross validation and receiver-operating characteristic (ROC) curve analyses were performed to evaluate the accuracy and robustness of the Bayesian network models. Both of our Bayesian network models showed that weaker muscle power before surgery (pretibialis anterior ≤ 1) and longer duration of neurologic injury before treatment (> 30 days) were associated with a decreased likelihood of return of function by 2 years. The models for posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater were the same in terms of the graphs, showing that the two direct predictors were pretibialis anterior muscle strength (score ≤ 1 or ≥ 2) and duration (≤ 30 days or > 30 days). Age, herniated soft disc, and leg pain were identified as indirect predictors. We developed a decision-support tool in which the clinician can enter pretibialis anterior muscle strength and duration, and from this obtain the probability estimates of posttibialis anterior muscle strength. The probability estimates of posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater were 94% and 85%, respectively, in the most-favorable conditions (pretibialis anterior ≥ 2; duration ≤ 30 days) and 18% and 14%, respectively, in the least-favorable conditions (pretibialis anterior ≤ 1; duration > 30 days). On the sevenfold cross validation, the area under the ROC curve yielded means of 0.78 (95% CI, 0.68-0.87) and 0.74 (95% CI, 0.64-0.84) for posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater, respectively. The results of this study suggest that the clinician can understand intuitively the layered correlation among predictors by Bayesian network models. Based on the models, the decision-support tool successfully provided the probability estimates of posttibialis anterior muscle strength to treat drop foot attributable to lumbar degenerative diseases. These models were shown to be robust on the internal validation but should be externally validated in other populations. Level III, therapeutic study.

Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability.

PubMed

Ahn, Jin Hwan; Bae, Tae Soo; Kang, Ki-Ser; Kang, Soo Yong; Lee, Sang Hak

2011-10-01

Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees. An MMPH tear in an ACL-deficient knee increases the anterior-posterior tibial translation and rotatory instability. In addition, MMPH repair will restore the tibial translation to the level before the tear. Controlled laboratory study. Ten human cadaveric knees were tested sequentially using a custom testing system under 5 conditions: intact, ACL deficient, ACL deficient with an MMPH peripheral longitudinal tear, ACL deficient with an MMPH repair, and ACL deficient with a total medial meniscectomy. The knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 134-N anterior and 200-N axial compressive tibial load. The rotatory kinematics were also measured at 15° and 30° of flexion in a combined rotatory load of 5 N·m of internal tibial torque and 10 N·m of valgus torque. Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90° (P < .05). An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60° compared with the ACL-deficient/MMPH tear state (P < .05). The total anterior-posterior translation of the ACL-deficient/MMPH repaired knee was not significantly increased compared with the ACL (only)-deficient knee but was increased compared with the ACL-intact knee (P > .05). A total medial meniscectomy in an ACL-deficient knee did not increase the anterior-posterior tibial translation significantly compared with MMPH tears in ACL-deficient knees at all flexion angles (P > .05). In a combined rotatory load, tibial rotation after MMPH tears or a total medial meniscectomy in an ACL-deficient knee were not affected significantly at all flexion angles. This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. MMPH repair significantly improved anterior-posterior tibial translation in ACL-deficient knees. These findings may help improve the treatment of patients with ACL and MMPH longitudinal tear by suggesting that the medial meniscal repairs should be performed for greater longevity when combined with an ACL reconstruction.

Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

PubMed

Kamide, Tomoya; Burkhardt, Jan-Karl; Tabani, Halima; Safaee, Michael M; Lawton, Michael T

2018-01-01

Although most posterior communicating artery (PCoA) aneurysms can be clipped easily with excellent results, some require anterior clinoidectomy for safe and complete clipping. To review our microsurgical series of ruptured PCoA aneurysms and identify the preoperative predictors for anterior clinoidectomy during microsurgical clipping for PCoA aneurysms. Results from microsurgical clipping of 104 patients with ruptured PCoA aneurysms were reviewed retrospectively. Distances and angles were obtained from computed tomographic angiography and compared between the anterior and nonanterior clinoidectomy groups. Anterior clinoidectomy was required in 19 of the 104 cases (18%). None developed surgical complications due to anterior clinoid process (ACP) resection, including postoperative visual deficit. Univariate and multivariate analyses revealed that the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were statistically significant predictive factors for the need of anterior clinoidectomy. Based on a receiver operating characteristic analysis, the distances from the ACP tip to the aneurysmal proximal neck <4.0 mm and from the ACP line to the aneurysmal proximal neck ≤2.0 mm were selected as optimal cutoff values for predicting the necessity of anterior clinoidectomy, and the area under the receiver operating characteristic curve values were 0.991 and 0.955, respectively. In case of ruptured PCoA aneurysm surgery, the distances from the ACP tip to the aneurysmal proximal neck and from the ACP line to the aneurysmal proximal neck were both found to be useful predictors of whether anterior clinoidectomy was required. Copyright © 2017 Elsevier Inc. All rights reserved.

Cephalometric features in isolated growth hormone deficiency.

PubMed

Oliveira-Neto, Luiz Alves; Melo, Mariade de Fátima B; Franco, Alexandre A; Oliveira, Alaíde H A; Souza, Anita H O; Valença, Eugênia H O; Britto, Isabela M P A; Salvatori, Roberto; Aguiar-Oliveira, Manuel H

2011-07-01

To analyze cephalometric features in adults with isolated growth hormone (GH) deficiency (IGHD). Nine adult IGHD individuals (7 males and 2 females; mean age, 37.8 ± 13.8 years) underwent a cross-sectional cephalometric study, including 9 linear and 5 angular measurements. Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were calculated. To pool cephalometric measurements in both genders, results were normalized by standard deviation scores (SDS), using the population means from an atlas of the normal Brazilian population. All linear measurements were reduced in IGHD subjects. Total maxillary length was the most reduced parameter (-6.5 ± 1.7), followed by a cluster of six measurements: posterior cranial base length (-4.9 ± 1.1), total mandibular length (-4.4 ± 0.7), total posterior facial height (-4.4 ± 1.1), total anterior facial height (-4.3 ± 0.9), mandibular corpus length (-4.2 ± 0.8), and anterior cranial base length (-4.1 ± 1.7). Less affected measurements were lower-anterior facial height (-2.7 ± 0.7) and mandibular ramus height (-2.5 ± 1.5). SDS angular measurements were in the normal range, except for increased gonial angle (+2.5 ± 1.1). Posterior facial height/anterior facial height and lower-anterior facial height/anterior facial height ratios were not different from those of the reference group. Congenital, untreated IGHD causes reduction of all linear measurements of craniofacial growth, particularly total maxillary length. Angular measurements and facial height ratios are less affected, suggesting that lGHD causes proportional blunting of craniofacial growth.

The effect of internal fixation lamp on anterior chamber angle width measured by anterior segment optical coherence tomography.

PubMed

Nakamine, Sakari; Sakai, Hiroshi; Arakaki, Yoshikuni; Yonahara, Michiko; Kaiya, Tadayoshi

2018-01-01

To study the effect of the internal fixation lamp on anterior chamber width measured by anterior segment optical coherence tomography. In a prospective cross sectional observational study, consecutive 22 right eyes of 22 patients (4 men and 18 women) with suspected primary angle closure underwent swept source domain anterior segment optical coherence tomography (AS-OCT), (CASIA SS-1000, Tomey, Nagoya, Japan). Anterior chamber parameters of angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) at 500 or 750 µm from scleral spur and pupil diameter were measured by AS-OCT in a three-dimensional mode in 4 quadrants (superior, inferior, temporal and nasal) in dark room setting both with and without internal fixation lamp. Anterior segment parameters of AOD 500 in superior, inferior and temporal quadrants, AOD 750 at superior and nasal, TIA 500 at superior, and inferior and TIA 750 at superior and nasal, and ARA 500 or 750 at superior and inferior with internal fixation lamp were greater and the pupil diameter was significantly (all P < 0.05, paired t test) smaller than when measured without fixation lamp. Internal fixation lamp of the anterior segment OCT makes the pupil constrict and angle wider. When using AS-OCT with usual setting with internal fixation lamp on with eyes in which the anterior chamber angle is narrow but open, it is recommended that the internal fixation lamp be turned off to ensure a clear indication as to whether the angle is open or closed in the dark.

Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

PubMed

Chan, V O; Moran, D E; Mwangi, I; Eustace, S J

2013-08-01

To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment. Retrospective study over a 1-year period reviewing the MR knee examinations of all patients who were referred for assessment of anterior knee pain. Only patients with isolated lateral patellofemoral disease were included. Age, gender, distribution of lateral patellofemoral chondromalacia, and grade of cartilaginous defects were documented for each patient. Correlation between the distribution of lateral patellofemoral chondromalacia and patient demographics, patellar shape, and indices of patellar alignment (femoral sulcus angle and modified Q angle) was then ascertained. There were 50 patients (22 males, 28 females) with anterior knee pain and isolated patellofemoral disease. The majority of the patients (78 %) had co-existent disease with grade 1 chondromalacia. No significant correlation was found between patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle and age, gender, patellar shape, or modified Q angle (p > 0.05). However, patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle had a shallower femoral sulcus angle (mean 141.8°) compared to the patients with lateral patellar facet disease (mean 133.8°) (p = 0.002). A small percentage of patients with anterior knee pain have chondromalacia isolated to the anterior margin of the lateral femoral condyle. This was associated with a shallower femoral sulcus angle.

[Magnetic resonance imaging study of effects of accommodation on human lens morphological characters].

PubMed

Zheng, Sui-lian; Zhang, Ai; Shi, Jian-jing; Zhou, Yun-xin

2013-11-05

To evaluate the effects of accommodation on lens morphological characters. From January 2011 to June 2011, magnetic resonance images of eyes were acquired from 30 subjects aged 20 to 24 years during accommodation and at rest. The optimal images were analyzed by Autocad 2010 to obtain the total lens cross-sectional area (CSA) and CSA of anterior and posterior portions of lens, anterior chamber depth, lens thickness, lens diameter, vitreous chamber depth and axial length during accommodation and at rest. Paired-t test was performed. The anterior curvature radius (mm), posterior curvature radius (mm), CSA of anterior portion (mm(2)), CSA of posterior portion (mm(2)), total lens CSA (mm(2)) was (8.7 ± 0.8), (6.2 ± 0.5), (7.5 ± 2.1), (12.0 ± 2.6), (20 ± 4) during relaxed accommodation; anterior curvature radius (mm), posterior curvature radius (mm), CSA of anterior portion (mm(2)), CSA of posterior portion (mm(2)), total lens CSA (mm(2)) was (7.1 ± 1.3), (5.6 ± 0.5), (14.7 ± 2.9), (12.2 ± 2.1) and (27 ± 4) during accommodation. The total lens CSA (t = -11.556, P < 0.01) and CSA of anterior portion (t = -15.653, P < 0.01) both increased in accommodative states. The CSA of posterior portion of lens (t = -0.437, P > 0.05) under a statistically independent accommodative state. There was significant difference in the anterior chamber depth (t = 4.366, P < 0.01), lens thickness (t = -5.456, P < 0.01) and lens diameter (t = 4.597, P < 0.01) in accommodative states. There were insignificant differences both in vitreous chamber depth (t = 0.428, P > 0.05) and axial length (t = 0.418, P > 0.05) under accommodative states. During accommodation, the anterior chamber depth decreases, lens thickness increases and diameter of lens decreases while anterior portions and total lens CSA increase. There are insignificant changes in posterior portions of lens CSA, vitreous chamber depth and axial length. The accommodative changes in CSA indicate that the anterior portion of lens may be related with the properties of anterior capsule and lens material, the position of zonular attachments and the location of fetal nucleus. Helmholtz theory is supported.

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes

PubMed Central

Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Nick, Todd G.; Hewett, Timothy E.

2012-01-01

Background Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design Case control study; Level of evidence, 3. Methods From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension >90° (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament–injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament–injured status increased 4-fold (95% confidence interval, 1.68–9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament–injured status 5-fold (95% confidence interval, 1.24–18.44). Conclusion The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk. PMID:18326833

Comparison of maxillary anterior tooth width and facial dimensions of 3 ethnicities.

PubMed

Parciak, Ewa C; Dahiya, Ankur T; AlRumaih, Hamad S; Kattadiyil, Mathew T; Baba, Nadim Z; Goodacre, Charles J

2017-10-01

As the cosmetic demands of patients increase, determining the appropriate dimensions of the maxillary anterior teeth has become increasingly relevant. The relationship between facial measurements and tooth size provide guidance for maxillary anterior tooth size selection. However, most publications on this topic have focused on the white population, and more data for tooth sizes and their proportions in other ethnicities are needed. The purpose of this observational study was to investigate the relationship between the mesiodistal dimensions of the 6 maxillary anterior teeth and the bizygomatic width, interpupillary distance, intercanthal distance, interalar width, and intercommissural width of individuals of Asian, African-American, and white ethnicities. Standardized digital images of 360 participants (120 Asian, 120 African-American, and 120 white) were used to measure facial segments. Individual dimensions of the 6 maxillary anterior teeth were measured using stone casts with digital sliding caliper. The combined width of the 6 maxillary anterior teeth on a straight line corresponded to the sum of the anterior tooth width. The means and standard deviations from descriptive measurements were calculated and analyzed for face and maxillary anterior tooth ratios and correlations. Statistical analysis was done using the Kruskal-Wallis procedure to compare facial and tooth parameters among the 3 ethnicities. Appropriate post hoc comparisons that adjusted for multiple testing were conducted when warranted (α=.05). The Spearman rho correlation, a nonparametric correlate of the Pearson correlation, was used to associate the facial and tooth parameters within the strata of sex and ethnicity. No consistent ratios were found among the examined facial dimensions and the mesiodistal dimensions of the 6 maxillary anterior teeth among the 3 ethnicities, except for the central incisor width-to-bizygomatic width ratio. No correlations were found between the facial dimensions and mesiodistal dimensions of the 6 maxillary anterior teeth among the 3 ethnicities except in Asian women. For Asian women, the intercommissural width correlated with the width of the central incisor (P=.001), the width of 2 central incisors (P=.001), the width of 4 incisors (P=.003), and the width of 6 maxillary anterior teeth (P=.005). No facial proportions by which the exact width of maxillary anterior teeth could be predicted were found in Asian, African-American, or white populations. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Effects of overhead work involving different heights and distances on neck and shoulder muscle activity.

PubMed

Shin, Seung-Je; Yoo, Won-Gyu

2015-06-05

Although overhead work is closely related to musculoskeletal disorders, it is difficult to avoid these postures in daily working conditions. In industrial tasks that require elevated arm postures above shoulder height, flexibility in the location of the task is necessary. This study investigated the sternocleidomastoid, upper trapezius, lower trapezius, and anterior deltoid, serratus anterior muscle activities during overhead work involving four different height and distance locations performed by healthy adult participants. Eighteen young male right-hand-dominant workers were recruited. The right upper trapezius, lower trapezius, serratus anterior, anterior deltoid, and sternocleidomastoid muscle activities were measured under for overhead work condition (Location 1: overhead work with a height of 10 cm above the head of each subject and distance of 15 cm, Location 2: overhead work with a height of 10 cm above the head of each subject and distance of 30 cm, Location 3: overhead work with a height of 20 cm above the head of each subject and distance of 15 cm, Location 4: overhead work with a height of 20 cm above the head of each subject and distance of 30 cm). In Location 3, there was significantly higher neck extension range of motion compared to Location 1, Location 2 and Location 4. In Location 1, the activities of the upper trapezius, lower trapezius, serratus anterior, anterior deltoid, and sternocleidomastoid muscles were significantly lower than those in Location 3 (p<0.05). In Location 2, the activities of the upper trapezius, lower trapezius, serratus anterior, anterior deltoid, and sternocleidomastoid muscles were significantly lower than those in Location 4 (p<0.05). In Location 1, there were significantly lower upper trapezius, lower trapezius, serratus anterior, and anterior deltoid muscle activities than in Location 2 (p<0.05). In Location 3, there were significantly lower upper trapezius, lower trapezius, serratus anterior, and anterior deltoid muscle activities than in Location 4 (p<0.05). In Location 1, there was significantly higher sternocleidomastoid muscle activity than in Location 2 (p<0.05). Finally, In Location 3, there was significantly higher sternocleidomastoid muscle activity than in Location 4 (p<0.05). Overhead workers should engage in work that involves a low height and near distance. Height appears to be a stronger risk factor than distance in overhead work.

Subcranial approach in the surgical treatment of anterior skull base trauma.

PubMed

Schaller, B

2005-04-01

Fractures of the anterior skull base, because of the region's anatomical relationships, are readily complicated by neurological damage to the brain or cranial nerves. This review highlights the use of a subcranial approach in the operative treatment of injuries of the anterior skull base and compares it to the more traditional neurosurgical transcranial approach. The extended anterior subcranial approach takes advantage of the specific features of injuries in this region and allows direct access to the central anterior cranial base in order to repair fractures, close CSF fistulae and relieve of optic nerve compression. It avoids extensive frontal lobe manipulation. The success of the approach in achieving the aims of surgery with low morbidity is reviewed.

Traumatic anterior dislocation of the crystalline lens and its surgical management.

PubMed

Srećković, Sunčica; Janićijević Petrović, Mirjana; Jovanović, Svetlana; Paunović, Svetlana; Sarenac, Tatjana

2012-02-01

This paper reports a case of a 57-year old female who had sustained a blunt ocular trauma resulting in anterior dislocation of the crystalline lens and acute painful visual loss in the left eye. The patient was managed with anterior chamber intracapsular phacoemulsification through a small anterior capsulotomy, pars plana vitrectomy, and surgical iridotomy. Aphakia was corrected by a contact lens. Two months after the surgery, the best corrected visual acuity was 0.9 in the left eye. The vision and retina remained stable in her follow-up examination 1 year later. Anterior dislocation of the crystalline lens can cause severe complications so that dislocated lens should be removed immediately.

Vocal characteristics of congenital anterior glottic webs in children: A case report.

PubMed

Shah, Jay; White, Katherine; Dohar, Joseph

2015-06-01

This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Synthesis, stability range and characterization of Pr2Cu2O5

NASA Astrophysics Data System (ADS)

Fernández-Sanjulián, Javier; Morán, Emilio; Ángel Alario-Franco, Miguel

2010-03-01

A novel Pr2Cu2O5 phase has been prepared under high-pressure and high-temperature conditions (P ∼6 GPa and T ∼1673 K) in a Belt-type apparatus and characterized by X-ray diffraction and electron microscopy. The crystal structure appears to be an orthorhombic "oxygen-deficient perovskite" (M.T. Anderson, J.T. Vaughey, and K.R. Poeppelmeier, Structural similarities among oxygen-deficient perovskites, Chem. Mater. 5 (1993), pp. 151-165) isostructural with La2Cu2O5 (J.F. Bringley, B.A. Scott, S.J. La Placa, R.F. Boheme, T.M. Shaw, M.W. McElfresh, S.S. Trail, and D.E. Cox, Synthesis of the defect perovskite series LaCuO 3-δ with copper valence varying from 2+to 3+, Nature 347 (1990), pp. 263-265) and Nd2Cu2O5 (B.-H. Chen, D. Walker, E. Suard, B.A. Scott, B. Mercey, M. Hervieu, and B. Raveau, High pressure synthesis of NdCuO3-δ perovskites (0≤δ≤0.5). Inorg. Chem. 34 (1995), pp. 2077-2083).

Espectroscopia del Cometa Halley

NASA Astrophysics Data System (ADS)

Naranjo, O.; Fuenmayor, F.; Ferrin, L.; Bulka, P.; Mendoza, C.

1987-05-01

Se reportan observaciones espectroscópicas del cometa Halley. Los espectros fueron tomados usando el espectrógrafo del telescopio reflector de 1 metro del Observatorio Nacional de Venezuela. Se utilizó óptica azul, con una red de difracción de 600 lineas/min, obteniéndose una dispersión de 74.2 A/mm y una resolución de 2.5 A, en el rango espectral de 3500 a 6500 A. Seis placas fueron tomadas con emulsión IIa-O y dos con IIa-D. Los tiempos de exposición fueron entre 10 y 150 minutos. El cometa se encontraba entre 0.70 y 1.04 UA del Sol, y entre 1.28 y 0.73 UA de la Tierra. Las emisiones más prominentes en el espectro, son las del CN, C2, y C3. Otras emisiones detectadas corresponden a CH, NH2 y Na. Los espectros muestran un fuerte continuo, indicando un contenido significativo de polvo. Se detectó mayor intensidad del contínuo, en la dirección anti solar, lo cual es evidencia de la cola de polvo.

Laser speckle flowgraphy for differentiating between nonarteritic ischemic optic neuropathy and anterior optic neuritis.

PubMed

Maekubo, Tomoyuki; Chuman, Hideki; Nao-I, Nobuhisa

2013-07-01

The aim of this study was to investigate the usefulness of laser speckle flowgraphy (LSFG) for the differentiation of acute nonarteritic ischemic optic neuropathy (NAION) from anterior optic neuritis (ON). To investigate blood flow in the optic disc under normal conditions, NAION, and anterior ON, we compared the tissue blood flow of the right eye with that of the left eye in the control group, and that of the affected eye with that of the unaffected eye in the NAION and anterior ON groups. In the normal control group, the tissue blood flow did not significantly differ between the right and left eyes. In the NAION group, all 6 patients had decreased optic disc blood flow in the NAION eye when compared with the unaffected eye. By contrast, in the anterior ON group, all 6 patients had increased optic disc blood flow in the anterior ON eye when compared with the unaffected eye. In the NAION group, the mean blur rate (MBR) of the affected eyes was 29.5 % lower than that of the unaffected eyes. In the anterior ON group, the MBR of the affected eyes was 15.9 % higher than that of the unaffected eyes. LSFG could be useful in differentiating between NAION and anterior ON. In addition, this imaging technique saves time and is noninvasive.

A rare variation of the digastric muscle

PubMed Central

KALNIEV, MANOL; KRASTEV, DIMO; KRASTEV, NIKOLAY; VIDINOV, KALIN; VELTCHEV, LUDMIL; APOSTOLOV, ALEXANDER; MILEVA, MILKA

2013-01-01

The digastric muscle is composed by two muscle bellies: an anterior and a posterior, joined by an intermediate tendon. This muscle is situated in the anterior region of the neck. The region between the hyoid bone and the mandible is divided by an anterior belly into two triangles: the submandibular situated laterally and the submental triangle which is located medially. We found that the anatomical variations described in the literature relate mainly to the anterior belly and consist of differences in shape and attachment of the muscle. During routine dissection in February 2013 in the section hall of the Department of Anatomy and Histology in Medical University – Sofia we came across a very interesting variation of the digastric muscle. The digastric muscles that presented anatomical variations were photographed using a Sony Cyber-shot DSC-T1 camera, with a Carl Zeiss Vario-Tessar lens. We found out bilateral variation of the digastric muscle in one cadaver. The anterior bellies were very thin and insert to the hyoid bone. Two anterior bellies connect each other and thus they formed a loop. The anatomical variations observed of our study related only to the anterior belly, as previously described by other authors. It is very important to consider the occurrence of the above mentioned variations in the digastric muscle when surgical procedures are performed on the anterior region of the neck. PMID:26527971

Effect of retinoic acid on midkine gene expression in rat anterior pituitary cells.

PubMed

Maliza, Rita; Fujiwara, Ken; Azuma, Morio; Kikuchi, Motoshi; Yashiro, Takashi

2017-06-29

Retinoic acid (RA) is converted from retinal by retinaldehyde dehydrogenases (RALDHs) and is an essential signaling molecule in embryonic and adult tissue. We previously reported that RALDH1 was produced in the rat anterior pituitary gland and hypothesized that RA was generated in the gland. Midkine (MK) is an RA-inducible growth factor, and MK production in the rat anterior pituitary gland was recently reported. However, the mechanism that regulates gene expression of MK in the pituitary gland has not been determined. To investigate regulation of MK production in the anterior pituitary gland, we analyzed changes in MK mRNA in cultured rat anterior pituitary cells. We identified MK-expressing cells by double-staining with in situ hybridization and immunohistochemical techniques for RALDH1. MK mRNA was expressed in RALDH1-producing cells in the anterior pituitary gland. Using isolated anterior pituitary cells of rats, we examined the effect of RA on gene expression of MK. Quantitative real-time PCR revealed that 72 h exposure to a concentration of 10 -6 M of retinal and all-trans retinoic acid increased MK mRNA levels by about 2-fold. Moreover, the stimulatory effect of all-trans retinoic acid was mimicked by the RA receptor agonist Am80. This is the first report to show that RA is important in regulating MK expression in rat anterior pituitary gland.

Shoulder dislocation in patients older than 60 years of age

PubMed Central

Rapariz, Jose M.; Martin-Martin, Silvia; Pareja-Bezares, Antonio; Ortega-Klein, Jose

2010-01-01

Purpose: Recurrent anterior shoulder dislocation in elderly patients is a little studied condition. The goal of this paper is to clarify the role of associated injuries with respect to loss of function and recurrence of dislocation. Materials and Methods: We have conducted a retrospective, descriptive study on 29 patients older than 60 years at the moment they suffered their first dislocation episode. All patients were assessed clinically (Constant test) and by imaging testing (X-ray, MRI). Results: Nine (31.03%) out of 29 patients had a recurrent dislocation. Four of them required reconstructive surgery to maintain joint stability. Injury to the anterior support (anterior labrum, anterior glenoid rim) showed a statistically significant relation to the recurrence of dislocations. The occurrence or non-occurrence of a rotator cuff tear does have an impact on the shoulder function. The degree of rotator cuff involvement on the coronal plane does not significantly affect the shoulder’s functional outcome. The tear extension on the sagittal plane does cause impairment on the Constant test. Conclusions: Labrum and/or anterior glenoid involvement should be suspected in elderly patients presenting with recurrent shoulder dislocation. Recurrence is due to an injury in the anterior support or both (anterior and posterior), even though shoulder function gets impaired when a rotation cuff tear occurs with anterior extension on the sagittal plane. Evidence level: IV Case series. PMID:21655003

Pupil Tracking for Real-Time Motion Corrected Anterior Segment Optical Coherence Tomography

PubMed Central

Carrasco-Zevallos, Oscar M.; Nankivil, Derek; Viehland, Christian; Keller, Brenton; Izatt, Joseph A.

2016-01-01

Volumetric acquisition with anterior segment optical coherence tomography (ASOCT) is necessary to obtain accurate representations of the tissue structure and to account for asymmetries of the anterior eye anatomy. Additionally, recent interest in imaging of anterior segment vasculature and aqueous humor flow resulted in application of OCT angiography techniques to generate en face and 3D micro-vasculature maps of the anterior segment. Unfortunately, ASOCT structural and vasculature imaging systems do not capture volumes instantaneously and are subject to motion artifacts due to involuntary eye motion that may hinder their accuracy and repeatability. Several groups have demonstrated real-time tracking for motion-compensated in vivo OCT retinal imaging, but these techniques are not applicable in the anterior segment. In this work, we demonstrate a simple and low-cost pupil tracking system integrated into a custom swept-source OCT system for real-time motion-compensated anterior segment volumetric imaging. Pupil oculography hardware coaxial with the swept-source OCT system enabled fast detection and tracking of the pupil centroid. The pupil tracking ASOCT system with a field of view of 15 x 15 mm achieved diffraction-limited imaging over a lateral tracking range of +/- 2.5 mm and was able to correct eye motion at up to 22 Hz. Pupil tracking ASOCT offers a novel real-time motion compensation approach that may facilitate accurate and reproducible anterior segment imaging. PMID:27574800

Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children.

PubMed

Siawash, Murid; Mol, Frederique; Tjon-A-Ten, Walther; Perquin, Christel; van Eerten, Percy; van Heurn, Ernst; Roumen, Rudi; Scheltinga, Marc

2017-05-01

Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking. Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome. Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed. Injections were administered using a free-hand technique in the outpatient department. A total of 85 children were included (median age 15 years, range 8-17, 76% female). Eighty-three children reported immediate pain relief following a single lidocaine block and 13 achieved long-term success. Another 19 children was successfully treated with additional blocks combined with steroids. A total 38% success ratio was attained after a median 17-month follow-up (range, 4-39). Pain intensity and diagnostic delay were not associated with a beneficial outcome. However, young age predicted success. An infrequently occurring adverse event was temporarily increased pain some 6 h post injection. Anterior rectus sheath blocks using local anesthetics and steroids are safe and long-term successful in more than one-third of children suffering from abdominal pain due to anterior cutaneous nerve entrapment syndrome. © 2017 John Wiley & Sons Ltd.

The efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace anterior chamber cell severity following cataract surgery

PubMed Central

Silverstein, Steven M; Jackson, Mitchell A; Goldberg, Damien F; Muñoz, Mauricio

2014-01-01

Purpose To evaluate the efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace (0–5 cells) anterior chamber cells, following cataract surgery with posterior chamber intraocular lens implantation. Methods The study designed employed two Phase III, double-masked, placebo-controlled, multicenter clinical trials of 440 subjects, randomized to either bromfenac ophthalmic solution 0.07% (n=222) or placebo (n=218). Subjects self-dosed once daily, beginning 1 day before undergoing cataract surgery with intraocular lens implantation (day –1) and again on the day of surgery (day 0) and for 14 days postoperatively. Follow-up was on days 1, 3, 8, and 15. The outcome measures included the percentage of subjects with zero-to-trace anterior chamber cells at each visit, as determined by the percentage of subjects with ≤5 anterior chamber cells, overall anterior chamber cell grades, and summed ocular inflammation score (SOIS) (combined anterior chamber cell and flare scores). Results The proportion of subjects with zero-to-trace anterior chamber cells was significantly higher in the bromfenac 0.07% group compared with the placebo group as early as day 3 (P=0.0007), continued at day 8 (P<0.0001), and through day 15 (P<0.0001). At day 15, 80.2% of subjects in the bromfenac 0.07% group achieved zero-to-trace anterior chamber cells compared with 47.2% of subjects who did so in the placebo group. The overall anterior chamber cell scores were significantly lower in the bromfenac 0.07% group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). The SOIS were also significantly lower in the bromfenac group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). Conclusion Bromfenac ophthalmic solution 0.07%, dosed once daily was clinically effective in achieving zero-to-trace anterior chamber cell severity after cataract surgery and was superior to placebo in all anterior chamber cell severity and inflammation outcome measures. PMID:24876763

Effects of systolic anterior motion of the mitral valve on haemodynamics. Evaluation by a direct method.

PubMed

Kaku, T; Sakurai, S; Furuno, Y; Yashiro, A; Nakashima, Y; Kuroiwa, A

1995-08-01

We evaluated the effects of systolic anterior motion systolic anterior motion of the mitral valve on cardiac haemodynamics. Seven adult mongrel dogs in which systolic anterior motion-septal contact was observed after dobutamine administration were used. To exclude the effects of left ventricular function and morphology, a stone removal basket catheter was placed in the left ventricular outflow tract, and haemodynamics were compared with the basket closed and opened. The basket was opened five times in three dogs not showing systolic anterior motion-septal contact, but the basket itself did not effect the haemodynamics. In the seven dogs that showed systolic anterior motion-septal contact without left ventricular hypertrophy, the basket was opened a total of 33 times in the presence of various degrees of systolic anterior motion-septal contact. After opening the basket, systolic anterior motion was reduced echocardiographically, and significant (P<0.01) changes were observed in the left ventricle-aorta pressure gradient (from 68 +/- 22 to 25 +/- 15 mm Hg), the systolic ejection period (from 146 +/- 19 to 135 +/- 16 ms), and the stroke volume (SV; from 9.4 +/- 2.9 to 10.1 +/- 3.3 ml). After basket inflation, aortic pressure and aortic flow waveforms changed but the peak pressure and flow velocity did not. The temporal distribution of left ventricular ejection also definitely changed after the basket was opened. No changes were observed in the peak dp/dt, peak negative dp/dt, time constant, left ventricular end-diastolic pressure, or left atrial pressure. These observations in this animal model of systolic anterior motion without left ventricular hypertrophy suggest that: (1) there is no potential for generation of an intra-cavity gradient in the absence of systolic anterior motion of the mitral valve, so that (2) systolic anterior motion narrowed the left ventricular outflow tract and, consequently, produced the systolic ejection period, and affected the left ventricular ejection dynamics, and that (3) the basket catheter is useful because it allows these assessments in the same heart with a nearly fixed left ventricular contractility, at least in our animal model.

Quadriceps force and anterior tibial force occur obviously later than vertical ground reaction force: a simulation study.

PubMed

Ueno, Ryo; Ishida, Tomoya; Yamanaka, Masanori; Taniguchi, Shohei; Ikuta, Ryohei; Samukawa, Mina; Saito, Hiroshi; Tohyama, Harukazu

2017-11-18

Although it is well known that quadriceps force generates anterior tibial force, it has been unclear whether quadriceps force causes great anterior tibial force during the early phase of a landing task. The purpose of the present study was to examine whether the quadriceps force induced great anterior tibial force during the early phase of a landing task. Fourteen young, healthy, female subjects performed a single-leg landing task. Muscle force and anterior tibial force were estimated from motion capture data and synchronized force data from the force plate. One-way repeated measures analysis of variance and the post hoc Bonferroni test were conducted to compare the peak time of the vertical ground reaction force, quadriceps force and anterior tibial force during the single-leg landing. In addition, we examined the contribution of vertical and posterior ground reaction force, knee flexion angle and moment to peak quadriceps force using multiple linear regression. The peak times of the estimated quadriceps force (96.0 ± 23.0 ms) and anterior tibial force (111.9 ± 18.9 ms) were significantly later than that of the vertical ground reaction force (63.5 ± 6.8 ms) during the single-leg landing. The peak quadriceps force was positively correlated with the peak anterior tibial force (R = 0.953, P < 0.001). Multiple linear regression analysis showed that the peak knee flexion moment contributed significantly to the peak quadriceps force (R 2  = 0.778, P < 0.001). The peak times of the quadriceps force and the anterior tibial force were obviously later than that of the vertical ground reaction force for the female athletes during successful single-leg landings. Studies have reported that the peak time of the vertical ground reaction force was close to the time of anterior cruciate ligament (ACL) disruption in ACL injury cases. It is possible that early contraction of the quadriceps during landing might induce ACL disruption as a result of excessive anterior tibial force in unanticipated situations in ACL injury cases.

Identification and prognostic value of anterior gradient protein 2 expression in breast cancer based on tissue microarray.

PubMed

Guo, Jilong; Gong, Guohua; Zhang, Bin

2017-07-01

Breast cancer has attracted substantial attention as one of the major cancers causing death in women. It is crucial to find potential biomarkers of prognostic value in breast cancer. In this study, the expression pattern of anterior gradient protein 2 in breast cancer was identified based on the main molecular subgroups. Through analysis of 69 samples from the Gene Expression Omnibus database, we found that anterior gradient protein 2 expression was significantly higher in non-triple-negative breast cancer tissues compared with normal tissues and triple-negative breast cancer tissues (p < 0.05). The data from a total of 622 patients from The Cancer Genome Atlas were analysed. The data from The Cancer Genome Atlas and results from quantitative reverse transcription polymerase chain reaction also verified the anterior gradient protein 2 expression pattern. Furthermore, we performed immunohistochemical analysis. The quantification results revealed that anterior gradient protein 2 is highly expressed in non-triple-negative breast cancer (grade 3 excluded) and grade 1 + 2 (triple-negative breast cancer excluded) tumours compared with normal tissues. Anterior gradient protein 2 was significantly highly expressed in non-triple-negative breast cancer (grade 3 excluded) and non-triple-negative breast cancer tissues compared with triple-negative breast cancer tissues (p < 0.01). In addition, anterior gradient protein 2 was significantly highly expressed in grade 1 + 2 (triple-negative breast cancer excluded) and grade 1 + 2 tissues compared with grade 3 tissues (p < 0.05). Analysis by Fisher's exact test revealed that anterior gradient protein 2 expression was significantly associated with histologic type, histological grade, oestrogen status and progesterone status. Univariate analysis of clinicopathological variables showed that anterior gradient protein 2 expression, tumour size and lymph node status were significantly correlated with overall survival in patients with grade 1 and 2 tumours. Cox multivariate analysis revealed anterior gradient protein 2 as a putative independent indicator of unfavourable outcomes (p = 0.031). All these data clearly showed that anterior gradient protein 2 is highly expressed in breast cancer and can be regarded as a putative biomarker for breast cancer prognosis.

Anterior but not posterior choroid changed before and during Valsalva manoeuvre in healthy Chinese: a UBM and SS-OCT study

PubMed Central

Li, Fei; Gao, Kai; Li, Xingyi; Chen, Shida; Huang, Wenbin; Zhang, Xiulan

2017-01-01

Purpose To determine if the anterior choroid is involved in ocular change during the Valsalva manoeuvre (VM). Materials and methods Fifty-three healthy volunteers aged 18–65 years with normal visual field test results and no history of intraocular pressure (IOP) exceeding 21 mm Hg were recruited. Anterior and posterior choroidal changes before and during VM were recorded by ultrasound microscope and swept-source optical coherence tomography, respectively. Parameters of the anterior segment included ciliary body thickness (CBT0), thickness of the choroid at a distance of 4 mm from the root of the iris (CT4), anterior placement of the ciliary body (APCB) and trabecular–ciliary angle (TCA). Thickness of different layers of retina and posterior choroid were also measured and compared before and during VM. IOP, blood pressure (BP), heart rate (HR), axial length, spherical equivalent refractive error and pupil diameter (PD) were also recorded and analysed. Results VM caused elevated IOP, systolic BP, diastolic BP and increased HR. There was a significant increase in anterior parameters including CBT0, CT4 and APCB (p<0.001), but not in TCA or PD (p>0.05). The mean change of CBT0, CT4 and APCB were: from 1.00±0.09 mm to 1.11±0.10 mm (p<0.001), from 0.29±0.04 mm to 0.36±0.05 mm (p<0.001), from 0.76±0.11 mm to 0.88±0.13 mm (p<0.001), respectively. However, there is no significant change in posterior choroid (from 215.74±60.23 µm to 214.82±61.32 µm, p=0.17). Conclusion We found that VM did not affect the posterior choroid, but it did cause thickening of the anterior choroid and the ciliary body, both of which led to a larger anterior placement of the ciliary body and a narrowed anterior chamber. The anterior (but not the posterior) choroid could be related to IOP elevation and a narrowed anterior chamber in primary angle closure diseases. PMID:28432110

The accessory parotid gland and facial process of the parotid gland on computed tomography

PubMed Central

Ahn, Dongbin; Yeo, Chang Ki; Han, Soon Yong

2017-01-01

The purpose of this study was to determine the incidence of an anterior extension of the parotid gland, such as an accessory parotid gland (APG) or facial process (FP) and to evaluate its characteristics on computed tomography (CT) scans. We reviewed CT scans of 1,600 parotid glands from 800 patients. An APG on CT was defined as a soft-tissue mass of the same density as the main parotid gland, located at the anterior part of the main parotid gland, and completely separate from the main parotid gland. An FP was defined as a lobe of the parotid gland protruding anteriorly over the anterior edge of the ramus of the mandible on CT and showing continuity with the main gland. The overall incidence rates and characteristics of APGs and FPs were evaluated according to age, sex, and side. The incidence rates of APGs and FPs were 10.2% (163/1,600) and 28.3% (452/1,600), respectively. The mean size of an APG was 15.8 mm × 5.0 mm and the mean distance from the main parotid gland was 10.5 mm. The FP reached anteriorly between the anterior edge of the mandibular ramus and the anterior border of the masseter muscle in 405 (89.6%) cases, while it extended over the anterior border of the masseter muscle in 47 (10.4%) cases. The incidence rates of APGs and FPs decreased and increased, respectively, with increasing age, showing significant linear correlations. However, the incidence of an anterior extension of the parotid gland (either an APG or an FP) was similar across all age groups. The present study showed that CT might be helpful in identifying anterior extensions of the parotid gland including APGs and FPs. The anatomical information gained from this study contributes to a better understanding of APGs and FPs and how their incidence changes with age. PMID:28915265

[Evaluation of the risk of mediastinal or retroperitoneal injuries caused by dorso-lumbar pedicle screws].

PubMed

Hernigou, P; Germany, W

1998-09-01

Within an anatomical and a clinical study, the authors employed computerized tomographic scans to evaluate the risks of anterior surrounding tissues injuries during screw insertion. CT scans of 20 patients suffering from cardiac disease were reviewed retrospectively. Scans through the thoracic and lumbar spine were obtained using 6 mm slice thickness. These examinations were performed with intravenous contrast medium. Measurements of vessel diameters and distance of the soft tissues situated directly anterior to the spine were done. A retrospective study of 61 pedicle screws implanted for spine fractures evaluated the penetration of the anterior vertebral cordex with X rays and CT scans. Computerized tomographic scans of the thoracic and lumbar spine of the 20 patients in the control group confirmed proximity of the posterior mediastinal structures to the anterior vertebral cortex. Many structures of the posterior mediastinum were within five millimeters of the anterior vertebral cortex and thus were at risk: aorta, azygos vein, vena cava, parietal pleura and lungs. The theoretical risk of unrecognized screw penetrations evaluated on geometric shape of the anterior vertebral body is as high as 21 per cent when screw position is only seen with an antero posterior and a lateral X Ray. In the other group, computerized tomographic scans showed that 30 per cent of the implanted screws were outside the boundaries of the anterior thoracic spine. Two orthogonal incidences do not enable determination of whether the extremity of the screw is slightly outside the anterior cortex of the vertebral body. However the geometric shape of the anterior vertebral body enables peroperative definition of a safety zone on two orthogonal incidences. Even if a breach of a few millimeters of the anterior cortical boundaries of the vertebral body may not initially damage the adjacent soft-tissue structures, chronic irritation may result in late damages of these structures. The use of metallic markers and the respect of a safe vertebral zone on X Rays could guide the choice of the appropriate screw length.

Three-dimensional finite element analysis of occipitocervical fixation using an anterior occiput-to-axis locking plate system: a pilot study.

PubMed

Cai, Xianhua; Yu, Yang; Liu, Zhichao; Zhang, Meichao; Huang, Weibing

2014-08-01

Although there are many techniques for occipitocervical fixation, there have been no reports regarding occipitocervical fixation via the use of an anterior anatomical locking plate system. The biomechanics of this new system were analyzed by a three-dimensional finite element to provide a theoretical basis for clinical application. This was a modeling study. We studied a 27-year-old healthy male volunteer in whom cervical disease was excluded via X-ray examination. The states of stress and strain of these two internal fixation devices were analyzed. A three-dimensional finite element model of normal occiput-C2 was established based on the anatomical data from a Chinese population. An unstable model of occipital-cervical region was established by subtracting several unit structures from the normal model. An anterior occiput-to-axis locking titanium plate system was then applied and an anterior occiput-to-axis screw fixation was performed on the unstable model. Limitation of motion was performed on the surface of the fixed model, and physiological loads were imposed on the surface of the skull base. Under various loads from different directions, the peak values of displacement of the anterior occiput-to-axis locking titanium plate system decreased 15.5%, 12.5%, 14.4%, and 23.7%, respectively, under the loads of flexion, extension, lateral bending, and axial rotation. Compared with the anterior occiput-to-axis screw fixation, the peak values of stress of the anterior occiput-to-axis locking titanium plate system also decreased 3.9%, 2.9%, 9.7%, and 7.2%, respectively, under the loads of flexion, extension, lateral bending, and axial rotation. The anterior occiput-to-axis locking titanium plate system proved superior to the anterior occiput-to-axis screw system both in the stress distribution and fixation stability based on finite element analysis. It provides a new clinical option for anterior occipitocervical fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

Single anterior portal: A better option for arthroscopic treatment of traumatic anterior shoulder instability?

PubMed

Çiçek, Hakan; Tuhanioğlu, Ümit; Oğur, Hasan Ulaş; Seyfettinoğlu, Fırat; Çiloğlu, Osman; Beyzadeoğlu, Tahsin

2017-07-01

The aim of this study was to compare single and double anterior portal techniques in the arthroscopic treatment of traumatic anterior shoulder instability. A total of 91 cases who underwent arthroscopic Bankart repair for anterior shoulder instability were reviewed. The patients were divided into 2 groups as Group 1 (47 male and 2 female; mean age: 25.8 ± 6.8) for arthroscopic single anterior portal approach and Group 2 (41 male and 1 female; mean age: 25.4 ± 6.6) for the classical anterior double portal approach. The groups were compared for clinical scores, range of motion, analgesia requirement, complications, duration of surgery, cost and learning curve according to a short questionnaire completed by the relevant healthcare professionals. No statistically significant difference was found between the 2 groups in terms of pre-operative and post-operative Constant and Rowe Shoulder Scores, range of motion and complications (p > 0.05). In Group 2 patients, the requirement for post-operative analgesics was significantly higher (p < 0.001), whereas the duration of surgery was statistically significantly shorter in Group 1 (p < 0.001). In the assessment of the questionnaire, it was seen that a single portal anterior approach was preferred at a higher ratio (p = 0.035). The cost analysis revealed that the cost was 5.7% less for patients with a single portal. In the arthroscopic treatment of traumatic anterior shoulder instability accompanied by a Bankart lesion, the anterior single portal technique is as successful in terms of clinical results as the conventional double portal approach. The single portal technique has advantages such as less postoperative pain, a shorter surgical learning curve and lower costs. Level III, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

OCT 3-D surface topography of isolated human crystalline lenses

PubMed Central

Sun, Mengchan; Birkenfeld, Judith; de Castro, Alberto; Ortiz, Sergio; Marcos, Susana

2014-01-01

Quantitative 3-D Optical Coherence Tomography was used to measure surface topography of 36 isolated human lenses, and to evaluate the relationship between anterior and posterior lens surface shape and their changes with age. All lens surfaces were fitted to 6th order Zernike polynomials. Astigmatism was the predominant surface aberration in anterior and posterior lens surfaces (accounting for ~55% and ~63% of the variance respectively), followed by spherical terms, coma, trefoil and tetrafoil. The amount of anterior and posterior surface astigmatism did not vary significantly with age. The relative angle between anterior and posterior surface astigmatism axes was on average 36.5 deg, tended to decrease with age, and was >45 deg in 36.1% lenses. The anterior surface RMS spherical term, RMS coma and 3rd order RMS decreased significantly with age. In general, there was a statistically significant correlation between the 3rd and 4th order terms of the anterior and posterior surfaces. Understanding the coordination of anterior and posterior lens surface geometries and their topographical changes with age sheds light into the role of the lens in the optical properties of the eye and the lens aging mechanism. PMID:25360371

OCT 3-D surface topography of isolated human crystalline lenses.

PubMed

Sun, Mengchan; Birkenfeld, Judith; de Castro, Alberto; Ortiz, Sergio; Marcos, Susana

2014-10-01

Quantitative 3-D Optical Coherence Tomography was used to measure surface topography of 36 isolated human lenses, and to evaluate the relationship between anterior and posterior lens surface shape and their changes with age. All lens surfaces were fitted to 6th order Zernike polynomials. Astigmatism was the predominant surface aberration in anterior and posterior lens surfaces (accounting for ~55% and ~63% of the variance respectively), followed by spherical terms, coma, trefoil and tetrafoil. The amount of anterior and posterior surface astigmatism did not vary significantly with age. The relative angle between anterior and posterior surface astigmatism axes was on average 36.5 deg, tended to decrease with age, and was >45 deg in 36.1% lenses. The anterior surface RMS spherical term, RMS coma and 3rd order RMS decreased significantly with age. In general, there was a statistically significant correlation between the 3rd and 4th order terms of the anterior and posterior surfaces. Understanding the coordination of anterior and posterior lens surface geometries and their topographical changes with age sheds light into the role of the lens in the optical properties of the eye and the lens aging mechanism.

Modulation of iTBS after-effects via concurrent directional TDCS: A proof of principle study.

PubMed

Tremblay, Sara; Hannah, Ricci; Rawji, Vishal; Rothwell, John C

Polarising currents can modulate membrane potentials in animals, affecting the after-effect of theta burst stimulation (TBS) on synaptic strength. We examined whether a similar phenomenon could also be observed in human motor cortex (M1) using transcranial direct current stimulation (TDCS) during monophasic intermittent TBS (iTBS). TDCS was applied during posterior-anterior iTBS using three different conditions: posterior-anterior TDCS (anode 3.5 cm posterior to M1, cathode 3.5 cm anterior to M1), anterior-posterior TDCS (cathode 3.5 cm posterior to M1, anode 3.5 cm anterior to M1), and sham TDCS. When the direction of TDCS (posterior-anterior) matched the direction of the electrical field induced by iTBS, we found a 19% non-significant increase in excitability changes in comparison with iTBS combined with sham TDCS. When the TDCS was reversed (anterior-posterior), the excitatory effect of iTBS was abolished. Our findings suggest that excitatory after-effects of iTBS can be modulated by directionally-specific TDCS. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Anterior hypopituitarism is rare and autoimmune disease is common in adults with idiopathic central diabetes insipidus.

PubMed

Hannon, M J; Orr, C; Moran, C; Behan, L A; Agha, A; Ball, S G; Thompson, C J

2012-05-01

Central diabetes insipidus is a rare clinical condition with a heterogenous aetiology. Up to 40% of cases are classified as idiopathic, although many of these are thought to have an autoimmune basis. Published data have suggested that anterior hypopituitarism is common in childhood-onset idiopathic diabetes insipidus. We aimed to assess the incidence of anterior hypopituitarism in a cohort of adult patients with idiopathic diabetes insipidus. We performed a retrospective review of the databases of two pituitary investigation units. This identified 39 patients with idiopathic diabetes insipidus. All had undergone magnetic resonance imaging scanning and dynamic pituitary testing (either insulin tolerance testing or GHRH/arginine and short synacthen testing) to assess anterior pituitary function. One patient had partial growth hormone deficiency; no other anterior pituitary hormonal deficits were found. Thirty-three percent had at least one autoimmune disease in addition to central diabetes insipidus. Our data suggest that anterior hypopituitarism is rare in adult idiopathic diabetes insipidus. Routine screening of these patients for anterior hypopituitarism may not, therefore, be indicated. The significant prevalence of autoimmune disease in this cohort supports the hypothesis that idiopathic diabetes insipidus may have an autoimmune aetiology. © 2012 Blackwell Publishing Ltd.

Unusual extraction treatment in Class II division 1 using C-orthodontic mini-implants.

PubMed

Chung, Kyu-Rhim; Cho, Jae-Hee; Kim, Seong-Hun; Kook, Yoon-Ah; Cozzani, Mauro

2007-01-01

This paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants(R) were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding.

Transoral Decompression and Anterior Stabilization of Atlantoaxial Joint in Patients with Basilar Impression and Chiari Malformation Type I: A Technical Report of 2 Clinical Cases.

PubMed

Shkarubo, Alexey N; Kuleshov, Alexander A; Chernov, Ilia V; Vetrile, Marchel S

2017-06-01

Presentation of clinical cases involving successful anterior stabilization of the C1-C2 segment in patients with invaginated C2 odontoid process and Chiari malformation type I. Clinical case description. Two patients with C2 odontoid processes invagination and Chiari malformation type I were surgically treated using the transoral approach. In both cases, anterior decompression of the upper cervical region was performed, followed by anterior stabilization of the C1-C2 segment. In 1 of the cases, this procedure was performed after posterior decompression, which led to transient regression of neurologic symptoms. In both cases, custom-made cervical plates were used for anterior stabilization of the C1-C2 segment. During the follow-up period of more than 2 years, a persistent regression of both the neurologic symptoms and Chiari malformation was observed. Anterior decompression followed by anterior stabilization of the C1-C2 segment is a novel and promising approach to treating Chiari malformation type I in association with C2 odontoid process invagination. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

PubMed Central

Machado, Daniella Borges; Brizon, Valéria Silva Cândido; Ambrosano, Gláucia Maria Bovi; Madureira, Davidson Fróis; Gomes, Viviane Elisângela; de Oliveira, Ana Cristina Borges

2014-01-01

INTRODUCTION: The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children. METHODS: A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance. RESULTS: The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03). CONCLUSION: There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite. PMID:25715723

Transient left septal fascicular block and left anterior fascicular block as a consequence of proximal subocclusion of the left anterior descending coronary artery.

PubMed

Pérez-Riera, Andrés Ricardo; Barbosa-Barros, Raimundo; Daminello-Raimundo, Rodrigo; de Abreu, Luiz Carlos; Nikus, Kjell

2018-04-19

The association of left anterior fascicular block (LAFB) with left septal fascicular block (LSFB) characterizes a left bifascicular block subtype rarely described in the literature, probably due to the fact that most researchers are not aware of the existence of the left septal fascicle. We describe a case with this transient intraventricular dromotropic disturbance due to left anterior descending coronary artery subocclusion. © 2018 Wiley Periodicals, Inc.

Use of overlapping buccal mucosa graft urethroplasty for complex anterior urethral strictures

PubMed Central

2015-01-01

Complex anterior urethral stricture disease typically manifests as a symptomatic, severely narrowed, long stricture (or multiple strictures) in which conventional excision and/or augmentation is not feasible. Overlapping buccal mucosal graft urethroplasty (OBMGU) is an innovative hybrid technique, combining the well-established principles of dorsal and ventral graft augmentation to allow single stage reconstruction of complex anterior urethral strictures. In this review, we discuss the rationale, techniques, and outcomes of OBMGU for complex anterior urethral strictures. PMID:26813234

Anterior capsule relaxing incisions with neodymium:YAG laser for patients at high-risk for anterior capsule contraction.

PubMed

Hayashi, Ken; Yoshida, Motoaki; Hirata, Akira; Hayashi, Hideyuki

2011-01-01

To examine the effect of anterior capsule relaxing incisions created with a neodymium:YAG (Nd:YAG) laser on prevention of anterior capsule contraction after cataract surgery in high-risk patients. Hayashi Eye Hospital, Fukuoka, Japan. Randomized masked clinical trials. Patients at high risk for anterior capsule contraction had anterior capsule relaxing incisions in either eye 3 days postoperatively. The anterior capsule opening was measured using a Scheimpflug videophotography system (EAS-1000) immediately and 1, 3, and 6 months after capsulotomy, and the percentage reduction in area was calculated. The degree of intraocular lens (IOL) decentration and tilt, posterior capsule opacification (PCO), and other complications were also assessed. Of the 84 patients included, 30 had primary angle closure, 28 had pseudoexfoliation, and 26 had diabetic retinopathy. There was no significant difference in the mean opening area between fellow eyes at baseline. In patients with primary angle closure, the area was significantly greater and the percentage reduction in area was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0428). In patients with pseudoexfoliation or diabetic retinopathy, the percentage reduction was significantly less in the capsulotomy group than in the no-capsulotomy group (P≤.0493), although there was no significant difference in area. No significant difference was found in IOL decentration or tilt, PCO, or incidence of other complications. Neodymium:YAG laser anterior capsule relaxing incisions in the early period after cataract surgery were effective in preventing anterior capsule contraction in high-risk patients and had no adverse effects. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Activation of the serratus anterior and upper trapezius in a population with winged and tipped scapulae during push-up-plus and diagonal shoulder-elevation.

PubMed

Park, Se-Yeon; Yoo, Won-Gyu

2015-01-01

Scapular winging and tipping are types of abnormal scapular kinematics, which is caused by not only the entrapment of peripheral nerve, but also imbalance of the scapulothoracic musculatures. The purpose of this study was to investigate the presence of muscular imbalance in the middle and lower parts of the serratus anterior and upper trapezius in people with scapular winging and tipping. Twenty male participants (age, 23.0 ± 1.92 y) were placed into symptomatic group (n = 10) and control group (n = 10). Participants completed two individual trials of a push-up plus, and a diagonal shoulder elevation, while electromyography (EMG) recorded muscle activity of the low and middle serratus anterior and upper trapezius. The root mean squared EMG values for three muscles were normalized using maximum voluntary isometric contractions (%MVIC). The value was calculated using modified isolation equation for comparing activation of middle and lower serratus anterior (%isolation). During a diagonal shoulder elevation, the % maximal voluntary isometric contraction (%MVIC) data showed that the symptomatic participants had significantly greater activation of the middle serratus anterior compared to the control group (P = 0.01). During a diagonal shoulder elevation, the symptomatic participants had not only significantly increased %isolation of the middle serratus anterior, but also significantly decreased for the lower serratus anterior compare with the control group (p = 0.00). Present result indicated that different muscle activation between middle and lower serratus anterior could represent in group with scapular dyskinesis, and need for selective activation of the lower serratus anterior in patients with scapular winging and tipping.

[Analysis of refractive status after cataract surgery in age-related cataract patients with shallow anterior chamber].

PubMed

Yang, Fei; Hou, Xianru; Wu, Huijuan; Bao, Yongzhen

2014-02-01

To evaluate the characteristics of postoperative refractive status in age-related cataract patients with shallow anterior chamber and the correlation between pre-operative anterior chamber depth and postoperative refractive status. Prospective case-control study. Sixty-eight cases (90 eyes) with age-related cataract were recruited from October 2010 to January 2012 in People's Hospital Peking University including 28 cases (34 eyes) in control group and 40 cases (56 eyes) in shallow anterior chamber group according to anterior chamber depth (ACD) measured by Pentacam system. Axial length and keratometer were measured by IOL Master and intraocular lens power was calculated using SRK/T formula. Postoperative refraction, ACD and comprehensive eye examination were performed at 1 month and 3 months after cataract surgery. Using SPSS13.0 software to establish a database, the two groups were compared with independent samples t-test and correlation analysis were performed with binary logical regression. The postoperative refractive deviation at 1 month were (-0.39 ± 0.62) D in control group and (+0.73 ± 0.26) D in shallow anterior chamber group respectively which present statistical significance between the two groups (P = 0.00, t = 3.67); the postoperative refractive deviation in 3 month was (-0.37 ± 0.62) D in control group and (+0.79 ± 0.28) D in shallow anterior chamber group operatively which present statistical significance between the two groups (P = 0.00, t = 3.33). In shallow anterior chamber group, with the shallower of ACD, the greater of refractive deviation (P = 0.00, r1 month = -0.57, r3 months = -0.61). Hyperopic shift existed in age-related cataract patients with shallow anterior chamber and the shallower of ACD was, the greater of hyperopic shift happened.

Sagittal alignment after lumbar interbody fusion: comparing anterior, lateral, and transforaminal approaches.

PubMed

Watkins, Robert G; Hanna, Robert; Chang, David; Watkins, Robert G

2014-07-01

Retrospective radiographic analysis. To determine which lumbar interbody technique is most effective for restoring lordosis, increasing disk height, and reducing spondylolisthesis. Lumbar interbody fusions are performed in hopes of increasing fusion potential, correcting deformity, and indirectly decompressing nerve roots. No published study has directly compared anterior, lateral, and transforaminal lumber interbody fusions in terms of ability to restore lordosis, increase disk height, and reduce spondylolisthesis. Lumbar interbody fusion techniques were retrospectively compared in terms of improvement of lordosis, disk height, and spondylolisthesis between preoperative and follow-up lateral radiographs. A total of 220 consecutive patients with 309 operative levels were compared by surgery type: anterior (184 levels), lateral (86 levels), and transforaminal (39 levels). Average follow-up was 19.2 months (range, 1-56 mo), with no statistical difference between the groups. Intragroup analysis showed that the anterior (4.5 degrees) and lateral (2.2 degrees) groups significantly improved lordosis from preoperative to follow-up, whereas the transforaminal (0.8 degrees) group did not. Intergroup analysis showed that the anterior group significantly improved lordosis more than both the lateral and transforaminal groups. The anterior (2.2 mm) and lateral (2.0 mm) groups both significantly improved disk height more than the transforaminal (0.5 mm) group. All 3 groups significantly reduced spondylolisthesis, with no difference between the groups. After lumbar interbody fusion, improvement of lordosis was significant for both the anterior and lateral groups, but not the transforaminal group. Intergroup analysis showed the anterior group had significantly improved lordosis compared to both the other groups. The anterior and lateral groups had significantly increased disk height compared to the transforaminal group. All the 3 groups significantly reduced spondylolisthesis, with no difference between the groups.

hmmr mediates anterior neural tube closure and morphogenesis in the frog Xenopus.

PubMed

Prager, Angela; Hagenlocher, Cathrin; Ott, Tim; Schambony, Alexandra; Feistel, Kerstin

2017-10-01

Development of the central nervous system requires orchestration of morphogenetic processes which drive elevation and apposition of the neural folds and their fusion into a neural tube. The newly formed tube gives rise to the brain in anterior regions and continues to develop into the spinal cord posteriorly. Conspicuous differences between the anterior and posterior neural tube become visible already during neural tube closure (NTC). Planar cell polarity (PCP)-mediated convergent extension (CE) movements are restricted to the posterior neural plate, i.e. hindbrain and spinal cord, where they propagate neural fold apposition. The lack of CE in the anterior neural plate correlates with a much slower mode of neural fold apposition anteriorly. The morphogenetic processes driving anterior NTC have not been addressed in detail. Here, we report a novel role for the breast cancer susceptibility gene and microtubule (MT) binding protein Hmmr (Hyaluronan-mediated motility receptor, RHAMM) in anterior neurulation and forebrain development in Xenopus laevis. Loss of hmmr function resulted in a lack of telencephalic hemisphere separation, arising from defective roof plate formation, which in turn was caused by impaired neural tissue narrowing. hmmr regulated polarization of neural cells, a function which was dependent on the MT binding domains. hmmr cooperated with the core PCP component vangl2 in regulating cell polarity and neural morphogenesis. Disrupted cell polarization and elongation in hmmr and vangl2 morphants prevented radial intercalation (RI), a cell behavior essential for neural morphogenesis. Our results pinpoint a novel role of hmmr in anterior neural development and support the notion that RI is a major driving force for anterior neurulation and forebrain morphogenesis. Copyright © 2017 Elsevier Inc. All rights reserved.

Opposite effects of dihydrotestosterone and estradiol on apoptosis in the anterior pituitary gland from male rats.

PubMed

Magri, María Laura; Gottardo, María Florencia; Zárate, Sandra; Eijo, Guadalupe; Ferraris, Jimena; Jaita, Gabriela; Ayala, Mariela Moreno; Candolfi, Marianela; Pisera, Daniel; Seilicovich, Adriana

2016-03-01

Hormones locally synthesized in the anterior pituitary gland are involved in regulation of pituitary cell renewal. In the pituitary, testosterone (T) may exert its actions per se or by conversion to dihydrotestosterone (DHT) or 17β-estradiol (E2) by 5α-reductase and aromatase activity, which are expressed in this gland. Previous reports from our laboratory showed that estrogens modulate apoptosis of lactotropes and somatotropes from female rats. Now, we examined the in vitro and in vivo effects of gonadal steroids on apoptosis of anterior pituitary cells from adult male rats. T in vitro did not modify apoptosis in anterior pituitary cells from gonadectomized (GNX) male rats. DHT, a non-aromatizable androgen, exerted direct antiapoptotic action on total anterior pituitary cells and folliculo-stellate cells, but not on lactotropes, somatotropes, or gonadotropes. On the contrary, E2 exerted a rapid apoptotic effect on total cells as well as on lactotropes and somatotropes. Incubation of anterior pituitary cells with T in presence of Finasteride, an inhibitor of 5α-reductase, increased the percentage of TUNEL-positive cells. In vivo administration of DHT to GNX rats reduced apoptosis in the anterior pituitary whereas E2 exerted proapoptotic action and reduced cells in G2/M-phase of the cell cycle. In summary, our results indicate that DHT and E2 have opposite effects on apoptosis in the anterior pituitary gland suggesting that local metabolization of T to these steroids could be involved in pituitary cell turnover in males. Changes in expression and/or activity of 5α-reductase and aromatase may play a role in the development of anterior pituitary tumors.

Prolapse repair with and without apical resuspension-Practice patterns among certifying American urologists.

PubMed

Liu, Joceline S; Nettey, Oluwarotimi; Vo, Amanda X; Hofer, Matthias D; Flury, Sarah C; Kielb, Stephanie J

2017-02-01

To examine surgeon characteristics in certifying urologists performing prolapse surgeries. Anterior compartment prolapse is often associated with apical prolapse, with high rates of recurrence when anterior repair is performed without apical resuspension. Six-month case log data of certifying urologists between 2003 and 2013 was obtained from the American Board of Urology (ABU). Cases with a CPT code for common prolapse repairs in females ≥18 years were analyzed. Among 2,588 urologists logging at least one prolapse surgery and a total of 30,983 surgeries, 320 (1.0% of all cases) uterosacral ligament suspension, 3,673 (11.9%) sacrospinous ligament suspension, and 2,618 (8.4%) abdominal sacrocolpopexy were identified. The remaining 14,585 cases were logged as anterior repair. 54.7% of anterior repairs did not include apical suspension. The proportion of anterior repairs without apical suspension has decreased from 77.7% in 2004 to 41.4% in 2012 (P < 0.001). Female subspecialists before 2011 performed anterior repair without apical suspension in 58.5%, versus 70.3% by all others. Since 2011 there has been a decrease in number of anterior repairs without apical suspension, notably in those applying for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) certification (17.1% vs. 30.7% by all other urologists, P < 0.001); nonacademically affiliated urologists are 2.1 times more likely to report anterior repair without apical suspension than academically affiliated colleagues (P < 0.001). The proportion of prolapse repairs reported as anterior repairs without apical suspension is decreasing, although it remains a substantial portion. Recent log year, FPMRS, and academic affiliation were associated with prolapse repairs addressing apical support. Neurourol. Urodynam. 36:344-348, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Conjugation of gold nanoparticles and recombinant human endostatin modulates vascular normalization via interruption of anterior gradient 2-mediated angiogenesis.

PubMed

Pan, Fan; Yang, Wende; Li, Wei; Yang, Xiao-Yan; Liu, Shuhao; Li, Xin; Zhao, Xiaoxu; Ding, Hui; Qin, Li; Pan, Yunlong

2017-07-01

Several studies have revealed the potential of normalizing tumor vessels in anti-angiogenic treatment. Recombinant human endostatin is an anti-angiogenic agent which has been applied in clinical tumor treatment. Our previous research indicated that gold nanoparticles could be a nanoparticle carrier for recombinant human endostatin delivery. The recombinant human endostatin-gold nanoparticle conjugates normalized vessels, which improved chemotherapy. However, the mechanism of recombinant human endostatin-gold nanoparticle-induced vascular normalization has not been explored. Anterior gradient 2 has been reported to be over-expressed in many malignant tumors and involved in tumor angiogenesis. To date, the precise efficacy of recombinant human endostatin-gold nanoparticles on anterior gradient 2-mediated angiogenesis or anterior gradient 2-related signaling cohort remained unknown. In this study, we aimed to explore whether recombinant human endostatin-gold nanoparticles could normalize vessels in metastatic colorectal cancer xenografts, and we further elucidated whether recombinant human endostatin-gold nanoparticles could interrupt anterior gradient 2-induced angiogenesis. In vivo, it was indicated that recombinant human endostatin-gold nanoparticles increased pericyte expression while inhibit vascular endothelial growth factor receptor 2 and anterior gradient 2 expression in metastatic colorectal cancer xenografts. In vitro, we uncovered that recombinant human endostatin-gold nanoparticles reduced cell migration and tube formation induced by anterior gradient 2 in human umbilical vein endothelial cells. Treatment with recombinant human endostatin-gold nanoparticles attenuated anterior gradient 2-mediated activation of MMP2, cMyc, VE-cadherin, phosphorylation of p38, and extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) in human umbilical vein endothelial cells. Our findings demonstrated recombinant human endostatin-gold nanoparticles might normalize vessels by interfering anterior gradient 2-mediated angiogenesis in metastatic colorectal cancer.

Zero-profile Anchored Spacer Reduces Rate of Dysphagia Compared With ACDF With Anterior Plating.

PubMed

Hofstetter, Christoph P; Kesavabhotla, Kartik; Boockvar, John A

2015-06-01

Retrospective cohort study. To study clinical and radiologic outcomes after anterior cervical discectomy and fusion (ACDF) using a zero-profile anchored spacer compared with a standard interposition graft with anterior plating. Anterior plating increases fusion rates in ACDF but is associated with higher rates of postoperative dysphagia. Reduction of plate thickness or zero-profile fixation of the interposition graft have been suggested to decrease the incidence of postoperative dysphagia. Retrospective cohort study of 70 consecutive patients of whom the first 35 patients underwent ACDF with anterior plating and the remaining patients received an LDR device. Patient demographics, operative details, neurological impairment, complications, and radiographic imaging were reviewed. Dysphagia occurring in the immediate postoperative period and lasting for >3 months was recorded. Both the zero-profile anchored spacer and a standard interposition graft with anterior plating resulted in improvement of neurological outcome at a mean follow-up time of 13.9 months. Fusion rates were found to be similar between ACDF with anterior plating (96.0%) and LDR (95.2%). Evaluation of postoperative radiographs revealed significantly more swelling of the prevertebral space (20.4±0.9 mm) after implantation of an anterior locking plate compared with a zero-profile device (15.6±0.7 mm, P<0.001). This difference remained significant at 6-month follow-up (P=0.035). Seven patients (20%) with ACDF and plating complained about swallowing difficulties beyond 3 months compared with only 1 patient with the LDR device (P=0.027). The severity of dysphagia was mild in all but 2 patients. Both patients with moderate and severe swallowing difficulties had undergone ACDF with anterior plating. Zero-profile anchored spacers lead to similar clinical and radiographic outcomes compared with ACDF with plating and may carry a lower risk of postoperative dysphagia.

Anterior Cruciate Ligament Biomechanics During Robotic and Mechanical Simulations of Physiologic and Clinical Motion Tasks: A Systematic Review and Meta-Analysis

PubMed Central

Bates, Nathaniel A.; Myer, Gregory D.; Shearn, Jason T.; Hewett, Timothy E.

2014-01-01

Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

[Distortion of the anterior airway anatomy and cervical spine motion during laryngoscopy with GlideScope videolaryngoscope: a comparison of mid-size blade vs large blade].

PubMed

Otsuka, Yoji; Hirabayashi, Yoshihiro; Fujita, Akifumi; Sugimoto, Hideharu; Seo, Norimasa

2011-03-01

GlideScope videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL. Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy with both mid-size and large GVLs. During each laryngoscopy, a radiograph for the lateral view of the head and neck was taken when the best view of the larynx was obtained. Based on the radiographs, independent radiologists evaluated anterior airway movement and cervical spine movement. The tip of the mid-size GVL was anteriorly positioned during laryngoscopy, compared with large GVL. The distance between epiglottis and posterior laryngeal wall was longer with the mid-size GVL than with the large GVL. Both the mid-size and large GVL caused a significant anterior movement in the cervical spine during laryngoscope. The difference in the movement in the atlas and C2 was small, but statistically significant. No difference was found in the anterior movement with C3 and C4. During laryngoscopy, cervical spinal extension occurred with both GVLs, while there was no difference in the cervical spinal extension between the mid-size and large GVL. The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.

Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract.

PubMed

Huang, Guofu; Gonzalez, Eduardo; Lee, Roland; Chen, Yi-Chun; He, Mingguang; Lin, Shan C

2012-01-01

To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. University of California, San Francisco, California, USA. Case series. Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027). Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Expected Prevalence From the Differential Diagnosis of Anterior Knee Pain in Adolescent Female Athletes During Preparticipation Screening

PubMed Central

Barber Foss, Kim D.; Myer, Gregory D.; Chen, Stephen S.; Hewett, Timothy E.

2012-01-01

Context Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined. Objective To determine the prevalence of specific patellofemoral disorders obtained using the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening. Design Descriptive epidemiology study. Setting Preparticipation screening evaluations at a county public school district in Kentucky. Patients or Other Participants A total of 419 unique middle and high school–aged female athletes. Main Outcome Measure(s) Participants were evaluated by physicians for anterior knee pain over 3 consecutive basketball seasons. Given the longitudinal nature of this study, some participants were tested longitudinally over multiple years. Results Over the course of 3 basketball seasons, 688 patient evaluations were performed. Of these, 183 (26.6%) were positive for anterior knee pain. A statistically significant difference was noted in the prevalence of anterior knee pain by school level, with 34.4% (n = 67) in high school–aged athletes versus 23.5% (n = 116) in middle school–aged athletes (P < .05). In the 1376 knees evaluated, patellofemoral dysfunction was the most common diagnosis, with an overall prevalence of 7.3% (n = 100). The only diagnosis shown to be statistically different between age levels was Sinding-Larsen-Johansson disease or patellar tendinopathy, with 38 cases (9.7%) in high school–aged and 31 (3.1%) in middle school–aged athletes (P < .05). Conclusions Anterior knee pain was present in 26.6% of the adolescent female athletes screened over 3 years. Symptoms of anterior knee pain likely persist after middle school–aged onset and reach peak prevalence during the high school years. PMID:23068589

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

PubMed

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

2017-09-01

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

The zinc finger gene Xblimp1 controls anterior endomesodermal cell fate in Spemann's organizer.

PubMed Central

de Souza, F S; Gawantka, V; Gómez, A P; Delius, H; Ang, S L; Niehrs, C

1999-01-01

The anterior endomesoderm of the early Xenopus gastrula is a part of Spemann's organizer and is important for head induction. Here we describe Xblimp1, which encodes a zinc finger transcriptional repressor expressed in the anterior endomesoderm. Xblimp1 represses trunk mesoderm and induces anterior endomesoderm in a cooperative manner with the pan-endodermal gene Mix.1. Furthermore, Xblimp1 can cooperate with the BMP inhibitor chordin to induce ectopic heads, while a dominant-negative Xblimp1 inhibits head formation. The head inducer cerberus is positively regulated by Xblimp1 and is able to rescue microcephalic embryos caused by dominant-negative Xblimp1. Our results indicate that Xblimp1 is required for anterior endomesodermal cell fate and head induction. PMID:10545117

The effects of Helicobacter pylori infection on intraocular pressure in anterior uveitis

PubMed Central

Kim, J M; Park, K H; Choi, M J; Ha, M M; Sohn, Y H; Kim, H K; Caprioli, J

2012-01-01

Purpose We investigated the influence of H. pylori infection on intraocular pressure (IOP) in anterior uveitis patients to clarify whether H. pylori infection is related to high IOP in anterior uveitis. Methods In this prospective study, 165 Korean anterior uveitis patients were examined. All patients underwent serological analysis to identify the cause of uveitis, including the presence of H. pylori infection by enzyme-linked immunosorbent assay. Serological values were compared between patients with and without high IOP. Results Seropositivity for H. pylori was 69.70% of patients with high IOP and 38.38% of patients with normal IOP (P<0.01). Conclusion This study suggests that H. pylori infection is associated with high IOP in anterior uveitis. PMID:23154495

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

PubMed

Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

2013-12-01

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. Copyright © 2013 Elsevier Ltd. All rights reserved.

Permissive and instructive anterior patterning rely on mRNA localization in the wasp embryo.

PubMed

Brent, Ava E; Yucel, Gozde; Small, Stephen; Desplan, Claude

2007-03-30

The long-germ mode of embryogenesis, in which segments arise simultaneously along the anteriorposterior axis, has evolved several times in different lineages of the holometabolous, or fully metamorphosing, insects. Drosophila's long-germ fate map is established largely by the activity of the dipteran-specific Bicoid (Bcd) morphogen gradient, which operates both instructively and permissively to accomplish anterior patterning. By contrast, all nondipteran long-germ insects must achieve anterior patterning independently of bcd. We show that bcd's permissive function is mimicked in the wasp by a maternal repression system in which anterior localization of the wasp ortholog of giant represses anterior expression of the trunk gap genes so that head and thorax can properly form.

Automatic anterior chamber angle assessment for HD-OCT images.

PubMed

Tian, Jing; Marziliano, Pina; Baskaran, Mani; Wong, Hong-Tym; Aung, Tin

2011-11-01

Angle-closure glaucoma is a major blinding eye disease and could be detected by measuring the anterior chamber angle in the human eyes. High-definition OCT (Cirrus HD-OCT) is an emerging noninvasive, high-speed, and high-resolution imaging modality for the anterior segment of the eye. Here, we propose a novel algorithm which automatically detects a new landmark, Schwalbe's line, and measures the anterior chamber angle in the HD-OCT images. The distortion caused by refraction is corrected by dewarping the HD-OCT images, and three biometric measurements are defined to quantitatively assess the anterior chamber angle. The proposed algorithm was tested on 40 HD-OCT images of the eye and provided accurate measurements in about 1 second.

Role of fusiform and anterior temporal cortical areas in facial recognition.

PubMed

Nasr, Shahin; Tootell, Roger B H

2012-11-15

Recent fMRI studies suggest that cortical face processing extends well beyond the fusiform face area (FFA), including unspecified portions of the anterior temporal lobe. However, the exact location of such anterior temporal region(s), and their role during active face recognition, remain unclear. Here we demonstrate that (in addition to FFA) a small bilateral site in the anterior tip of the collateral sulcus ('AT'; the anterior temporal face patch) is selectively activated during recognition of faces but not houses (a non-face object). In contrast to the psychophysical prediction that inverted and contrast reversed faces are processed like other non-face objects, both FFA and AT (but not other visual areas) were also activated during recognition of inverted and contrast reversed faces. However, response accuracy was better correlated to recognition-driven activity in AT, compared to FFA. These data support a segregated, hierarchical model of face recognition processing, extending to the anterior temporal cortex. Copyright © 2012 Elsevier Inc. All rights reserved.

Activation of anterior paralimbic structures during guilt-related script-driven imagery.

PubMed

Shin, L M; Dougherty, D D; Orr, S P; Pitman, R K; Lasko, M; Macklin, M L; Alpert, N M; Fischman, A J; Rauch, S L

2000-07-01

Several recent neuroimaging studies have examined the neuroanatomical correlates of normal emotional states, such as happiness, sadness, fear, anger, anxiety, and disgust; however, no previous study has examined the emotional state of guilt. In the current study, we used positron emission tomography and the script-driven imagery paradigm to study regional cerebral blood flow (rCBF) during the transient emotional experience of guilt in eight healthy male participants. In the Guilt condition, participants recalled and imagined participating in a personal event involving the most guilt they had ever experienced. In the Neutral condition, participants recalled and imagined participating in an emotionally neutral personal event. In the Guilt versus Neutral comparison, rCBF increases occurred in anterior paralimbic regions of the brain: bilateral anterior temporal poles, anterior cingulate gyrus, and left anterior insular cortex/inferior frontal gyrus. These results, along with those of previous studies, are consistent with the notion that anterior paralimbic regions of the brain mediate negative emotional states in healthy individuals.

Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.

PubMed

Barbier, Johan; Gabriëls, Loes; van Laere, Koen; Nuttin, Bart

2011-09-01

State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD. A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up. This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.

Role of Fusiform and Anterior Temporal Cortical Areas in Facial Recognition

PubMed Central

Nasr, Shahin; Tootell, Roger BH

2012-01-01

Recent FMRI studies suggest that cortical face processing extends well beyond the fusiform face area (FFA), including unspecified portions of the anterior temporal lobe. However, the exact location of such anterior temporal region(s), and their role during active face recognition, remain unclear. Here we demonstrate that (in addition to FFA) a small bilateral site in the anterior tip of the collateral sulcus (‘AT’; the anterior temporal face patch) is selectively activated during recognition of faces but not houses (a non-face object). In contrast to the psychophysical prediction that inverted and contrast reversed faces are processed like other non-face objects, both FFA and AT (but not other visual areas) were also activated during recognition of inverted and contrast reversed faces. However, response accuracy was better correlated to recognition-driven activity in AT, compared to FFA. These data support a segregated, hierarchical model of face recognition processing, extending to the anterior temporal cortex. PMID:23034518

ZBTB20 is required for anterior pituitary development and lactotrope specification.

PubMed

Cao, Dongmei; Ma, Xianhua; Cai, Jiao; Luan, Jing; Liu, An-Jun; Yang, Rui; Cao, Yi; Zhu, Xiaotong; Zhang, Hai; Chen, Yu-Xia; Shi, Yuguang; Shi, Guang-Xia; Zou, Dajin; Cao, Xuetao; Grusby, Michael J; Xie, Zhifang; Zhang, Weiping J

2016-04-15

The anterior pituitary harbours five distinct hormone-producing cell types, and their cellular differentiation is a highly regulated and coordinated process. Here we show that ZBTB20 is essential for anterior pituitary development and lactotrope specification in mice. In anterior pituitary, ZBTB20 is highly expressed by all the mature endocrine cell types, and to some less extent by somatolactotropes, the precursors of prolactin (PRL)-producing lactotropes. Disruption of Zbtb20 leads to anterior pituitary hypoplasia, hypopituitary dwarfism and a complete loss of mature lactotropes. In ZBTB20-null mice, although lactotrope lineage commitment is normally initiated, somatolactotropes exhibit profound defects in lineage specification and expansion. Furthermore, endogenous ZBTB20 protein binds to Prl promoter, and its knockdown decreases PRL expression and secretion in a lactotrope cell line MMQ. In addition, ZBTB20 overexpression enhances the transcriptional activity of Prl promoter in vitro. In conclusion, our findings point to ZBTB20 as a critical regulator of anterior pituitary development and lactotrope specification.

ZBTB20 is required for anterior pituitary development and lactotrope specification

PubMed Central

Cao, Dongmei; Ma, Xianhua; Cai, Jiao; Luan, Jing; Liu, An-Jun; Yang, Rui; Cao, Yi; Zhu, Xiaotong; Zhang, Hai; Chen, Yu-Xia; Shi, Yuguang; Shi, Guang-Xia; Zou, Dajin; Cao, Xuetao; Grusby, Michael J.; Xie, Zhifang; Zhang, Weiping J.

2016-01-01

The anterior pituitary harbours five distinct hormone-producing cell types, and their cellular differentiation is a highly regulated and coordinated process. Here we show that ZBTB20 is essential for anterior pituitary development and lactotrope specification in mice. In anterior pituitary, ZBTB20 is highly expressed by all the mature endocrine cell types, and to some less extent by somatolactotropes, the precursors of prolactin (PRL)-producing lactotropes. Disruption of Zbtb20 leads to anterior pituitary hypoplasia, hypopituitary dwarfism and a complete loss of mature lactotropes. In ZBTB20-null mice, although lactotrope lineage commitment is normally initiated, somatolactotropes exhibit profound defects in lineage specification and expansion. Furthermore, endogenous ZBTB20 protein binds to Prl promoter, and its knockdown decreases PRL expression and secretion in a lactotrope cell line MMQ. In addition, ZBTB20 overexpression enhances the transcriptional activity of Prl promoter in vitro. In conclusion, our findings point to ZBTB20 as a critical regulator of anterior pituitary development and lactotrope specification. PMID:27079169

"A Tale of Two Planes": Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome.

PubMed

Piracha, Mohammad M; Thorp, Stephen L; Puttanniah, Vinay; Gulati, Amitabh

Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS. Four patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients' outcomes was obtained through postprocedure interviews. Three of the patients previously had a superficial serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB. We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.

The transmission of stress to grafted bone inside a titanium mesh cage used in anterior column reconstruction after total spondylectomy: a finite-element analysis.

PubMed

Akamaru, Tomoyuki; Kawahara, Norio; Sakamoto, Jiro; Yoshida, Akira; Murakami, Hideki; Hato, Taizo; Awamori, Serina; Oda, Juhachi; Tomita, Katsuro

2005-12-15

A finite-element study of posterior alone or anterior/posterior combined instrumentation following total spondylectomy and replacement with a titanium mesh cage used as an anterior strut. To compare the effect of posterior instrumentation versus anterior/posterior instrumentation on transmission of the stress to grafted bone inside a titanium mesh cage following total spondylectomy. The most recent reconstruction techniques following total spondylectomy for malignant spinal tumor include a titanium mesh cage filled with autologous bone as an anterior strut. The need for additional anterior instrumentation with posterior pedicle screws and rods is controversial. Transmission of the mechanical stress to grafted bone inside a titanium mesh cage is important for fusion and remodeling. To our knowledge, there are no published reports comparing the load-sharing properties of the different reconstruction methods following total spondylectomy. A 3-dimensional finite-element model of the reconstructed spine (T10-L4) following total spondylectomy at T12 was constructed. A Harms titanium mesh cage (DePuy Spine, Raynham, MA) was positioned as an anterior replacement, and 3 types of the reconstruction methods were compared: (1) multilevel posterior instrumentation (MPI) (i.e., posterior pedicle screws and rods at T10-L2 without anterior instrumentation); (2) MPI with anterior instrumentation (MPAI) (i.e., MPAI [Kaneda SR; DePuy Spine] at T11-L1); and (3) short posterior and anterior instrumentation (SPAI) (i.e., posterior pedicle screws and rods with anterior instrumentation at T11-L1). The mechanical energy stress distribution exerted inside the titanium mesh cage was evaluated and compared by finite-element analysis for the 3 different reconstruction methods. Simulated forces were applied to give axial compression, flexion, extension, and lateral bending. In flexion mode, the energy stress distribution in MPI was higher than 3.0 x 10 MPa in 73.0% of the total volume inside the titanium mesh cage, while 38.0% in MPAI, and 43.3% in SPAI. In axial compression and extension modes, there were no remarkable differences for each reconstruction method. In left-bending mode, there was little stress energy in the cancellous bone inside the titanium mesh cage in MPAI and SPAI. This experiment shows that from the viewpoint of stress shielding, the reconstruction method, using additional anterior instrumentation with posterior pedicle screws (MPAI and SPAI), stress shields the cancellous bone inside the titanium mesh cage to a higher degree than does the system using posterior pedicle screw fixation alone (MPI). Thus, a reconstruction method with no anterior fixation should be better at allowing stress for remodeling of the bone graft inside the titanium mesh cage.

Anticipatory effects on anterior cruciate ligament loading during sidestep cutting.

PubMed

Weinhandl, Joshua T; Earl-Boehm, Jennifer E; Ebersole, Kyle T; Huddleston, Wendy E; Armstrong, Brian S R; O'Connor, Kristian M

2013-07-01

A key to understanding potential anterior cruciate ligament injury mechanisms is to determine joint loading characteristics associated with an injury-causing event. However, direct measurement of anterior cruciate ligament loading during athletic tasks is invasive. Thus, previous research has been unable to study the association between neuromuscular variables and anterior cruciate ligament loading. Therefore, the purpose of this study was to determine the influence of movement anticipation on anterior cruciate ligament loading using a musculoskeletal modeling approach. Twenty healthy recreationally active females were recruited to perform anticipated and unanticipated sidestep cutting. Three-dimensional kinematics and kinetics of the right leg were calculated. Muscle, joint and anterior cruciate ligament forces were then estimated using a musculoskeletal model. Dependent t-tests were conducted to investigate differences between the two cutting conditions. ACL loading significantly increased during unanticipated sidestep cutting (p<0.05). This increase was primarily due to a significant increase in the sagittal plane ACL loading, which contributed 62% of the total loading. Frontal plane ACL loading contributed 26% and transverse plane ACL loading contributed 12%. These results suggest that anterior cruciate ligament loading resulted from a multifaceted interaction of the sagittal plane shear forces (i.e., quadriceps, hamstrings, and tibiofemoral), as well as the frontal and transverse plane knee moments. Additionally, the results of this study confirm the hypothesis in the current literature that unanticipated movements such as sidestep cutting increase anterior cruciate ligament loading. Copyright © 2013 Elsevier Ltd. All rights reserved.

Totally implanted ports: the trapezius approach in practice.

PubMed

Hill, Steve

Implanted ports (IPs) are an essential device for many patients who require long-term vascular access. IPs offer some advantages over other central venous access devices, such as lifestyle, body image benefits and lower infection rates. A typical implantation site for a port is the anterior chest wall. For some patients with breast cancer who have metastatic chest wall disease this site may lead to problems with the function of the device if disease spreads to the port site. One option for this patient group is to place the implanted port over the trapezius muscle. This article discusses six patients, all of whom had metastatic breast cancer with some degree of subcutaneous disease on the anterior chest wall. Three patients had received trapezius port placements and three had anterior chest wall placements. A retrospective review of the patients' medical records was undertaken from the time of insertion until removal or until the patient died. The anterior chest wall group of patients had their devices in for an average of 368 days vs 214 in the trapezius group. The total complications were higher in the anterior chest wall group (7 vs 2 in the trapezius group). Disease spread to two of the devices in the anterior chest wall group meaning the devices could no longer be used. The trapezius approach appears to be a safe and a reliable form of vascular access and may offer fewer complications than the traditional method of anterior chest wall placement when standard anterior chest wall approach is not suitable.

Effect of the Mitral Valve's Anterior Leaflet on Axisymmetry of Transmitral Vortex Ring.

PubMed

Falahatpisheh, Ahmad; Pahlevan, Niema M; Kheradvar, Arash

2015-10-01

The shape and formation of transmitral vortex ring are shown to be associated with diastolic function of the left ventricle (LV). Transmitral vortex ring is a flow feature that is observed to be non-axisymmetric in a healthy heart and its inherent asymmetry in the LV assists in efficient ejection of the blood during systole. This study is a first step towards understanding the effects of the mitral valve's anterior leaflet on transmitral flow. We experimentally study a single-leaflet model of the mitral valve to investigate the effect of the anterior leaflet on the axisymmetry of the generated vortex ring based on the three-dimensional data acquired using defocusing digital particle image velocimetry. Vortex rings form downstream of a D-shaped orifice in presence or absence of the anterior leaflet in various physiological stroke ratios. The results of the statistical analysis indicate that the formed vortex ring downstream of a D-shaped orifice is markedly non-axisymmetric, and presence of the anterior leaflet improves the ring's axisymmetry. This study suggests that the improvement of axisymmetry in presence of the anterior leaflet might be due to coupled dynamic interaction between rolling-up of the shear layer at the edges of the D-shaped orifice and the borders of the anterior leaflet. This interaction can reduce the non-uniformity in vorticity generation, which results in more axisymmetric behavior compared to the D-shaped orifice without the anterior leaflet.

Botulinum toxin-induced acute anterior uveitis in a patient with Behçet's disease under infliximab treatment: a case report.

PubMed

Sasajima, Hirofumi; Yagi, Syunsuke; Osada, Hiromu; Zako, Masahiro

2017-05-04

Injections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe an unusual case in which acute anterior uveitis was dramatically activated subsequent to botulinum toxin injection in a patient with Behçet's disease but the acute anterior uveitis was satisfactorily attenuated by infliximab. A 53-year-old Japanese man had normal ocular findings at his regularly scheduled appointment. He had been diagnosed as having incomplete-type Behçet's disease 11 years before. Three years after the diagnosis he was given systemic infusions of 5 mg/kg infliximab every 8 weeks and he had not experienced a uveitis attack for 8 years with no treatment other than infliximab. Two days after the eye examination, he received intracutaneous botulinum toxin injections to treat axillary hyperhidrosis on both sides. Three hours after the injections, he noted rapidly increasing floaters in his right eye. Four days after the injections, his right eye showed severe acute anterior uveitis with deteriorated aqueous flare and anterior vitreous opacity. He received his scheduled infliximab injection, and the right acute anterior uveitis immediately attenuated. Botulinum toxin may have clinical effects similar to those of lipopolysaccharide in endotoxin-induced uveitis models. To the best of our knowledge, this is the first report to suggest that botulinum toxin may trigger acute anterior uveitis, although the precise mechanism is still unclear.

[The recovery study of excising the different range of dog's anterior commissure by semiconductor laser].

PubMed

Sun, Guangbin; Tang, Haihong; Fang, Qin; Liang, Gengtian; Xu, Limin; Huang, Yideng

2008-05-01

To explore the effective method to treat the glottic carcinoma invading the anterior commissure, we observed the difference of three kinds of operation to the anterior commissure of dogs by semiconductor laser. Twelve dogs were divided into 3 groups at random, A: to cauterize to the thyroid cartilage's inner membrane of the anterior commissure, the right ventricular bands and vocal cord, the anterior and 1/3 of the left vocal cord; B: to cauterize part of the thyroid cartilage of the anterior commissure besides A; C: to open a window about 5 mm x 5 mm on the thyroid cartilage of the anterior commissure besides B. To take photos to observe the dogs' laryngeal wound with digital camera or electrolaryngoscope immediately, 1 week and 4 weeks, then to record the hoarseness, body weight and complications etc. All the dogs' laser surgery were completed successfully. To observe the gross specimen, it was identical between the extent of excising and the design preoperation. One week later, the neonatal membrane covered the wound incomplete. Edematization, inflammatory reaction, pseudomembrane and the hoarseness were not heavy too. No obvious complication in group A. The neonatal membrane covered the wound incomplete. Edema, inflammatory reaction, pseudomembrane and granulation can be seen in group B. Exudation was heavy in local, erosion and infected, the hoarseness was severe. No other obvious complications in C. Different extent of adhesion could be seen at the anterior commissure in group A, B and C after 4 weeks, the laryngeal web formed, and the length of vocal cord was shorter than before. The color and luster of anterior commissure membrane was normal basically, the inflammatory reaction was not heavy in A and B groups. The anterior commissural membrane appeared the dark red chronic inflammatory reaction; the window was closed by neonatal membrane completely and had no infection in group C. To observe the gross specimen: the wound of anterior commissure was covered by prosthetic epithelia completely in three groups. The window was closed by complete membrane at the anterior commissure. The No. 1- 3 dog's conditions of hoarseness in three groups after 4 weeks: slight in A group, little severe in B and C group. The change of weight was not obvious at the pre or postoperative in group A and B. No obvious complication happened in each group postoperation. The three operative methods have satisfied effects,the recovery of wound can cure well finally and no severe complications happened. It is valuable in clinic.

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

PubMed

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

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

Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: a new concept in composite layering--Part I.

PubMed

Manauta, J; Salat, A; Putignano, A; Devoto, W; Paolone, G; Hardan, L S

2014-06-01

Restoring an anterior tooth has always been a challenge, regarding the shade matching, the choice of colors, opacities, translucencies of our composites and the final anatomical outcome. This article proposes a new method for color matching and a clinical stratification using a simple and reproducible procedure for anterior restorations. The physical and optical characteristics of enamel and dentine will be studied and applied to our dental materials that we are using to restore anterior teeth.

Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis.

PubMed

Bele, Keerthiraj; Pendharkar, Hima Shriniwas; Venkat, Easwer; Gupta, Arun Kumar

2011-12-01

Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease.

PubMed

Panchal, Anita H; Patel, Vasumati G; Bhavsar, Neeta V; Mehta, Hardik V

2013-05-01

This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

PubMed

Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

2017-01-01

This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

The natural history of the anterior knee instability by stress radiography

PubMed Central

de Rezende, Márcia Uchôa; Hernandez, Arnaldo José; Camanho, Gilberto Luis

2014-01-01

OBJECTIVE: To analyze the anteroposterior displacement of the knee by means of stress radiography in individuals with unilateral anterior knee instability and relate to time of instability. METHODS: Sixty individuals with intact knees (control group) and 125 patients with unilateral anterior instability (AI group) agreed to participate in the study. Gender, age, weight, height, age at injury, time between injury and testing, and surgical findings are studied. Both groups are submitted to anterior and posterior stress radiographies of both knees. Anterior (ADD) and posterior displacement difference (PDD) were calculated between sides. RESULTS: In the control group ADD and PDD are in average, zero, whereas in the AI group ADD averaged 9.8mm and PDD, 1.92mm. Gender, age, weight, height, age at trauma and presence of menisci's lesions do not intervene in the values of ADD and PDD. Meniscal injuries increase with time. ADD and PDD do not relate with the presence or absence of associated menisci's lesions. The ADD and the PDD are related to each other and increase with time. CONCLUSION: There is a permanent anterior subluxation of the injured knee that is related to the amount of anterior displacement that increases with time. Level of Evidence III, Study Types Case-control study. PMID:25246846

Is tibialis anterior tendon transfer effective for recurrent clubfoot?

PubMed

Gray, Kelly; Burns, Joshua; Little, David; Bellemore, Michael; Gibbons, Paul

2014-02-01

Tibialis anterior tendon transfer surgery forms a part of Ponseti management for children with congenital talipes equinovarus who, after initial correction, present with residual dynamic supination. Although retrospective studies support good outcomes, prospective longitudinal studies in this population are lacking. We assessed strength, plantar loading, ROM, foot alignment, function, satisfaction, and quality of life in patients with clubfoot that recurred after Ponseti casting who met indications for tibialis anterior tendon transfer surgery, and compared them with a group of patients with clubfoot treated with casting but whose deformity did not recur (therefore who were not indicated for tibialis anterior tendon transfer surgery). Twenty children with idiopathic congenital talipes equinovarus indicated for tibialis anterior tendon transfer surgery were recruited. Assessment at baseline (before surgery), and 3, 6, and 12 months (after surgery) included strength (hand-held dynamometry), plantar loading (capacitance transducer matrix platform), ROM (Dimeglio scale), foot alignment (Foot Posture Index(©)), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire™). Outcomes were compared with those of 12 age-matched children with congenital talipes equinovarus not indicated for tibialis anterior tendon transfer surgery. Followup was 100% in the control group and 95% (19 of 20) in the tibialis anterior transfer group. At baseline, the tibialis anterior tendon transfer group had a significantly worse eversion-to-inversion strength ratio, plantar loading, ROM, foot alignment, and function and satisfaction. At 3 months after surgery, eversion-to-inversion strength, plantar loading, and function and satisfaction were no longer different between groups. Improvements were maintained at 12 months after surgery (eversion-to-inversion strength mean difference, 8% body weight; 95% CI, -26% to 11%; p = 0.412; plantar loading, p > 0.251; function and satisfaction, p = 0.076). ROM remained less and foot alignment more supinated in the tibialis anterior tendon transfer group between baseline and followup (p < 0.001, p < 0.001). Tibialis anterior tendon transfer surgery was an effective procedure, which at 12-month followup restored the balance of eversion-to-inversion strength and resulted in plantar loading and function and satisfaction outcomes similar to those of age-matched children with congenital talipes equinovarus who after Ponseti casting were not indicated for tibialis anterior tendon transfer.

Gadolinium-enhanced 7.0 T magnetic resonance imaging assessment of the aqueous inflow in rat eyes in vivo.

PubMed

Li, Lu; Yuan, Yuxiang; Chen, Liwen; Li, Mu; Ji, Pingting; Gong, Jieling; Zhao, Yin; Zhang, Hong

2017-09-01

The goal of this study was to calculate the anterior chamber volume and assess aqueous inflow in rat eyes in vivo, under anesthetic condition. Gadolinium-contrast agent (Gd-DTPA, 234.5 mg/ml) was administered to Sprague-Dawley rat eyes via anterior chamber injection or instillation of 234.5 or 117.25 mg/ml Gd-DTPA in 0.2% azone as eye drops, and changes of Gd signal visualized by 7.0 T magnetic resonance imaging (MRI). The safety of local application of Gd-DTPA and azone were performed after MRI scanning. The anterior chamber injection of Gd-DTPA (234.5 mg/ml) group was used for anterior chamber volume and aqueous inflow calculating. Serial changes in Gd-DTPA relative concentration in the anterior chamber was determined based on the initial Gd signal gray values and the initial relative concentration of Gd-DTPA after anterior chamber Gd-DTPA injection. The mean aqueous inflow in rat eyes in vivo was assessed based on changes in Gd-DTPA relative concentration and the anterior chamber volume. Eye drops of Gd-DTPA (234.5 mg/ml) in 0.2% azone readily allowed safe assessment of the aqueous inflow by 7.0 T MRI. Under anesthetic condition in vivo, the mean anterior chamber volume (ACV) in rats was 8493.6 ± 657.4 μm 3 , no differences were observed in the aqueous inflow measured by topical instillation of 234.5 mg/ml Gd-DTPA in 0.2% azone (0.182 ± 0.011 μl/min) between that measured by anterior chamber injection (0.165 ± 0.041 μl/min, P > 0.05), Timolol reduced aqueous inflow to 0.124 ± 0.020 μl/min (P < 0.05). Our results indicated that Gd-enhanced 7.0 T MRI allows evaluation of the Gd signal variation and anterior chamber volume in rats in vivo. The aqueous inflow calculation via non-invasive local application of 234.5 mg/ml Gd-DTPA can be assessed by the variability of relative concentration of Gd-DTPA in anterior chamber and ACV in vivo, under anesthetic condition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Global rotation has high sensitivity in ACL lesions within stress MRI.

PubMed

Espregueira-Mendes, João; Andrade, Renato; Leal, Ana; Pereira, Hélder; Skaf, Abdala; Rodrigues-Gomes, Sérgio; Oliveira, J Miguel; Reis, Rui L; Pereira, Rogério

2017-10-01

This study aims to objectively compare side-to-side differences of P-A laxity alone and coupled with rotatory laxity within magnetic resonance imaging, in patients with total anterior cruciate ligament (ACL) rupture. This prospective study enrolled sixty-one patients with signs and symptoms of unilateral total anterior cruciate ligament rupture, which were referred to magnetic resonance evaluation with simultaneous instrumented laxity measurements. Sixteen of those patients were randomly selected to also have the contralateral healthy knee laxity profile tested. Images were acquired for the medial and lateral tibial plateaus without pressure, with postero-anterior translation, and postero-anterior translation coupled with maximum internal and external rotation, respectively. All parameters measured were significantly different between healthy and injured knees (P < 0.05), with exception of lateral plateau without stress. The difference between injured and healthy knees for medial and lateral tibial plateaus anterior displacement (P < 0.05) and rotation (P < 0.001) was statistically significant. It was found a significant correlation between the global rotation of the lateral tibial plateau (lateral plateau with internal + external rotation) with pivot-shift, and between the anterior global translation of both tibial plateaus (medial + lateral tibial plateau) with Lachman. The anterior global translation of both tibial plateaus was the most specific test with a cut-off point of 11.1 mm (93.8 %), and the global rotation of the lateral tibial plateau was the most sensitive test with a correspondent cut-off point of 15.1 mm (92.9 %). Objective laxity quantification of ACL-injured knees showed increased sagittal laxity, and simultaneously in sagittal and transversal planes, when compared to their healthy contralateral knee. Moreover, when measuring instability from anterior cruciate ligament ruptures, the anterior global translation of both tibial plateaus and global rotation of the lateral tibial plateau add diagnostic specificity and sensitivity. This work strengthens the evidence that the anterior cruciate ligament plays an important biomechanical role in controlling the anterior translation, but also both internal and external rotation. The high sensitivity and specificity of this device in objectively identifying and measuring the multiplanar instability clearly guides stability restoration clinical procedures. Level of evidence Cross-sectional study, Level III.

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

PubMed Central

Marieswaran, M.; Jain, Ishita; Garg, Bhavuk; Sharma, Vijay

2018-01-01

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work. PMID:29861784

Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

PubMed Central

Sim, Jae Ang; Gadikota, Hemanth R.; Li, Jing-Sheng; Li, Guoan; Gill, Thomas J.

2013-01-01

Background Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design Controlled laboratory study. Hypothesis Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation (P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations (P <.05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation (P > .05) at 0° of flexion but could not do so at 30° of flexion (P <.05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques (P <.05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique. PMID:21908717

Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.

PubMed

Sharif, Dawod; Abu-Salem, Mira; Sharif-Rasslan, Amal; Rosenschein, Uri

2017-10-01

Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes. The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function. A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of <200 K, 200-300 K, 300-400 K and >400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed. Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts <200 K had higher peak diastolic left anterior descending coronary artery velocity both early and late after primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P<0.05). Patients with platelet counts >400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, P<0.01. Patients with anterior STEMI treated by primary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery-descending coronary artery velocity deceleration time >600 ms. Patients with higher platelet counts had lower left ventricular systolic function both at admission and before discharge.

Simulated type II superior labral anterior posterior lesions do not alter the path of glenohumeral articulation: a cadaveric biomechanical study.

PubMed

Youm, Thomas; Tibone, James E; ElAttrache, Neal S; McGarry, Michelle H; Lee, Thay Q

2008-04-01

Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. Controlled laboratory study. Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30 degrees, 60 degrees, 90 degrees, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. A subtle but significant increase in external rotation (2.7 degrees) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair.

Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament.

PubMed

Rue, John-Paul H; Ghodadra, Neil; Bach, Bernard R

2008-01-01

There is controversy regarding the necessity of reconstructing both the posterolateral and anteromedial bundles of the anterior cruciate ligament. A laterally oriented transtibial drilled femoral tunnel replaces portions of the femoral footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Descriptive laboratory study. Footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament were preserved on 7 matched pairs (5 female, 2 male) of fresh-frozen human cadaveric femurs (14 femurs total). Each femur was anatomically oriented and secured in a custom size-appropriate, side-matched replica tibia model to simulate transtibial retrograde drilling of a 10-mm femoral tunnel in each specimen. The relationship of the tunnel relative to footprints of both bundles of the anterior cruciate ligament was recorded using a Microscribe MX digitizer. The angle of the femoral tunnel relative to the vertical 12-o'clock position was recorded for all 14 specimens; only 10 specimens were used for footprint measurements. On average, the 10-mm femoral tunnel overlapped 50% of the anteromedial bundle (range, 2%-83%) and 51% of the posterolateral bundle (range, 16%-97%). The footprint of the anteromedial bundle occupied 32% (range, 3%-49%) of the area of the tunnel; the footprint of the posterolateral bundle contributed 26% (range, 7%-41%). The remainder of the area of the 10-mm tunnel did not overlap with the anterior cruciate ligament footprint. The mean absolute angle of the femoral tunnel as measured directly on the specimen was 48 degrees (range, 42 degrees-53 degrees) from vertical, corresponding to approximately a 10:30 clock face position on a right knee. Anterior cruciate ligament reconstruction using a laterally oriented transtibial drilled femoral tunnel incorporates portions of the anteromedial and posterolateral bundle origins of the native anterior cruciate ligament. A laterally oriented transtibial drilled femoral tunnel placed at the 10:30 position (1:30 for left knees) reconstructs portions of the anteromedial and posterolateral bundles of the anterior cruciate ligament.

Anxiety sensitivity correlates with two indices of right anterior insula structure in specific animal phobia.

PubMed

Rosso, Isabelle M; Makris, Nikos; Britton, Jennifer C; Price, Lauren M; Gold, Andrea L; Zai, David; Bruyere, John; Deckersbach, Thilo; Killgore, William D S; Rauch, Scott L

2010-12-01

Anxiety sensitivity (AS) is a dispositional trait involving fear of anxiety-related symptoms. Functional imaging research suggests that the activity of the anterior insular cortex, particularly the right insula, may both mediate AS and play a role in the pathophysiology of phobias. However, no imaging studies have examined whether AS relates to insula morphology. We examined whether AS was significantly correlated with right anterior insula volume and thickness among adults with specific animal phobia (SAP) and healthy comparison (HC) subjects. Nineteen adults with SAP and 20 demographically group-matched HC subjects underwent magnetic resonance imaging at 3 Tesla. Subjects also completed the Anxiety Sensitivity Index (ASI). Regression and correlation analyses examined ASI scores in relation to anterior and posterior insular cortex volume and thickness within and across subject groups. SAP subjects had significantly higher ASI scores than HC, but did not differ in terms of insula volumes or thickness. ASI scores predicted right anterior insula thickness in SAP but not HC subjects, and right anterior insula volume in the sample as a whole. Correlations of ASI scores with the anterior and posterior insula volume and thickness were not significant in either group. These findings suggest that the right anterior insular cortex size is a neural substrate of AS within specific phobia, rather than an independent diagnostic marker of the disorder. Future investigations should examine whether heightened AS represents a shared intermediate phenotype across anxiety disorders, manifesting functionally as increased insular reactivity and clinically as a fear of anxiety symptoms. © 2010 Wiley-Liss, Inc.

Correct Patterning of the Primitive Streak Requires the Anterior Visceral Endoderm

PubMed Central

Stuckey, Daniel W.; Di Gregorio, Aida; Clements, Melanie; Rodriguez, Tristan A.

2011-01-01

Anterior-posterior axis specification in the mouse requires signalling from a specialised extra-embryonic tissue called the anterior visceral endoderm (AVE). AVE precursors are induced at the distal tip of the embryo and move to the prospective anterior. Embryological and genetic analysis has demonstrated that the AVE is required for anterior patterning and for correctly positioning the site of primitive streak formation by inhibiting Nodal activity. We have carried out a genetic ablation of the Hex-expressing cells of the AVE (Hex-AVE) by knocking the Diphtheria toxin subunit A into the Hex locus in an inducible manner. Using this model we have identified that, in addition to its requirement in the anterior of the embryo, the Hex-AVE sub-population has a novel role between 5.5 and 6.5dpc in patterning the primitive streak. Embryos lacking the Hex-AVE display delayed initiation of primitive streak formation and miss-patterning of the anterior primitive streak. We demonstrate that in the absence of the Hex-AVE the restriction of Bmp2 expression to the proximal visceral endoderm is also defective and expression of Wnt3 and Nodal is not correctly restricted to the posterior epiblast. These results, coupled with the observation that reducing Nodal signalling in Hex-AVE ablated embryos increases the frequency of phenotypes observed, suggests that these primitive streak patterning defects are due to defective Nodal signalling. Together, our experiments demonstrate that the AVE is not only required for anterior patterning, but also that specific sub-populations of this tissue are required to pattern the posterior of the embryo. PMID:21445260

Phakic iris-fixated intraocular lens placement in the anterior chamber: effects on aqueous flow.

PubMed

Repetto, Rodolfo; Pralits, Jan O; Siggers, Jennifer H; Soleri, Paolo

2015-05-01

Phakic intraocular lenses (pIOLs) are used for correcting vision; in this paper we investigate the fluid dynamical effects of an iris-fixated lens in the anterior chamber. In particular, we focus on changes in the wall shear stress (WSS) on the cornea and iris, which could be responsible for endothelial and pigment cell loss, respectively, and also on the possible increase of the intraocular pressure, which is known to correlate with the incidence of secondary glaucoma. We use a mathematical model to study fluid flow in the anterior chamber in the presence of a pIOL. The governing equations are solved numerically using the open source software OpenFOAM. We use an idealized standard geometry for the anterior chamber and a realistic geometric description of the pIOL. We consider separately the main mechanisms that produce fluid flow in the anterior chamber. The numerical simulations allow us to obtain a detailed description of the velocity and pressure distribution in the anterior chamber, and indicated that implantation of the pIOL significantly modifies the fluid dynamics in the anterior chamber. However, lens implantation has negligible influence on the intraocular pressure and does not produce a significant increase of the shear stress on the cornea, while the shear stress on the iris, although increased, is not enough to cause detachment of cells. We conclude that alterations in the fluid dynamics in the anterior chamber as a result of lens implantation are unlikely to be the cause of medical complications associated with its use.

Management for the anterior combined with posterior urethral stricture: a 9-year single centre experience

PubMed Central

Deng, Tuo; Liao, Banghua; Luo, Deyi; Liu, Bing; Wang, Kunjie; Liu, Jiaming; Jin, Tao

2015-01-01

Objective: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. Patients and methods: 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. Results: The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. Conclusions: The management for anterior combined with posterior urethral stricture following our standard process is effective and safe. PMID:26064293

Anxiety sensitivity correlates with two indices of right anterior insula structure in specific animal phobia

PubMed Central

Rosso, Isabelle M.; Makris, Nikos; Britton, Jennifer C.; Price, Lauren M.; Gold, Andrea L.; Zai, David; Bruyere, John; Deckersbach, Thilo; Killgore, William D. S.; Rauch, Scott L.

2010-01-01

Background Anxiety sensitivity (AS) is a dispositional trait involving fear of anxiety-related symptoms. Functional imaging research suggests that activity of the anterior insular cortex, particularly the right insula, may both mediate AS and play a role in the pathophysiology of phobias. However, no imaging studies have examined whether AS relates to insula morphology. We examined whether AS was significantly correlated with right anterior insula volume and thickness among adults with specific animal phobia (SAP) and healthy comparison (HC) subjects. Methods Nineteen adults with SAP and 20 demographically group-matched HC subjects underwent magnetic resonance imaging (MRI) at 3 Tesla. Subjects also completed the Anxiety Sensitivity Index (ASI). Regression and correlation analyses examined ASI scores in relation to anterior and posterior insular cortex volume and thickness within and across subject groups. Results SAP subjects had significantly higher ASI scores than HC, but did not differ in terms of insula volumes or thickness. ASI scores predicted right anterior insula thickness in SAP but not HC subjects, and right anterior insula volume in the sample as a whole. Correlations of ASI scores with left anterior and posterior insula volume and thickness were not significant in either group. Conclusions These findings suggest that right anterior insular cortex size is a neural substrate of AS within specific phobia, rather than an independent diagnostic marker of the disorder. Future investigations should examine whether heightened AS represents a shared intermediate phenotype across anxiety disorders, manifesting functionally as increased insular reactivity and clinically as a fear of anxiety symptoms. PMID:21132846

Partitioning an Artificial Anterior Chamber With a Latex Diaphragm to Simulate Anterior and Posterior Segment Pressure Dynamics: The "DMEK Practice Stage," Where Surgeons Can Rehearse the "DMEK Dance".

PubMed

Sáles, Christopher S; Straiko, Michael D; Fernandez, Ana Alzaga; Odell, Kelly; Dye, Philip K; Tran, Khoa D

2018-02-01

To present a novel apparatus for simulating the anterior and posterior segment pressure dynamics involved in executing Descemet membrane endothelial keratoplasty (DMEK) surgery when using a chamber-shallowing technique. An artificial anterior chamber (AAC), 18-mm trephine, latex glove, two 3-mL syringes, and one donor cornea comprising an intact corneoscleral cap from which a DMEK tissue was peeled and punched are required for the model. After making the corneal incisions with the corneoscleral cap mounted on the AAC in the usual fashion, the corneoscleral cap is remounted onto the dried AAC over an 18-mm latex diaphragm. The space between the latex diaphragm and the cornea is filled with saline to pressurize the anterior chamber, and the posterior segment is pressurized with air from a syringe. The resulting apparatus comprises a posterior segment and anterior chamber that exert pressure on each other by way of a distensible latex diaphragm. A novice and experienced DMEK surgeon and 2 eye bank technicians were able to assemble the apparatus and perform the routine steps of a DMEK procedure, including maneuvers that require shallowing the anterior chamber and lowering its pressure. Only one cornea was required per apparatus. We present a novel in vitro model of the human eye that more closely mimics the anterior and posterior segment pressure dynamics of in vivo DMEK surgery than average human and animal cadaveric globes. The model is easy to assemble, inexpensive, and applicable to a range of teaching environments.

The anterior borders of the clavicle and the acromion are not always aligned in the intact acromioclavicular joint: a cadaveric study.

PubMed

Barth, Johannes; Boutsiadis, Achilleas; Narbona, Pablo; Lädermann, Alexandre; Arrigoni, Paolo; Adams, Christopher R; Burkhart, Stephen S; Denard, Patrick J

2017-07-01

The aim of this study was to find reliable anatomic landmarks of the normal acromioclavicular joint (ACJ) that could enable the precise evaluation of the horizontal displacement of the clavicle after dislocation. The hypothesis was that the anterior borders of the acromion and the clavicle are always aligned in intact ACJs. In 30 cadaveric specimens, the anterior and posterior borders of the ACJ's articular facets and the most prominent anterior and posterior bony landmarks of the acromion and the clavicle were identified. The anterior and posterior overhang of the acromion and the clavicle was measured in relation to the borders of the articular facets. Therefore, the possible anterior and posterior alignment of the ACJ was evaluated. Anteriorly, only 18 ACJs (60%) were aligned whereas 7 (24%) had major overhang of the acromion and 3 (10%) had major overhang of the clavicle. Similarly, 18 cases (60%) were posteriorly aligned, whereas 6 (20%) had major clavicular overhang and 4 (14%) had major overhang of the acromion. In 78% of these cases, the ACJ was aligned as well anteriorly as posteriorly (P < .001). Finally, the larger the width of the acromion (P = .032) or the clavicle (P = .049), the better the posterior joint alignment. Our hypothesis was not verified. The acromion and clavicle are not perfectly aligned in a significant number of specimens with intact ACJs (40% of cases). The most reliable landmarks remain their articular facets. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Hidden (end-on) patent ductus arteriosus: recognition and device closure.

PubMed

Garg, Naveen; Madan, Bevunahalli Kantharaj

2016-02-01

Sometimes, it is difficult to visualize a patent ductus arteriosus and deploy a device in the standard lateral view because of an end-on orientation. The right anterior oblique view may be helpful by separating the ductus arteriosus from the aorta. This study was undertaken to evaluate the incidence of end-on patent ductus arteriosus and the utility of the right anterior oblique view during device closure. Aortography was performed in lateral and right anterior oblique views before, during, and after successful device deployment in 117 consecutive patients. When a ductus arteriosus was not clearly visible in the lateral view due to overlapping by the aorta, it was termed "right anterior oblique view useful". The types of patent ductus arteriosus were A, B, C, and E in 86 (73.5%), 20 (17.1%), 4 (3.4%), and 7 (6.0%) patients, respectively. An end-on ductus arteriosus was present in 24 (20.5%) patients (14 type B, 10 type A). The right anterior oblique view was useful during device closure in 15 (12.8%) cases (all end-on type). Among all cases of end-on patent ductus arteriosus, it was useful in 62.5% (most type B and a few type A). In all of these, the device appeared obliquely oriented and foreshortened in the lateral view but fully profiled in the right anterior oblique view. Recognizing an end-on patent ductus arteriosus and utilizing the right anterior oblique view simplified device closure. For ducts well-profiled in the lateral view, the right anterior oblique view is unnecessary and avoidable. © The Author(s) 2016.

Biometric Factors Associated With Acute Primary Angle Closure: Comparison of the Affected and Fellow Eye.

PubMed

Atalay, Eray; Nongpiur, Monisha E; Baskaran, Mani; Sharma, Sourabh; Perera, Shamira A; Aung, Tin

2016-10-01

To compare ocular biometric and anterior segment parameters between the affected and fellow eye in subjects with acute primary angle closure (APAC). We evaluated 76 subjects with unilateral APAC who had undergone bilateral laser peripheral iridotomy before enrollment. Imaging was done using anterior segment optical coherence tomography and a customized software was used to measure the following: angle opening distance (AOD750); trabecular-iris space area (TISA750); iris thickness (IT750); iris curvature (ICURV); iris area (IAREA); anterior chamber depth; area and volume (ACD; ACA and ACV); anterior chamber width (ACW); anterior vault (ACD+LV); lens vault (LV); and pupil diameter (PD). We used A-scan ultrasonography to measure axial length (AL) and lens thickness (LT). Mean differences in ocular biometric and anterior segment parameters were assessed using linear mixed model adjusting for PD. A total of 53 subjects (36 females, 67.9%) with a mean age of 62.7 ± 8.1 years were analyzed after excluding 17 unanalyzable images in at least one eye. Affected eyes had shallower ACD, smaller ACA, ACV, anterior vault, TISA750, AOD750, and ICURV (all P < 0.05). Axial length, ACW, LV, LT, IAREA, and IT750 did not differ between the eyes. In the affected eyes, IT750 was significantly associated AOD750 (P < 0.05); whereas in the fellow eyes, IT750 and AL was predictive of AOD750 (all P < 0.05). Eyes with previous APAC had smaller anterior segment dimensions when compared with their fellow eyes. Iris thickness was the strongest predictor of angle width in both affected and fellow eyes.

Anterior cervical spine surgery-associated complications in a retrospective case-control study.

PubMed

Tasiou, Anastasia; Giannis, Theofanis; Brotis, Alexandros G; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N

2017-09-01

Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

Changes in Swallowing after Anterior Cervical Discectomy and Fusion with Instrumentation: A Presurgical versus Postsurgical Videofluoroscopic Comparison

ERIC Educational Resources Information Center

Muss, Lydia; Wilmskoetter, Janina; Richter, Kerstin; Fix, Constanze; Stanschus, Soenke; Pitzen, Tobias; Drumm, Joerg; Molfenter, Sonja

2017-01-01

Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and…

Evaluation of Anterior Segment Parameters in Obesity

PubMed Central

Uzun, Feyzahan; Karaca, Emine Esra; Kalaycı, Mustafa

2015-01-01

Purpose To investigate anterior segment parameters in obese patients in comparison to healthy individuals. Methods Thirty-four obese subjects and 34 age-sex-matched healthy subjects were enrolled in this prospective cross-sectional study. Ophthalmological examinations including intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and axial length (AL) measurements were performed on each subject. Height and weight of all subjects were recorded and body mass index (BMI) was calculated. Results IOP was significantly higher in the obese group (p = 0.003). The mean ACD in obese subjects was significantly lower than that in control subjects (p = 0.036). AL, ACV, ACA and CCT were not significantly different between the groups. There was a positive correlation between BMI and IOP (r = 0.404, p < 0.001). ACD and ACA were negatively correlated with BMI. Conclusions IOP was significantly higher and ACD was significantly lower in obese subjects. AL, ACV, ACA and CCT were not significantly different between the groups. The impact of obesity on anterior chamber parameters should be further investigated. PMID:26240505

Femtosecond laser-assisted cataract surgery in Alport syndrome with anterior lenticonus.

PubMed

Ecsedy, Mónika; Súndor, Gúbor L; Takúcs, Úgnes I; Krúnitz, Kinga; Kiss, Zoltún; Kolev, Krasimir; Nagy, Zoltún Z

2015-01-01

To report the surgical treatment of 3 eyes of 2 patients with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS). Two patients with Alport syndrome presented to our department due to anterior lenticonus in both eyes. We performed FLACS with posterior chamber lens implantation in both eyes of one patient and in one eye of the other patient. Anterior segment morphologic changes were visualized with a Scheimpflug camera, and anterior segment optical coherence tomography preoperatively and 3 months after surgery. Ultrastructure of the cut capsule edges was observed with scanning electron microscopy and compared to the edge of femtosecond laser capsulotomy performed on an otherwise healthy patient with cataract (control). The intraocular lens (IOL) postoperative positioning parameters met the international requirements of aspherical and wavefront customized IOLs (tilt <10 degree, decentration <800 µm). Scanning electron microscopy revealed the same characteristics of the cut capsule edges in the Alport and in the control eyes. Femtosecond laser cataract surgery can be a safe and successful method for optical rehabilitation of anterior lenticonus in patients with Alport syndrome.

Role of estrogens in anterior pituitary gland remodeling during the estrous cycle.

PubMed

Zárate, S; Zaldivar, V; Jaita, G; Magri, L; Radl, D; Pisera, D; Seilicovich, A

2010-01-01

In this review, we analyze the action of estrogens leading to the remodeling of the anterior pituitary gland, especially during the estrous cycle. Proliferation and death of anterior pituitary cells and especially lactotropes is regulated by estrogens, which act by sensitizing these cells to both mitotic and apoptotic stimuli such as TNF-alpha, FasL and dopamine. During the estrous cycle, the changing pattern of gonadal steroids is thought to modulate both cell proliferation and death in the anterior pituitary gland, estrogens being key players in cell turnover. The mechanisms involved in estrogen-modulated cell renewal in the anterior pituitary gland during the estrous cycle could include an increase in the expression of proapoptotic cytokines as well as the increase in the Bax/Bcl-2 ratio at proestrus, when estrogen levels are highest and a peak of apoptosis, in particular of lactotropes, is evident in this gland. Estrogens exert rapid antimitogenic and proapoptotic actions in the anterior pituitary through membrane-associated estrogen receptors, a mechanism that might also be involved in remodeling of this gland during the estrous cycle. Copyright (c) 2010 S. Karger AG, Basel.

Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction.

PubMed

Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

2015-12-01

[Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used to detect the muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus before and after neuromuscular training. [Results] There was significant relaxation in tibial anterior displacement of the affected and sound sides in the supine position before neuromuscular training. Furthermore, the difference in the tibial anterior displacement of the affected knee joints in the standing position was reduced after neuromuscular training. Moreover, the variation of the muscle activation evoked higher muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus. [Conclusion] Neuromuscular training may improve functional joint stability in patients with orthopedic musculoskeletal injuries in the postoperative period.

Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

PubMed Central

Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

2015-01-01

[Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used to detect the muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus before and after neuromuscular training. [Results] There was significant relaxation in tibial anterior displacement of the affected and sound sides in the supine position before neuromuscular training. Furthermore, the difference in the tibial anterior displacement of the affected knee joints in the standing position was reduced after neuromuscular training. Moreover, the variation of the muscle activation evoked higher muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus. [Conclusion] Neuromuscular training may improve functional joint stability in patients with orthopedic musculoskeletal injuries in the postoperative period. PMID:26834316

HLA-B27 Anterior Uveitis: Immunology and Immunopathology.

PubMed

Wakefield, Denis; Yates, William; Amjadi, Shahriar; McCluskey, Peter

2016-08-01

Acute anterior uveitis (AAU) is the commonest type of uveitis and HLA-B27 AAU is the most frequently recognized type of acute anterior uveitis and anterior uveitis overall. Recent evidence indicates that acute anterior uveitis is a heterogenous disease, is polygenic and is frequently associated with the spondyloarthropathies (SpA). Studies of patients with AAU and animal models of disease indicate a role for innate immunity, the IL-23 cytokine pathway and exogenous factors, in the pathogenesis of both SpA and acute anterior uveitis. Recently described genetic associations cluster around immunologic pathways, including the IL-17 and IL-23 pathways, antigen processing and presentation, and lymphocyte development and activation. Patients with ankylosing spondylitis (AS) and AAU share other genetic markers, such as ERAP-1, which show strong evidence of gene-gene interaction and point to new mechanisms of disease pathogenesis. These observations have major implications for understanding the pathogenesis of HLA-B27 diseases, such as AAU, and may lead to the development of more specific therapy for AAU. Received 6 January 2016; revised 6 February 2016; accepted 18 February 2016; published online 31 May 2016.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

PubMed Central

Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra’Kerry K.; Isaacs, Robert E.; Smith, Justin S.; Shaffrey, Christopher; Thompson, Sara E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

2017-01-01

Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients’ charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. Results: The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Conclusions: Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality. PMID:28451488

Is running away right? The behavioral activation-behavioral inhibition model of anterior asymmetry.

PubMed

Wacker, Jan; Chavanon, Mira-Lynn; Leue, Anja; Stemmler, Gerhard

2008-04-01

The measurement of anterior electroencephalograph (EEG) asymmetries has become an important standard paradigm for the investigation of affective states and traits. Findings in this area are typically interpreted within the motivational direction model, which suggests a lateralization of approach and withdrawal motivational systems to the left and right anterior region, respectively. However, efforts to compare this widely adopted model with an alternative account-which relates the left anterior region to behavioral activation independent of the direction of behavior (approach or withdrawal) and the right anterior region to goal conflict-induced behavioral inhibition-are rare and inconclusive. Therefore, the authors measured the EEG in a sample of 93 young men during emotional imagery designed to provide a critical test between the 2 models. The results (e.g., a correlation between left anterior activation and withdrawal motivation) favor the alternative model on the basis of the concepts of behavioral activation and behavioral inhibition. In addition, the present study also supports an association of right parietal activation with physiological arousal and the conceptualization of parietal EEG asymmetry as a mediator of emotion-related physiological arousal. (Copyright) 2008 APA.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

PubMed

Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

Characterization of postsynaptic calcium signals in the pyramidal neurons of anterior cingulate cortex

PubMed Central

Li, Xu-Hui; Song, Qian; Chen, Tao; Zhuo, Min

2017-01-01

Calcium signaling is critical for synaptic transmission and plasticity. N-methyl-D-aspartic acid (NMDA) receptors play a key role in synaptic potentiation in the anterior cingulate cortex. Most previous studies of calcium signaling focus on hippocampal neurons, little is known about the activity-induced calcium signals in the anterior cingulate cortex. In the present study, we show that NMDA receptor-mediated postsynaptic calcium signals induced by different synaptic stimulation in anterior cingulate cortex pyramidal neurons. Single and multi-action potentials evoked significant suprathreshold Ca2+ increases in somas and spines. Both NMDA receptors and voltage-gated calcium channels contributed to this increase. Postsynaptic Ca2+signals were induced by puff-application of glutamate, and a NMDA receptor antagonist AP5 blocked these signals in both somas and spines. Finally, long-term potentiation inducing protocols triggered postsynaptic Ca2+ influx, and these influx were NMDA receptor dependent. Our results provide the first study of calcium signals in the anterior cingulate cortex and demonstrate that NMDA receptors play important roles in postsynaptic calcium signals in anterior cingulate cortex pyramidal neurons. PMID:28726541

Evidence from tooth surface morphology for a posterior maxillary origin of the proteroglyph gang

USGS Publications Warehouse

Jackson, K.; Fritts, T.H.

1995-01-01

Although the front-fanged venom delivery system of the Elapidae is believed to be derived from an aglyphous or opisthoglyphous colubroid ancestor, opinion is divided as to the end of the maxilla on which the proteroglyph fang originated. This study was undertaken to determine whether the evolutionary precursor of the proteroglyph fang was (a) a grooved posterior fang which migrated anteriorly, or (b) an enlarged anterior tooth which secondarily developed a groove for the conduction of venom. The surface morphology of the maxillary teeth of colubrid genera was examined using scanning electron microscopy. Ridges present on the lingual and labial surfaces of anterior maxillary teeth and on the anterior and posterior surfaces of posterior maxillary teeth were identified as morphological markers of potential value in distinguishing the anterior and posterior maxillary teeth of colubrid snakes, and in determining the origin of the proteroglyph fang. Patterns of ridges on the surfaces of elapid fangs examined were found to be consistent with the hypothesis that the evolutionary precursor of the proteroglyph fang was an opisthoglyph fang which migrated anteriorly.

A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

PubMed Central

Atsumi, Satoru; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2016-01-01

Avulsion fracture of the anterior tibial eminence is an uncommon injury. If bone union does not occur, knee extension will be limited by impingement of the avulsed fragment and knee instability will be induced by dysfunction of the anterior cruciate ligament (ACL). This report describes a 55-year-old woman who experienced an avulsion fracture of the right anterior tibial eminence during recreational skiing. Sixteen months later, she presented at our hospital with limitation of right knee extension. Plain radiography showed nonunion of the avulsion fracture region, and arthroscopy showed that the avulsed fragment impinged the femoral intercondylar notch during knee extension. The anterior region of the bony fragment was debrided arthroscopically until the knee could be extended completely. There was no subsequent instability, and the patient was able to climb a mountain 6 months after surgery. These findings indicate that arthroscopic debridement of an avulsed fragment for nonunion of an avulsion fracture of the anterior tibial eminence is a minimally invasive and effective treatment for middle-aged and elderly patients with a low level of sports activity. PMID:27119035

Anterior fracture dislocation of the sacroiliac joint: A case report and literature review.

PubMed

Xiao, Jianlin; Wang, Yang; Zhang, Minglei; Jiang, Rui; Zhu, Tongtong; Liu, Guangyao; Zuo, Jianlin

2017-08-09

Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks' gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.

Arthroscopic Anterior and Posterior Labral Repair After Traumatic Hip Dislocation: Case Report and Review of the Literature

PubMed Central

Shindle, Michael K.; Kelly, Bryan T.

2010-01-01

With the improvements in flexible instrumentation, hip arthroscopy is being increasingly used to treat a variety of hip pathology, including labral tears. However, up to this point, there has not been a case report of an anterior and a posterior labral tear successfully repaired arthroscopically. We present a case report of a 27-year-old male firefighter who presented to our institution with an anterior and posterior labral tear, as well as a cam lesion and loose body, following a traumatic hip dislocation. The purpose of this case report is to illustrate that both anterior and posterior labral tears can be repaired using hip arthroscopy. Anterior and posterior labral tears can be caused by a traumatic hip dislocation, and both can be successfully repaired using arthroscopic techniques. PMID:21886540

[Esthetic analysis on immediate single-tooth implant restoration in anterior maxilla].

PubMed

Li, Shao-wei; Wang, Guo-shi; Sha, Yan-zhi

2015-10-01

To evaluate the esthetic outcomes of immediate single-tooth implant restoration in anterior maxilla with the pink esthetic score (PES). Nine patients were treated with 9 Straumann implants by immediate single-tooth implant restoration in anterior maxilla. Assessment of PES after crown placement at 1 week (baseline) and 6 months after implantation was conducted. Statistical analysis was performed using SPSS 16.0 software package. Nine implants achieved a retention rate of 100%. PES for single-tooth implant was 10.33 ± 1.50 at 1 week and 11.44 ± 0.88 at 6 months after crown placement. The difference was significant(P=0.021). This study indicates that immediate single-tooth implant restoration in anterior maxilla is predictable. Immediate single-tooth implantation can result in good clinical esthetic results in most patients with single-tooth missing in anterior maxilla.

Memory-guided attention in the anterior thalamus.

PubMed

Leszczyński, Marcin; Staudigl, Tobias

2016-07-01

The anterior thalamus is densely connected with both the hippocampus and the prefrontal cortex. It is known to play a role in learning and episodic memory. Given its connectivity profile with the prefrontal cortex, it may also be expected to contribute to executive functions. Recent studies in both rodents and humans add to our understanding of anterior thalamic function, suggesting that it is a key region for allocating attention. We discuss the convergence between studies in rodents and humans, both of which imply that the anterior thalamus may play a key role in memory-guided attention. We suggest that efficient allocation of attention to memory representations requires interaction between the memory-related hippocampal and the attention related fronto-parietal networks. We further propose that the anterior thalamus is a hub that connects and modulates both systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

PubMed

Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

2008-02-01

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

Anterior-Posterior Cerebral Blood Volume Gradient in Human Subiculum

PubMed Central

Talati, Pratik; Rane, Swati; Kose, Samet; Gore, John; Heckers, Stephan

2014-01-01

The human hippocampal formation is characterized by anterior-posterior gradients of cell density, neurochemistry and hemodynamics. In addition, some functions are associated with specific subfields (subiculum, CA1–4, dentate gyrus) and regions (anterior and posterior). We performed contrast-enhanced, high-resolution T1-weighted 3T steady state (SS) imaging to investigate cerebral blood volume (CBV) gradients of the hippocampal formation. We studied 14 healthy subjects and found significant CBV gradients (anterior > posterior) in the subiculum but not in other hippocampal subfields. Since CBV is a marker of basal metabolism, these results indicate a greater baseline activity in the anterior compared to the posterior subiculum. This gradient might be related to the role of the subiculum as the main outflow station of the hippocampal formation and might have implications for the mechanisms of neuropsychiatric disorders. PMID:24677295

Surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy combined with lensectomy for glaucomatous eyes with extremely shallow anterior chamber and cataract.

PubMed

Zhang, Zhaotian; Zhang, Shaochong; Jiang, Xintong; Qiu, Suo; Wei, Yantao

2016-01-04

Glaucoma combined with an extremely shallow anterior chamber and cataracts remains as a complex condition to deal with. And the emergence of microincision vitrectomy surgery (MIVS) system may provide an ideal option for the treatment of that. We report a clinical study of surgical outcomes of 23-gauge transconjunctival pars plana vitrectomy (PPV) combined with lensectomy in the treatment of glaucomatous eyes with extremely shallow anterior chamber and cataract. Prospective, nonrandomized and noncomparative case series study. Consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited to have combined surgeries of 23-gauge transconjunctival pars plana vitrectomy and lensectomy. The main outcomes were best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), number of anti-glaucoma medications and surgery-associated complications. Seventeen consecutive patients with secondary glaucoma, extremely shallow anterior chamber and cataract were recruited. The mean follow-up was 21.2 ± 8.8 months. Postoperatively, there was no significant improvement of BCVA (P = 0.25). The mean intraocular (IOP) decreased significantly from 43.14 ± 6.53 mmHg to 17.29 ± 1.80 mmHg (P < 0.001), and the mean depth of anterior chamber increased significantly from 0.507 ± 0.212 mm to 3.080 ± 0.313 mm (P < 0.001). The mean number of anti-glaucoma medications decreased from 4.1 ± 0.8 to 0.6 ± 0.8 (P < 0.001). No severe vision-threatening intra- or post-operative complications occurred. Glaucoma with an extremely shallow anterior chamber and cataract can be managed well with the combined surgeries of 23-gauge pars plana vitrectomy and lensectomy. The surgical procedure is an effective and safe method to resolve the pupillary block and deepen the anterior chamber.

Changes in the crystalline lens resulting from insertion of a phakic IOL (ICL) into the porcine eye.

PubMed

Fujisawa, Kunitoshi; Shimizu, Kimiya; Uga, Shigekazu; Suzuki, Masanobu; Nagano, Koichi; Murakami, Yuuki; Goseki, Hiroko

2007-01-01

Insertion of a phakic IOL offers these advantages: the corneal optical zone is not dissected or resected; preservation of the crystalline lens results in preservation of the accommodation force; and since the phakic IOL is removable, any error or change in refraction can be countered by exchanging it. However, the cause of secondary cataracts has never been clarified or discussed to date. The following ICL lenses were inserted under general anaesthesia into 20 eyes of ten 3-month-old miniature pigs: a minus lens without holes into five eyes, a plus lens in two eyes, a minus lens with four holes around the lens haptics in three eyes, and a minus lens with a central hole in the optic in three eyes; and seven eyes were used as controls. The anterior segments were then photographed 1 week, 1 month and 3 months after surgery. At 3 months after surgery, Evans blue (EB) was infused into the vitreous under general anaesthesia, and after 30 min, the eyeball was enucleated, fixed and examined. In the case of the ICL without holes, the anterior subcapsular opacities were observed in all the eyes, and the anterior surfaces of the crystalline lenses were not stained with EB. Use of the ICL with four holes around the lens haptics resulted in light staining of the anterior surface of the crystalline lens, but the anterior subcapsular opacities observed were mild. As for the ICL with a hole in the centre of the optic, the anterior surface of the crystalline lens was stained and no anterior subcapsular opacities were observed. The results suggested that the insertion of an ICL brings about a change in the dynamics of the intraocular aqueous humour, reducing its circulation to the anterior surface of the crystalline lens. This is considered to cause a metabolic disturbance of the crystalline lens, resulting in anterior subcapsular opacification.

Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion.

PubMed

Dong, Jun; Lu, Meng; Lu, Teng; Liang, Baobao; Xu, Junkui; Zhou, Jun; Lv, Hongjun; Qin, Jie; Cai, Xuan; Huang, Sihua; Li, Haopeng; Wang, Dong; He, Xijing

2015-01-01

Anterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results. A meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques. Ten studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = -0.58 (95% CI = -0.77 to 0.40, p < 0.01)] and blood loss [SMD = -0.40, 95% CI (-0.59 to -0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia. Compared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.

Comparison of Revision Rates of Anterior- and Posterior-Approach Ptosis Surgery: A Retrospective Review of 1519 Cases.

PubMed

Chou, Eva; Liu, Jun; Seaworth, Cathleen; Furst, Meredith; Amato, Malena M; Blaydon, Sean M; Durairaj, Vikram D; Nakra, Tanuj; Shore, John W

To compare revision rates for ptosis surgery between posterior-approach and anterior-approach ptosis repair techniques. This is the retrospective, consecutive cohort study. All patients undergoing ptosis surgery at a high-volume oculofacial plastic surgery practice over a 4-year period. A retrospective chart review was conducted of all patients undergoing posterior-approach and anterior-approach ptosis surgery for all etiologies of ptosis between 2011 and 2014. Etiology of ptosis, concurrent oculofacial surgeries, revision, and complications were analyzed. The main outcome measure is the ptosis revision rate. A total of 1519 patients were included in this study. The mean age was 63 ± 15.4 years. A total of 1056 (70%) of patients were female, 1451 (95%) had involutional ptosis, and 1129 (74.3%) had concurrent upper blepharoplasty. Five hundred thirteen (33.8%) underwent posterior-approach ptosis repair, and 1006 (66.2%) underwent anterior-approach ptosis repair. The degree of ptosis was greater in the anterior-approach ptosis repair group. The overall revision rate for all patients was 8.7%. Of the posterior group, 6.8% required ptosis revision; of the anterior group, 9.5% required revision surgery. The main reason for ptosis revision surgery was undercorrection of one or both eyelids. Concurrent brow lifting was associated with a decreased, but not statistically significant, rate of revision surgery. Patients who underwent unilateral ptosis surgery had a 5.1% rate of Hering's phenomenon requiring ptosis repair in the contralateral eyelid. Multivariable logistic regression for predictive factors show that, when adjusted for gender and concurrent blepharoplasty, the revision rate in anterior-approach ptosis surgery is higher than posterior-approach ptosis surgery (odds ratio = 2.08; p = 0.002). The overall revision rate in patients undergoing ptosis repair via posterior-approach or anterior-approach techniques is 8.7%. There is a statistically higher rate of revision with anterior-approach ptosis repair.

Open Approaches to the Anterior Skull Base in Children: Review of the Literature.

PubMed

Wasserzug, Oshri; DeRowe, Ari; Ringel, Barak; Fishman, Gadi; Fliss, Dan M

2018-02-01

Introduction  Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the "gold standard" for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective  This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods  Comprehensive literature review. Results  Extensive intracranial-intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion  Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.

Lamina cribrosa position and Bruch's membrane opening differences between anterior ischemic optic neuropathy and open-angle glaucoma.

PubMed

Rebolleda, Gema; Pérez-Sarriegui, Ane; Díez-Álvarez, Laura; De Juan, Victoria; Muñoz-Negrete, Francisco J

2018-06-01

To compare the optic nerve head morphology among primary open-angle glaucoma, non-arteritic anterior ischemic optic neuropathy eyes, their fellow healthy eyes and control eyes, using spectral-domain optical coherence tomography with enhanced depth imaging. Observational cross-sectional study including 88 eyes of 68 patients. In this study, 23 non-arteritic anterior ischemic optic neuropathy eyes, 17 fellow unaffected eyes, 25 primary open-angle glaucoma eyes, and 23 age-matched control eyes were included. Peripapillary retinal nerve fiber layer thickness and optic disk area were evaluated. Bruch's membrane opening diameter, optic cup depth, anterior lamina cribrosa depth, and prelaminar tissue thickness were assessed. Non-arteritic anterior ischemic optic neuropathy and primary open-angle glaucoma eyes had similar visual field mean deviation and peripapillary retinal nerve fiber layer thickness (P = 0.6 and P = 0.56, respectively). Bruch's membrane opening diameter was significantly larger in primary open-angle glaucoma eyes than in control eyes (P = 0.02). Lamina cribrosa and disk cup were deeper in eyes with primary open-angle glaucoma than both control and non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Prelaminar tissue thickness was significantly thinner in primary open-angle glaucoma eyes than in non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Lamina cribrosa was shallower in both non-arteritic anterior ischemic optic neuropathy and unaffected fellow eyes compared to healthy eyes (P < 0.001 and P = 0.04, respectively). No differences were found in the optic disk area. A forward lamina cribrosa placement and not a smaller disk could be involved in the pathogenesis of non-arteritic anterior ischemic optic neuropathy. A significantly larger Bruch's membrane opening diameter was found in primary open-angle glaucoma eyes compared with control eyes. This issue has clinical implications because Bruch's membrane opening has been considered a stable reference for disk-related measures.

New technical tip for anterior cervical plating : make hole first and choose the proper plate size later.

PubMed

Park, Jeong Yoon; Zhang, Ho Yeol; Oh, Min Chul

2011-04-01

It is well known that plate-to-disc distance (PDD) is closely related to adjacent-level ossification following anterior cervical plate placement. The study was undertaken to compare the outcomes of two different anterior cervical plating methods for degenerative cervical condition. Specifically, the new method involves making holes for plate screws first with an air drill and then choosing a plate size. The other method was standard, that is, decide on the plate size first, locate the plate on the anterior vertebral body, and then drilling the screw holes. Our null hypothesis was that the new technical tip may increase PDD as compared with the standard anterior cervical plating procedure. We retrospectively reviewed 49 patients who had a solid fusion after anterior cervical arthrodesis with a plate for the treatment of cervical disc degeneration. Twenty-three patients underwent the new anterior cervical plating technique (Group A) and 26 patients underwent the standard technique (Group B). PDD and ratios between PDD to anterior body heights (ABH) were measured using postoperative lateral radiographs. In addition, operating times and clinical results were reviewed in all cases. The mean durations of follow-up were 16.42±5.99 (Group A) and 19.83±6.71 (Group B) months, range 12 to 35 months. Of these parameters mentioned above, cephalad PDD (5.43 versus 3.46 mm, p=0.005) and cephalad PDD/ABH (0.36 versus 0.23, p=0.004) were significantly greater in the Group A, whereas operation time for two segment arthrodesis (141.9 versus 170.6 minutes, p=0.047) was significantly lower in the Group A. There were no significant difference between the two groups in caudal PDD (5.92 versus 5.06 mm), caudal PDD/ABH (0.37 versus 0.32) and clinical results. The new anterior cervical plating method represents an improvement over the standard method in terms of cephalad plate-to-disc distance and operating time.

Anterior dental microwear textures show habitat-driven variability in Neandertal behavior.

PubMed

Krueger, Kristin L; Ungar, Peter S; Guatelli-Steinberg, Debbie; Hublin, Jean-Jacques; Pérez-Pérez, Alejandro; Trinkaus, Erik; Willman, John C

2017-04-01

The causes of Neandertal anterior tooth wear patterns, including labial rounding, labial scratches, and differential anterior-posterior wear, have been debated for decades. The most common explanation is the "stuff-and-cut" hypothesis, which describes Neandertals clamping down on a piece of meat and slicing a portion close to their lips. "Stuff-and-cut" has been accepted as a general aspect of Neandertal behavior without fully assessing its variability. This study analyzes anterior dental microwear textures across habitats, locations, and time intervals to discern possible variation in Neandertal anterior tooth-use behavior. Forty-five Neandertals from 24 sites were analyzed, represented by high-resolution replicas of permanent anterior teeth. The labial surface was scanned for antemortem microwear using a white-light confocal profiler. The resultant 3D-point clouds, representing 204 × 276 μm for each specimen, were uploaded into SSFA software packages for texture characterization. Statistical analyses, including MANOVAs, ANOVAs, and pairwise comparisons, were completed on ranked microwear data. Neandertal descriptive statistics were also compared to 10 bioarchaeological samples of known or inferred dietary and behavioral regimes. The Neandertal sample varied significantly by habitat, suggesting this factor was a principal driving force for differences in Neandertal anterior tooth-use behaviors. The Neandertals from open habitats showed significantly lower anisotropy and higher textural fill volume than those inhabiting more closed, forested environments. The texture signature from the open-habitat Neandertals was most similar to that of the Ipiutak and Nunavut, who used their anterior teeth for intense clamping and grasping behaviors related to hide preparation. Those in more closed habitats were most similar to the Arikara, who did not participate in non-dietary behaviors. These Neandertal individuals had a broad range of texture values consistent with non-dietary and dietary behaviors, suggesting they varied more in anterior tooth-use behaviors and exploited a wider variety of plant and animal resources than did those from open habitats. Copyright © 2017 Elsevier Ltd. All rights reserved.

Orthodontists' and laypeople's perception of smile height aesthetics in relation to varying degrees of transverse cant of anterior teeth.

PubMed

Shiyan, Huang; Xu, Qian; Shuhao, Xu; Nanquan, Rao; Xiaobing, Li

2016-05-01

To determine the effect of varying the transverse cant of the anterior teeth on orthodontists' and laypeople's perceptions of smile aesthetics, and the influence that smile height has on this perception. A 20-year-old Chinese female with an aesthetic smile and normal occlusion was chosen and agreed to participate. Digital pictures of her posed smile were taken and manipulated to create three smile height variations: low, medium, or high. Each variation was further manipulated to create varying degrees of transverse anterior tooth cant. Fifty-six laypeople and 40 orthodontists participated as raters of the dental and facial impact of the altered smile images. The orthodontists more commonly and precisely identified the transverse cants of the anterior teeth and the detracting influence on smile aesthetics compared with laypersons. The orthodontists accepted a lesser range of anterior transverse cant. Increased smile heights enhanced the capability of all raters to detect a transverse cant and reduced the acceptable cant range. In addition, an increased smile height worsened the detracting effects of the transverse anterior cant in all raters' perceptions of smile aesthetics. An increased display of teeth and angulation of an anterior cant increased the ability of raters in both groups to detect differences. Transverse cants of anterior teeth can affect orthodontists' and laypeople's perceptions of smile aesthetics. Smile height and incisor display were significant factors that affected the orthodontist's and layperson's perceptions of smile aesthetics, and suggested that a description of the detracting effect of an anterior transverse cant should also consider smile height. A transverse occlusal cant is an important aesthetic factor used by clinicians during orthodontic diagnosis and review. It is important to appreciate that there is a difference in perception between orthodontic professionals and patients (laypeople). The extent of this perceptual difference and influencing factors could help the clinician set more appropriate treatment goals.

The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study.

PubMed

Kongcharoensombat, Wirat; Ochi, Mitsuo; Abouheif, Mohamed; Adachi, Nobuo; Ohkawa, Shingo; Kamei, Goki; Okuhara, Atushi; Shibuya, Hoyatoshi; Niimoto, Takuya; Nakasa, Tomoyuki; Nakamae, Atsuo; Deie, Masataka

2011-10-01

The purpose of this study was to determine the relation between the position of the transverse ligament, the anterior edge of the anterior cruciate ligament (ACL) tibial footprint, and the center of the ACL tibial insertion. We used arthroscopy for localization of the anatomic landmarks, followed by insertions of guide pins under direct visualization, and then the position of these guide pins was checked on plain lateral radiographs. The transverse ligament and the anterior aspect of the ACL tibial footprint were identified by arthroscopy in 20 unpaired cadaveric knees (10 left and 10 right). Guide pins were inserted with tibial ACL adapter drill guides under direct observation at the transverse ligament, the anterior aspect of the tibial footprint, and the center of tibial insertion of the ACL. Then, plain lateral radiographs of specimens were taken. The Amis and Jakob line was used to define the attachment of the ACL tibial insertion and the transverse ligament. A sagittal percentage of the location of the insertion point was determined and calculated from the anterior margin of the tibia in the anteroposterior direction. The transverse ligament averaged 21.20% ± 4.1%, the anterior edge of the ACL tibial insertion averaged 21.60% ± 4.0%, and the center of the ACL tibial insertion averaged 40.30% ± 4.8%. There were similar percent variations between the transverse ligament and the anterior edge of the ACL tibial insertion, with no significant difference between them (P = .38). Intraobserver and interobserver reliability was high, with small standard errors of measurement. This study shows that the transverse ligament coincides with the anterior edge of the ACL tibial footprint in the sagittal plane. The transverse ligament can be considered as a new landmark for tibial tunnel positioning during anatomic ACL reconstruction. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effect of Surgical Approach on Pulmonary Function in Adolescent Idiopathic Scoliosis Patients: A Systemic Review and Meta-analysis.

PubMed

Lee, Andy C H; Feger, Mark A; Singla, Anuj; Abel, Mark F

2016-11-15

Systemic review and meta-analysis. To analyze the effect of spinal fusion and instrumentation for adolescent idiopathic scoliosis (AIS) on absolute pulmonary function test (PFTs). Pulmonary function is correlated with severity of deformity in AIS patients and studies that have analyzed the effect of spinal fusion and instrumentation on PFTs for AIS have reported inconsistent results. There is a need to analyze the effect of spinal fusion on PFTs with stratification by surgical approach. Our analysis included 22 studies. Cohen's d effect sizes were calculated for absolute PFT outcome measures with 95% confidence intervals (CI). Meta-analyses were performed at each postoperative time frame for six homogeneous surgical approaches: (i) combined anterior release and posterior fusion with instrumentation; (ii) combined video assisted anterior release and posterior fusion with instrumentation without thoracoplasty; (iii) posterior fusion with instrumentation without thoracoplasty; (iv) anterior fusion with instrumentation and without thoracoplasty; (v) video assisted anterior fusion with instrumentation without thoracoplasty; and (vi) any scoliosis surgery with additional thoracoplasty. Anterior spinal fusion with instrumentation, any scoliosis surgery with concomitant thoracoplasty, or video-assisted anterior fusion with instrumentation for AIS had similar absolute PFTs at their 2 year postoperative follow up compared with their preoperative PFTs (effect sizes ranging from -0.2-0.2 with all CI crossing "0"). Posterior spinal fusion with instrumentation (with or without an anterior release) demonstrated small to moderate increases in PFTs 2 years postoperatively (effect sizes ranging from 0.35-0.65 with all CI not crossing "0"). Anterior fusion with instrumentation, regardless of the approach, and any scoliosis surgery with concomitant thoracoplasty do not lead to significant change in pulmonary functions 2 year after surgery. Posterior spinal fusion with instrumentation (with or without an anterior release) resulted in small to moderate increases in PFTs. N/A.

Ocular Coherence Tomography in the Evaluation of Anterior Eye Injuries in Space Flight

NASA Technical Reports Server (NTRS)

Fer, Dan M.; Law, Jennifer; Wells, Julia

2017-01-01

While Ocular Coherence Tomography (OCT) is not a first-line modality to evaluate anterior eye structures terrestrially, it is a resource already available on the International Space Station (ISS) that can be used in medical contingencies that involve the anterior eye. With remote guidance and subject matter expert (SME) support from the ground, a minimally trained crewmember can now use OCT to evaluate anterior eye pathologies on orbit. OCT utilizes low-coherence interferometry to produce detailed cross-sectional and 3D images of the eye in real time. Terrestrially, it has been used to evaluate macular pathologies and glaucoma. Since 2013, OCT has been used onboard the ISS as one part of a suite of hardware to evaluate the Visual Impairment/Intracranial Pressure risk faced by astronauts, specifically assessing changes in the retina and choroid during space flight. The Anterior Segment Module (ASM), an add-on lens, was also flown for research studies, providing an opportunity to evaluate the anterior eye in real time if clinically indicated. Anterior eye pathologies that could be evaluated using OCT were identified. These included corneal abrasions and ulcers, scleritis, and acute angle closure glaucoma. A remote guider script was written to provide ground specialists with step-by-step instructions to guide ISS crewmembers, who do not get trained on the ASM, to evaluate the anterior eye. The instructions were tested on novice subjects and/or operators, whose feedback was incorporated iteratively. The final remote guider script was reviewed by SME optometrists and NASA flight surgeons. The novel application of OCT technology to space flight allows for the acquisition of objective data to diagnose anterior eye pathologies when other modalities are not available. This demonstrates the versatility of OCT and highlights the advantages of using existing hardware and remote guidance skills to expand clinical capabilities in space flight.

Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy.

PubMed

Cho, Jae Ho; Lee, Doo Hyung; Song, Hyung Keun; Bang, Joon Young; Lee, Kyung Tai; Park, Young Uk

2016-04-01

Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy. Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position. Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p < 0.001). Stress ultrasound may be useful for the diagnosis of chronic ankle instability in addition to the manual anterior drawer test and stress radiography. III.

An analysis of maxillary anterior teeth: facial and dental proportions.

PubMed

Hasanreisoglu, Ufuk; Berksun, Semih; Aras, Kerem; Arslan, Ilker

2005-12-01

The size and form of the maxillary anterior teeth are important in achieving pleasing dental and facial esthetics. However, little scientific data have been defined as criteria for evaluating these morphological features. This study analyzed the clinical crown dimensions of maxillary anterior teeth to determine whether consistent relationships exist between tooth width and several facial measurements in a subset of the Turkish population. Full-face and anterior tooth images of 100 Turkish dental students viewed from the front and engaged in maximum smiling were recorded with digital photography under standardized conditions. Gypsum casts of the maxillary arches of the subjects were also made. The dimensions of the anterior teeth, the occurrence of the golden ratio, the difference between the actual and perceived sizes, and the relationship between the anterior teeth and several facial measurements by gender were analyzed using the information obtained from both the computer images and the casts. One-sample, 2-sample, and paired t tests, and repeated-measures analysis of variance and Duncan multiple-range tests were performed to analyze the data (alpha=.05). The dimensions of the central incisors (P<.05) and canines (P<.01) varied by gender. The existence of the so-called "golden proportion" for the maxillary anterior teeth as a whole was not found. Significant differences emerged when the mean ratios between various perceived widths were compared with their ideal golden ratios (P<.01). Proportional relationships between the bizygomatic width and the width of the central incisor, and the intercanine distance and the interalar width in women were observed. The maxillary central incisor and canine dimensions of men were greater than those of women in the Turkish population studied, with the canines showing the greatest gender variation. Neither a golden proportion nor any other recurrent proportion for all anterior teeth was determined. Bizygomatic width and interalar width may serve as references for establishing the ideal width of the maxillary anterior teeth, particularly in women.

Cosmetic and functional outcomes following paramedian and anterolateral retroperitoneal access in anterior lumbar spine surgery.

PubMed

Jagannathan, Jay; Chankaew, Ekawut; Urban, Peter; Dumont, Aaron S; Sansur, Charles A; Kern, John; Peeler, Benjamin; Elias, W Jeffrey; Shen, Francis; Shaffrey, Mark E; Whitehill, Richard; Arlet, Vincent; Shaffrey, Christopher I

2008-11-01

In this paper, the authors review the functional and cosmetic outcomes and complications in 300 patients who underwent treatment for lumbar spine disease via either an anterior paramedian or conventional anterolateral retroperitoneal approach. Seven surgeons performed anterior lumbar surgeries in 300 patients between August 2004 and December 2006. One hundred and eighty patients were treated with an anterior paramedian approach, and 120 patients with an anterolateral retroperitoneal approach. An access surgeon was used in 220 cases (74%). Postoperative evaluation in all patients consisted of clinic visits, assessment with the modified Scoliosis Research Society-30 instrument, as well as a specific questionnaire relating to wound appearance and patient satisfaction with the wound. At a mean follow-up of 31 months (range 12-47 months), the mean Scoliosis Research Society-30 score (out of 25) was 21.2 in the patients who had undergone the anterior paramedian approach and 19.4 in those who had undergone the anterolateral retroperitoneal approach (p = 0.005). The largest differences in quality of life measures were observed in the areas of pain control (p = 0.001), self-image (p = 0.004), and functional activity (p = 0.003), with the anterior paramedian group having higher scores in all 3 categories. Abdominal bulging in the vicinity of the surgical site was the most common wound complication observed and was reported by 22 patients in the anterolateral retroperitoneal group (18%), and 2 patients (1.1%) in the anterior paramedian group. Exposures of >or= 3 levels with the anterolateral approach were associated with abdominal bulging (p = 0.04), while 1- or 2-level exposures were not (p > 0.05). Overall satisfaction with incisional appearance was higher in patients with an anterior paramedian incision (p = 0.001) and with approaches performed by an access surgeon (p = 0.004). Patients who undergo an anterior paramedian approach to the lumbar spine have a higher quality of life and better cosmetic outcomes than patients undergoing an anterolateral retroperitoneal approach.

Treatment considerations for bleaching and bonding white lesions in the anterior dentition.

PubMed

Greenwall, Linda Helene

2009-12-01

White lesions occur commonly on the anterior teeth. There are numerous reasons why these lesions appear in the anterior dentition, and these reasons will be discussed in detail. For some patients, these white lesions may be considered unsightly and the patients may seek treatment to have them removed; other patients are not concerned about their presence on their anterior teeth. Some of the white lesions are caused by demineralization and occur because of poor oral hygiene. For the purpose of this article, developmental white lesions will be discussed in detail, along with the options for treatment of these lesions.

Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum.

PubMed

Archdeacon, Michael T

2015-02-01

The ilioinguinal and anterior intrapelvic approaches to the acetabulum often involve different strategies for the treatment of acetabular fractures. The ilioinguinal approach allows access to the entire internal iliac fossa and pelvic brim, including indirect access to the quadrilateral surface. In contrast, the anterior intrapelvic approach allows access to the anterior elements from inside the pelvis with the surgeon standing opposite the fracture pathology. Therefore, the goal of this article is to clarify the advantages and disadvantages for each approach with respect to exposure, reduction, and fixation.

Correction of anterior crossbite using modified transparent aligners: An esthetic approach

PubMed Central

Abraham, K. Korath; James, Arun Roy; Thenumkal, Elza; Emmatty, Tharian

2016-01-01

Anterior crossbite results from the abnormal axial inclination of one or more anterior teeth. It is a major esthetic and functional anomaly which has to be corrected in the primary and early mixed dentition period to allow the normal development of maxilla and mandible as well as the occlusion. Several treatment options are available to correct the problem. A unique appliance, “modified transparent tray aligners” was used to correct the anterior crossbite in an 8-year-old child. The clinical presentation, fabrication of the appliance, and the outcome are discussed. PMID:27630508

Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous Thoracic Spinal Tuberculosis.

PubMed

Cui, Xu; Li, Li-Tao; Ma, Yuan-Zheng

2016-11-01

To evaluate the clinical outcomes of anterior and posterior instrumentation with different debridement and graft fusion methods for multi-level contiguous thoracic spinal tuberculosis. We retrospectively evaluated 81 patients with multi-level contiguous thoracic spinal tuberculosis who underwent anterior or posterior instrumentation combined with different methods of debridement, decompression, and graft fusion from January 2002 to December 2012. All patients were divided into an anterior instrumentation group and a posterior instrumentation group. In the anterior instrumentation group, there were 39 patients who underwent transthoracic debridement. In the posterior instrumentation group, there were 34 patients who underwent trans-costotransverse decompression and strut grafting with posterior instrumentation, and another 8 patients underwent combined anterior debridement and strut grafting with posterior instrumentation in a single-stage or two-stage procedure. The kyphotic angles were calculated from lateral spinal X-rays using the modified Konstam method. The symptoms and signs of tuberculosis, fusion level, fusion time of the bone graft, average kyphosis angle, average correction, average loss of correction, and clinical complications were recorded. The average follow-up period was 37 months (range, 17-72 months). The cohort consisted of 47 males and 34 females with an average age of 38 years. The mean durations of the operations were 3.5 ± 0.4 h in the anterior group and 4.0 ± 0.3 h in the posterior group ( P < 0.05). The mean blood loss volumes during surgery were 450 ± 42 and 560 ± 51 mL for the anterior group and the posterior group, respectively ( P < 0.01). The kyphotic deformities were corrected from 32.1° ± 10.3° to 10.2° ± 2.1° in the anterior group and from 33.8° ± 11.7° to 12.6° ± 2.7° in the posterior group ( P < 0.01). The neurologic statuses of the 23 patients with preoperative neurologic deficits improved in each group. Fusion was confirmed radiographically at 5.4 ± 1.2 months (range, 4-12 months) in the anterior group and 5.6 ± 1.4 months (range, 4-13 months) in the posterior group ( P > 0.05). Postoperative relapses were noted in 1 and 3 patients in the anterior and the posterior group, respectively. Posterior instrumentation was more effective than anterior instrumentation in the correction of kyphosis and the maintenance of the correction. However, postoperative sinus formation was more frequent in patients who underwent a single-stage posterior procedure. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Does concomitant anterior fundoplication promote dysphagia after laparoscopic Heller myotomy?

PubMed

Tapper, Donovan; Morton, Connor; Kraemer, Emily; Villadolid, Desiree; Ross, Sharona B; Cowgill, Sarah M; Rosemurgy, Alexander S

2008-07-01

Concerns for gastroesophageal reflux after laparoscopic Heller myotomy for achalasia justify considerations of concomitant anterior fundoplication. This study was undertaken to determine if concomitant anterior fundoplication reduces symptoms of reflux after myotomy without promoting dysphagia. From 1992 to 2004, 182 patients underwent laparoscopic Heller myotomy without fundoplication. After a prospective randomized trial justified its concomitant application, anterior fundoplication was undertaken with laparoscopic Heller myotomy in 171 patients from 2004 to 2007. All patients have been prospectively followed. Pre and postoperatively, patients scored the frequency and severity of symptoms of achalasia (including dysphagia, choking, vomiting, regurgitation, chest pain, and heartburn) using a Likert Scale (0 = never/not bothersome to 10 = always/very bothersome). Before myotomy, symptoms of achalasia were frequent and severe for all patients. After myotomy, the frequency and severity of all symptoms of achalasia significantly decreased for all patients (P < 0.001, Wilcoxon matched pairs test). Notably, relative to patients undergoing laparoscopic Heller myotomy alone, concomitant anterior fundoplication led to significantly less frequent and severe heartburn after myotomy (P < 0.05, Mann-Whitney Test) and to less frequent and severe dysphagia and choking (P < 0.05, Mann-Whitney Test). Laparoscopic Heller myotomy reduces the frequency and severity of symptoms of achalasia. Concomitant anterior fundoplication decreases the frequency and severity of heartburn and dysphagia after laparoscopic Heller myotomy. Concomitant anterior fundoplication promotes salutary relief in the frequency and severity of symptoms after myotomy and is warranted.

The Effect of the Crystalline Lens on Central Vault After Implantable Collamer Lens Implantation.

PubMed

Qi, Meng-Ying; Chen, Qian; Zeng, Qing-Yan

2017-08-01

To identify associations between crystalline lens-related factors and central vault after Implantable Collamer Lens (ICL) (Staar Surgical, Monrovia, CA) implantation. This retrospective clinical study included 320 eyes from 186 patients who underwent ICL implantation surgery. At 1 year after surgery, the central vault was measured using anterior segment optical coherence tomography. Preoperative anterior chamber depth, lens thickness, lens position (lens position = anterior chamber depth + 1/2 lens thickness), and vault were analyzed to investigate the effects of lens-related factors on postoperative vault. The mean vault was 513 ± 215 µm at 1 year after surgery. Vault was positively correlated with preoperative anterior chamber depth (r = 0.495, P < .001) and lens position (r = 0.371, P < .001), but negatively correlated with lens thickness (r = -0.262, P < .001). Eyes with vaults of less than 250 µm had shallower anterior chambers, thicker lenses, and smaller lens position than eyes in the other two vault groups (which had vaults ≥ 250 µm) (P < .001). Eyes with both anterior chamber depth less than 3.1 mm and lens position less than 5.1 mm had greatly reduced vaults (P < .001). The crystalline lens could have an important influence on postoperative vault. Eyes with a shallower anterior chamber and a forward lens position will have lower vaults. [J Refract Surg. 2017;33(8):519-523.]. Copyright 2017, SLACK Incorporated.

Brain metabolites in autonomic regulatory insular sites in heart failure.

PubMed

Woo, Mary A; Yadav, Santosh K; Macey, Paul M; Fonarow, Gregg C; Harper, Ronald M; Kumar, Rajesh

2014-11-15

Autonomic, pain, and neuropsychologic comorbidities appear in heart failure (HF), likely resulting from brain changes, indicated as loss of structural integrity and functional deficits. Among affected brain sites, the anterior insulae are prominent in serving major regulatory roles in many of the disrupted functions commonly seen in HF. Metabolite levels, including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and myo-inositol (MI), could indicate the nature of anterior insula tissue injury in HF. The study aim was to assess anterior insular metabolites to determine processes mediating autonomic, pain, and neuropsychologic disruptions in HF. We performed magnetic resonance spectroscopy in bilateral anterior insulae in 11 HF and 53 controls, using a 3.0-Tesla magnetic resonance imaging scanner. Peaks for NAA at 2.02 ppm, Cr at 3.02 ppm, Cho at 3.2 ppm, and MI at 3.56 ppm were assigned, peak areas were calculated, and metabolites were expressed as ratios, including NAA/Cr, Cho/Cr, and MI/Cr. HF patients showed significantly increased Cho/Cr ratios, indicative of glial proliferation or injury, on the left anterior insula, and reduced NAA/Cr levels, suggesting neuronal loss/dysfunction, on the right anterior insula over controls. No differences in MI/Cr ratios appeared between groups. Right anterior insular neuronal loss and left glial alterations may contribute to distorted autonomic, pain, and neuropsychologic functions found in HF. Copyright © 2014 Elsevier B.V. All rights reserved.

Anterior deltoid deficiency in reverse total shoulder replacement: a biomechanical study with cadavers.

PubMed

Gulotta, L V; Choi, D; Marinello, P; Wright, T; Cordasco, F A; Craig, E V; Warren, R F

2012-12-01

Reverse total shoulder replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver shoulders, except for tendon attachments. After implantation of the RTSR, the shoulders were mounted on a custom-made shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation. Two conditions were tested: 1) Control with an absent supraspinatus and infraspinatus; and 2) Control with anterior deltoid deficiency. Anterior deltoid deficiency resulted in a mean increase of 195% in subscapularis force at 30° when compared with the control (p = 0.02). At 60°, the subscapularis force increased a mean of 82% (p < 0.001) and the middle deltoid force increased a mean of 26% (p = 0.04). Scapular plane elevation may still be possible following an RTSR in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid. Attempts to preserve the subscapularis, if present, might maximise post-operative function.

Vasopressin differentially modulates aggression and anxiety in adolescent hamsters administered anabolic steroids.

PubMed

Morrison, Thomas R; Ricci, Lesley A; Melloni, Richard H

2016-11-01

Adolescent Syrian hamsters (Mesocricetus auratus) treated with anabolic/androgenic steroids display increased offensive aggression and decreased anxiety correlated with an increase in vasopressin afferent development, synthesis, and neural signaling within the anterior hypothalamus. Upon withdrawal from anabolic/androgenic steroids, this neurobehavioral relationship shifts as hamsters display decreased offensive aggression and increased anxiety correlated with a decrease in anterior hypothalamic vasopressin. This study investigated the hypothesis that alterations in anterior hypothalamic vasopressin neural signaling modulate behavioral shifting between adolescent anabolic/androgenic steroid-induced offensive aggression and anxiety. To test this, adolescent male hamsters were administered anabolic/androgenic steroids and tested for offensive aggression or anxiety following direct pharmacological manipulation of vasopressin V1A receptor signaling within the anterior hypothalamus. Blockade of anterior hypothalamic vasopressin V1A receptor signaling suppressed offensive aggression and enhanced general and social anxiety in hamsters administered anabolic/androgenic steroids during adolescence, effectively reversing the pattern of behavioral response pattern normally observed during the adolescent exposure period. Conversely, activation of anterior hypothalamic vasopressin V1A receptor signaling enhanced offensive aggression in hamsters exposed to anabolic/androgenic steroids during adolescence. Together, these findings suggest that the state of vasopressin neural development and signaling in the anterior hypothalamus plays an important role in behavioral shifting between aggression and anxiety following adolescent exposure to anabolic/androgenic steroids. Copyright © 2016 Elsevier Inc. All rights reserved.

Reduced event-related current density in the anterior cingulate cortex in schizophrenia.

PubMed

Mulert, C; Gallinat, J; Pascual-Marqui, R; Dorn, H; Frick, K; Schlattmann, P; Mientus, S; Herrmann, W M; Winterer, G

2001-04-01

There is good evidence from neuroanatomic postmortem and functional imaging studies that dysfunction of the anterior cingulate cortex plays a prominent role in the pathophysiology of schizophrenia. So far, no electrophysiological localization study has been performed to investigate this deficit. We investigated 18 drug-free schizophrenic patients and 25 normal subjects with an auditory choice reaction task and measured event-related activity with 19 electrodes. Estimation of the current source density distribution in Talairach space was performed with low-resolution electromagnetic tomography (LORETA). In normals, we could differentiate between an early event-related potential peak of the N1 (90-100 ms) and a later N1 peak (120-130 ms). Subsequent current-density LORETA analysis in Talairach space showed increased activity in the auditory cortex area during the first N1 peak and increased activity in the anterior cingulate gyrus during the second N1 peak. No activation difference was observed in the auditory cortex between normals and patients with schizophrenia. However, schizophrenics showed significantly less anterior cingulate gyrus activation and slowed reaction times. Our results confirm previous findings of an electrical source in the anterior cingulate and an anterior cingulate dysfunction in schizophrenics. Our data also suggest that anterior cingulate function in schizophrenics is disturbed at a relatively early time point in the information-processing stream (100-140 ms poststimulus). Copyright 2001 Academic Press.

[The clinical investigation of peripheral retinal changes of anterior uveitis].

PubMed

Guo, Chunying; Qiao, Lijun; Yang, Liu

2015-10-01

To observe the peripheral retinal changes of anterior uveitis patients using ultra-wide field fluorescein angiography. Retrospective case series study. Thirty-three eyes of 20 patients diagnosed as anterior uveitis from September to November 2013 in the ophthalmic clinic of Peking University First Hospital was included. All the patients underwent routine ocular examination, followed by ultra-wide field Fluorescein. There were 13 male patients and 7 female patients, aged 23-66, an average of 46 years old. The anterior uveitis recurrent in both eyes in 13 patients and only one eye in 7 patients. Uveitis duration ranging from months to 30 years. Twenty eyes were at the active stage of the anterior uveitis while 13 eyes in the quiescent stage. Peripheral retinal vessels leakage was detected in 57.6% (19/33) of the eyes, among which in eyes with active disease the rate of peripheral retinal vessels leakage was 75% (15/20), and in eyes with quiescent disease the rate was 30.8% (4/13). Optic disk hyperfluorescence was found in 6 of 20 eyes with active disease. Cystoid macular edema was found in 4 eyes. In addition, peripheral retinal hyperfluorescence dot and zone were detected in 2 eyes. Peripheral retinal vessels were detected to have inflammative leakage in patients of anterior uveitis by ultra-wide field fluorescein agiography. Peripheral retinal inflammation may still exist even in the quiescent stage of the anterior uveitis.

Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

PubMed

Dobrowolski, Piotr; Kowalski, Mirosław; Rybicka, Justyna; Lech, Agnieszka; Tyczyński, Paweł; Witkowski, Adam; Hoffman, Piotr

2016-01-01

The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

Relevance of anterior mandibular body ostectomy in mandibular prognathism.

PubMed

Bansal, Pankaj; Singh, Virender; Anand, S C; Bansal, Sumidha

2013-01-01

We tried to find out the relevance of anterior mandibular body ostectomy in deformities of the mandible specially prognathism, which is primarily limited to anterior part only. Ten patients with skeletal deformity along with malocclusion, which was limited to anterior body of mandible were selected. Selected patients had proper molar interdigitation (even if class 3) and in general had anterior crossbite (except one). All patients had crossed their growth spurts and had no hormonal influence on facial deformity. Specific protocol, including cephelometric analysis cephalometry for orthognathic surgery, prediction tracing and model surgeries were devised. Pre and post-surgical orthodontics and body ostectomy were performed in all patients along with 18-month post-op follow-up. There was significant reduction in prognathism and horizontal dysplasia in all ten patients. Anterior crossbite as well as axis of incisiors over mandibular plane was corrected in all patients due to decrease in length of mandibular body. All patients showed decreased facial height and better lip competence with intact posterior occlusion and no (negligible or transient) sensory loss. Our study could confirm that people whose deformity is limited to the anterior part of mandible with reasonable occlusion posteriorly can get satisfactory cosmetic and functional results through body ostectomy alone rather than going for surgical procedure in the ramal area, which is liable to cause sensory and occlusal disturbances.

The da Vinci robotic surgical assisted anterior lumbar interbody fusion: technical development and case report.

PubMed

Beutler, William J; Peppelman, Walter C; DiMarco, Luciano A

2013-02-15

Technique development to use the da Vince Robotic Surgical System for anterior lumbar interbody fusion at L5-S1 is detailed. A case report is also presented. To evaluate and develop the da Vinci robotic assisted laparoscopic anterior lumbar stand-alone interbody fusion procedure. Anterior lumbar interbody fusion is a common procedure associated with potential morbidity related to the surgical approach. The da Vinci robot provides intra-abdominal dissection and visualization advantages compared with the traditional open and laparoscopic approach. The surgical techniques for approach to the anterior lumbar spine using the da Vinci robot were developed and modified progressively beginning with operative models followed by placement of an interbody fusion cage in the living porcine model. Development continued to progress with placement of fusion cage in a human cadaver, completed first in the laboratory setting and then in the operating room. Finally, the first patient with fusion completed using the da Vinci robot-assisted approach is presented. The anterior transperitoneal approach to the lumbar spine is accomplished with enhanced visualization and dissection capability, with maintenance of pneumoperitoneum using the da Vinci robot. Blood loss is minimal. The visualization inside the disc space and surrounding structures was considered better than current open and laparoscopic techniques. The da Vinci robot Surgical System technique continues to develop and is now described for the transperitoneal approach to the anterior lumbar spine. 4.

Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study

PubMed Central

2012-01-01

Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass. PMID:22809563

Arthroscopic and magnetic resonance image appearance and reconstruction of the anterior talofibular ligament in cases of apparent functional ankle instability.

PubMed

Takao, Masato; Innami, Ken; Matsushita, Takashi; Uchio, Yuji; Ochi, Mitsuo

2008-08-01

Many patients report feeling functional ankle instability, despite having no clinically demonstrable lateral instability. Some patients who experience functional instability of the ankle have substantial abnormalities of the anterior talofibular ligament despite having apparently normal lateral laxity in clinical examination. Case series; Level of evidence, 4. Fourteen patients who had functional ankle instability after sprain, despite having no clinically demonstrable lateral instability, were included in this study. All subjects underwent standard stress radiography, magnetic resonance imaging, and ankle arthroscopy. These patients were treated with anatomical reconstruction of the anterior talofibular ligament. Arthroscopic assessment revealed 3 cases with no ligamentous structure with scar tissue, 9 cases with partial ligament tears and scar tissue on the disrupted anterior talofibular ligament fiber, and 2 cases of abnormal course of the ligament at the fibular or talar attachment. Magnetic resonance imaging revealed the following: 5 cases of discontinuity of the anterior talofibular ligament, 2 cases of narrowing of the anterior talofibular ligament, 4 cases of high-intensity lesion in the anterior talofibular ligament, and 3 normal cases. The mean American Orthopaedic Foot and Ankle Society Ankle Hindfoot scale score was 66.2 +/- 3.2 points at preoperation and 92.3 +/- 4.4 points 2 years after surgery. All patients in this study with functional ankle instability, despite their having no demonstrable abnormal lateral laxity, had morphologic ligamentous abnormality on arthroscopic assessment.

Brain Metabolites in Autonomic Regulatory Insular Sites in Heart Failure

PubMed Central

Woo, Mary A.; Yadav, Santosh K.; Macey, Paul M.; Fonarow, Gregg C.; Harper, Ronald M.; Kumar, Rajesh

2014-01-01

Autonomic, pain, and neuropsychologic comorbidities appear in heart failure (HF), likely resulting from brain changes, indicated as loss of structural integrity and functional deficits. Among affected brain sites, the anterior insulae are prominent in serving major regulatory roles in many of the disrupted functions commonly seen in HF. Metabolite levels, including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and myo-inositol (MI), could indicate the nature of anterior insula tissue injury in HF. The study aim was to assess anterior insular metabolites to determine processes mediating autonomic, pain, and neuropsychologic disruptions in HF. We performed magnetic resonance spectroscopy in bilateral anterior insulae in 11 HF and 53 controls, using a 3.0-Tesla magnetic resonance imaging scanner. Peaks for NAA at 2.02ppm, Cr at 3.02ppm, Cho at 3.2ppm, and MI at 3.56ppm were assigned, peak areas calculated, and metabolites expressed as ratios, including NAA/Cr, Cho/Cr, and MI/Cr. HF patients showed significantly increased Cho/Cr ratios, indicative of glial proliferation or injury, on the left anterior insula, and reduced NAA/Cr levels, suggesting neuronal loss/dysfunction, on the right anterior insula over controls. No differences in MI/Cr ratios appeared between groups. Right anterior insular neuronal loss and left glial alterations may contribute to distorted autonomic, pain, and neuropsychologic functions found in HF. PMID:25248953

Vasopressin Differentially Modulates Aggression and Anxiety in Adolescent Hamsters Administered Anabolic Steroids

PubMed Central

Morrison, Thomas R.; Ricci, Lesley A.; Melloni, Richard H.

2016-01-01

Adolescent Syrian hamsters (Mesocricetus auratus) treated with anabolic/androgenic steroids display increased offensive aggression and decreased anxiety correlated with an increase in vasopressin afferent development, synthesis, and neural signaling within the anterior hypothalamus. Upon withdrawal from anabolic/androgenic steroids, this neurobehavioral relationship shifts as hamsters display decreased offensive aggression and increased anxiety correlated with a decrease in anterior hypothalamic vasopressin. This study investigated the hypothesis that alterations in anterior hypothalamic vasopressin neural signaling modulate behavioral shifting between adolescent anabolic/androgenic steroid-induced offensive aggression and anxiety. To test this, adolescent male hamsters were administered anabolic/androgenic steroids and tested for offensive aggression or anxiety following direct pharmacological manipulation of vasopressin V1A receptor signaling within the anterior hypothalamus. Blockade of anterior hypothalamic vasopressin V1A receptor signaling suppressed offensive aggression and enhanced general and social anxiety in hamsters administered anabolic/androgenic steroids during adolescence, effectively reversing the pattern of behavioral response pattern normally observed during the adolescent exposure period. Conversely, activation of anterior hypothalamic vasopressin V1A receptor signaling enhanced offensive aggression in hamsters exposed to anabolic/androgenic steroids during adolescence. Together, these findings suggest that the state of vasopressin neural development and signaling in the anterior hypothalamus plays an important role in behavioral shifting between aggression and anxiety following adolescent exposure to anabolic/androgenic steroids. PMID:27149949

Temporalis myofascial repair of traumatic defects of the anterior fossa. Technical note.

PubMed

Gillespie, R P; Shagets, F W; de los Reyes, R A

1986-06-01

Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

Femtosecond laser-assisted cataract surgery in anterior lenticonus due to Alport syndrome.

PubMed

Barnes, Alexander C; Roth, Allen S

2017-06-01

We describe a case of bilateral anterior lenticonus in a patient with Alport syndrome treated with femtosecond laser-assisted cataract surgery (FLACS). FLACS was performed without complication, and a desirable postoperative visual acuity was achieved. Femtosecond laser-assisted cataract surgery is an effective approach for managing patients with anterior lenticonus secondary to Alport syndrome.

Cognitive Functioning after Medial Frontal Lobe Damage Including the Anterior Cingulate Cortex: A Preliminary Investigation

ERIC Educational Resources Information Center

Baird, Amee; Dewar, Bonnie-Kate; Critchley, Hugo; Gilbert, Sam J.; Dolan, Raymond J.; Cipolotti, Lisa

2006-01-01

Two patients with medial frontal lobe damage involving the anterior cingulate cortex (ACC) performed a range of cognitive tasks, including tests of executive function and anterior attention. Both patients lesions extended beyond the ACC, therefore caution needs to be exerted in ascribing observed deficits to the ACC alone. Patient performance was…

Anterior capsular rupture following blunt ocular injury

PubMed Central

Gremida, Anas; Kassem, Iris; Traish, Aisha

2011-01-01

Summary A 10-year-old boy suffered a large, oblique anterior capsular tear following blunt injury to his right eye. The boy was followed daily for hyphema resolution and progressive traumatic cataract formation. After the hyphema had resolved, the lens was removed using an anterior approach and an intraocular lens was placed with excellent visual outcome. PMID:23362402

Purkinje Cell Activity in the Cerebellar Anterior Lobe after Rabbit Eyeblink Conditioning

ERIC Educational Resources Information Center

Green, John T.; Steinmetz, Joseph E.

2005-01-01

The cerebellar anterior lobe may play a critical role in the execution and proper timing of learned responses. The current study was designed to monitor Purkinje cell activity in the rabbit cerebellar anterior lobe after eyeblink conditioning, and to assess whether Purkinje cells in recording locations may project to the interpositus nucleus.…

Anterior medial prefrontal cortex exhibits activation during task preparation but deactivation during task execution.

PubMed

Koshino, Hideya; Minamoto, Takehiro; Ikeda, Takashi; Osaka, Mariko; Otsuka, Yuki; Osaka, Naoyuki

2011-01-01

The anterior prefrontal cortex (PFC) exhibits activation during some cognitive tasks, including episodic memory, reasoning, attention, multitasking, task sets, decision making, mentalizing, and processing of self-referenced information. However, the medial part of anterior PFC is part of the default mode network (DMN), which shows deactivation during various goal-directed cognitive tasks compared to a resting baseline. One possible factor for this pattern is that activity in the anterior medial PFC (MPFC) is affected by dynamic allocation of attentional resources depending on task demands. We investigated this possibility using an event related fMRI with a face working memory task. Sixteen students participated in a single fMRI session. They were asked to form a task set to remember the faces (Face memory condition) or to ignore them (No face memory condition), then they were given 6 seconds of preparation period before the onset of the face stimuli. During this 6-second period, four single digits were presented one at a time at the center of the display, and participants were asked to add them and to remember the final answer. When participants formed a task set to remember faces, the anterior MPFC exhibited activation during a task preparation period but deactivation during a task execution period within a single trial. The results suggest that the anterior MPFC plays a role in task set formation but is not involved in execution of the face working memory task. Therefore, when attentional resources are allocated to other brain regions during task execution, the anterior MPFC shows deactivation. The results suggest that activation and deactivation in the anterior MPFC are affected by dynamic allocation of processing resources across different phases of processing.

Context-specific function of the LIM homeobox 1 transcription factor in head formation of the mouse embryo.

PubMed

Fossat, Nicolas; Ip, Chi Kin; Jones, Vanessa J; Studdert, Joshua B; Khoo, Poh-Lynn; Lewis, Samara L; Power, Melinda; Tourle, Karin; Loebel, David A F; Kwan, Kin Ming; Behringer, Richard R; Tam, Patrick P L

2015-06-01

Lhx1 encodes a LIM homeobox transcription factor that is expressed in the primitive streak, mesoderm and anterior mesendoderm of the mouse embryo. Using a conditional Lhx1 flox mutation and three different Cre deleters, we demonstrated that LHX1 is required in the anterior mesendoderm, but not in the mesoderm, for formation of the head. LHX1 enables the morphogenetic movement of cells that accompanies the formation of the anterior mesendoderm, in part through regulation of Pcdh7 expression. LHX1 also regulates, in the anterior mesendoderm, the transcription of genes encoding negative regulators of WNT signalling, such as Dkk1, Hesx1, Cer1 and Gsc. Embryos carrying mutations in Pcdh7, generated using CRISPR-Cas9 technology, and embryos without Lhx1 function specifically in the anterior mesendoderm displayed head defects that partially phenocopied the truncation defects of Lhx1-null mutants. Therefore, disruption of Lhx1-dependent movement of the anterior mesendoderm cells and failure to modulate WNT signalling both resulted in the truncation of head structures. Compound mutants of Lhx1, Dkk1 and Ctnnb1 show an enhanced head truncation phenotype, pointing to a functional link between LHX1 transcriptional activity and the regulation of WNT signalling. Collectively, these results provide comprehensive insight into the context-specific function of LHX1 in head formation: LHX1 enables the formation of the anterior mesendoderm that is instrumental for mediating the inductive interaction with the anterior neuroectoderm and LHX1 also regulates the expression of factors in the signalling cascade that modulate the level of WNT activity. © 2015. Published by The Company of Biologists Ltd.

Fgf and Hh signalling act on a symmetrical pre-pattern to specify anterior and posterior identity in the zebrafish otic placode and vesicle

PubMed Central

Hammond, Katherine L.; Whitfield, Tanya T.

2011-01-01

Specification of the otic anteroposterior axis is one of the earliest patterning events during inner ear development. In zebrafish, Hedgehog signalling is necessary and sufficient to specify posterior otic identity between the 10 somite (otic placode) and 20 somite (early otic vesicle) stages. We now show that Fgf signalling is both necessary and sufficient for anterior otic specification during a similar period, a function that is completely separable from its earlier role in otic placode induction. In lia–/– (fgf3–/–) mutants, anterior otic character is reduced, but not lost altogether. Blocking all Fgf signalling at 10-20 somites, however, using the pan-Fgf inhibitor SU5402, results in the loss of anterior otic structures and a mirror image duplication of posterior regions. Conversely, overexpression of fgf3 during a similar period, using a heat-shock inducible transgenic line, results in the loss of posterior otic structures and a duplication of anterior domains. These phenotypes are opposite to those observed when Hedgehog signalling is altered. Loss of both Fgf and Hedgehog function between 10 and 20 somites results in symmetrical otic vesicles with neither anterior nor posterior identity, which, nevertheless, retain defined poles at the anterior and posterior ends of the ear. These data suggest that Fgf and Hedgehog act on a symmetrical otic pre-pattern to specify anterior and posterior otic identity, respectively. Each signalling pathway has instructive activity: neither acts simply to repress activity of the other, and, together, they appear to be key players in the specification of anteroposterior asymmetries in the zebrafish ear. PMID:21831919

Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction.

PubMed

Bybee, Kevin A; Motiei, Arashk; Syed, Imran S; Kara, Tomas; Prasad, Abhiram; Lennon, Ryan J; Murphy, Joseph G; Hammill, Stephen C; Rihal, Charanjit S; Wright, R Scott

2007-01-01

The presentation and electrocardiographic (ECG) characteristics of transient left ventricular apical ballooning syndrome (TLVABS) can be similar to that of anterior ST-segment elevation myocardial infarction (STEMI). We tested the hypothesis that the ECG on presentation could reliably differentiate these syndromes. Between January 1, 2002 and July 31, 2004, we identified 18 consecutive patients with TLVABS who were matched with 36 subjects presenting with acute anterior STEMI due to atherothrombotic left anterior descending coronary artery occlusion. All patients with TLVABS were women (mean age, 72.0 +/- 13.1 years). The heart rate, PR interval, QRS duration, and corrected QT interval were similar between groups. Distribution of ST elevation was similar, but patients with anterior STEMI exhibited greater ST elevation. Regressive partitioning analysis indicated that the combination of ST elevation in lead V2 of less than 1.75 mm and ST-segment elevation in lead V3 of less than 2.5 mm was a suggestive predictor of TLVABS (sensitivity, 67%; specificity, 94%). Conditional logistic regression indicated that the formula: (3 x ST-elevation lead V2) + (ST-elevation V3) + (2 x ST-elevation V5) allowed possible discrimination between TLVABS and anterior STEMI with an optimal cutoff level of less than 11.5 mm for TLVABS (sensitivity, 94%; specificity, 72%). Patients with TLVABS were less likely to have concurrent ST-segment depression (6% vs 44%; P = .003). Women presenting with TLVABS have similar ECG findings to patients with anterior infarct but with less-prominent ST-segment elevation in the anterior precordial ECG leads. These ECG findings are relatively subtle and do not have sufficient predictive value to allow reliable emergency differentiation of these syndromes.

Histological analysis of the tibial anterior cruciate ligament insertion.

PubMed

Oka, Shinya; Schuhmacher, Peter; Brehmer, Axel; Traut, Ulrike; Kirsch, Joachim; Siebold, Rainer

2016-03-01

This study was performed to investigate the morphology of the tibial anterior cruciate ligament (ACL) by histological assessment. The native (undissected) tibial ACL insertion of six fresh-frozen cadaveric knees was cut into four sagittal sections parallel to the long axis of the medial tibial spine. For histological evaluation, the slices were stained with haematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analysed at a magnification of 20×. The anterior tibial ACL insertion was bordered by a bony anterior ridge. The most medial ACL fibres inserted from the medial tibial spine and were adjacent to the articular cartilage of the medial tibial plateau. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact with the lateral part of the tibial ACL insertion. A small fat pad was located just posterior to the functional ACL fibres. The anterior-posterior length of the medial ACL insertion was an average of 10.8 ± 1.1 mm compared with the lateral, which was only 6.2 ± 1.1 mm (p < 0.001). There were no central or posterolateral inserting ACL fibres. The shape of the bony tibial ACL insertion was 'duck-foot-like'. In contrast to previous findings, the functional mid-substance fibres arose from the most posterior part of the 'duck-foot' in a flat and 'c-shaped' way. The most anterior part of the tibial ACL insertion was bordered by a bony anterior ridge and the most medial by the medial tibial spine. No posterolateral fibres nor ACL bundles have been found histologically. This histological investigation may improve our understanding of the tibial ACL insertion and may provide important information for anatomical ACL reconstruction.

The Effects of Specialization and Sex on Anterior Y-Balance Performance in High School Athletes.

PubMed

Miller, Madeline M; Trapp, Jessica L; Post, Eric G; Trigsted, Stephanie M; McGuine, Timothy A; Brooks, M Alison; Bell, David R

Sport specialization and movement asymmetry have been separately discussed as potential risk factors for lower extremity injury. Early specialization may lead to the development of movement asymmetries that can predispose an athlete to injury, but this has not been thoroughly examined. Athletes rated as specialized would exhibit greater between-limb anterior reach asymmetry and decreased anterior reach distance on the Y-balance test (YBT) as compared with nonspecialized high school athletes, and these differences would not be dependent on sex. Cross-sectional study. Level 3. Two hundred ninety-five athletes (117 male, 178 female; mean age, 15.6 ± 1.2 years) from 2 local high schools participating in basketball, soccer, volleyball, and tennis responded to a questionnaire regarding sport specialization status and performed trials of the YBT during preseason testing. Specialization was categorized according to 3 previously utilized specialization classification methods (single/multisport, 3-point scale, and 6-point scale), and interactions between specialization and sex with Y-balance performance were calculated using 2-way analyses of variance. Single-sport male athletes displayed greater anterior reach asymmetry than other interaction groups. A consistent main effect was observed for sex, with men displaying greater anterior asymmetry and decreased anterior reach distance than women. However, the interaction effects of specialization and sex on anterior Y-balance performance varied based on the classification method used. Single-sport male athletes displayed greater anterior reach asymmetry on the YBT than multisport and female athletes. Specialization classification method is important because the 6- and 3-point scales may not accurately identify balance abnormalities. Male athletes performed worse than female athletes on both of the Y-balance tasks. Clinicians should be aware that single-sport male athletes may display deficits in dynamic balance, potentially increasing their risk of injury.

Ghrelin receptor expression and colocalization with anterior pituitary hormones using a GHSR-GFP mouse line.

PubMed

Reichenbach, Alex; Steyn, Frederik J; Sleeman, Mark W; Andrews, Zane B

2012-11-01

Ghrelin is the endogenous ligand for the GH secretagogue receptor (GHSR) and robustly stimulates GH release from the anterior pituitary gland. Ghrelin also regulates the secretion of anterior pituitary hormones including TSH, LH, prolactin (PRL), and ACTH. However, the relative contribution of a direct action at the GHSR in the anterior pituitary gland vs. an indirect action at the GHSR in the hypothalamus remains undefined. We used a novel GHSR-enhanced green fluorescent protein (eGFP) reporter mouse to quantify GHSR coexpression with GH, TSH, LH, PRL, and ACTH anterior pituitary cells in males vs. females and in chow-fed or calorie-restricted (CR) mice. GHSR-eGFP-expressing cells were only observed in anterior pituitary. The number of GHSR-eGFP-expressing cells was higher in male compared with females, and CR did not affect the GHSR-eGFP cell number. Double staining revealed 77% of somatotrophs expressed GHSR-eGFP in both males and females. Nineteen percent and 12.6% of corticotrophs, 21% and 9% of lactotrophs, 18% and 19% of gonadotrophs, and 3% and 9% of males and females, respectively, expressed GHSR-eGFP. CR increased the number of TSH cells, but suppressed the number of lactotrophs and gonadotrophs, expressing GHSR-eGFP compared with controls. These studies support a robust stimulatory action of ghrelin via the GHSR on GH secretion and identify a previously unknown sexual dimorphism in the GHSR expression in the anterior pituitary. CR affects GHSR-eGFP expression on lactotrophs, gonadotrophs, and thyrotrophs, which may mediate reproductive function and energy metabolism during periods of negative energy balance. The low to moderate expression of GHSR-eGFP suggests that ghrelin plays a minor direct role on remaining anterior pituitary cells.

Estradiol increases the Bax/Bcl-2 ratio and induces apoptosis in the anterior pituitary gland.

PubMed

Zaldivar, Verónica; Magri, María Laura; Zárate, Sandra; Jaita, Gabriela; Eijo, Guadalupe; Radl, Daniela; Ferraris, Jimena; Pisera, Daniel; Seilicovich, Adriana

2009-01-01

Estrogens are recognized as acting as modulators of pituitary cell renewal, sensitizing cells to mitogenic and apoptotic signals, thus participating in anterior pituitary homeostasis during the estrous cycle. The balance of pro- and antiapoptotic proteins of the Bcl-2 family is known to regulate cell survival and apoptosis. In order to understand the mechanisms underlying apoptosis during the estrous cycle, we evaluated the expression of the proapoptotic protein Bax and the antiapoptotic proteins Bcl-2 and Bcl-xL in the anterior pituitary gland in cycling female rats as well as the influence of estradiol on the expression of these proteins in anterior pituitary cells of ovariectomized rats. As determined by Western blot, the expression of Bax was higher in anterior pituitary glands from rats at proestrus than at diestrus I, Bcl-2 protein levels showed no difference and Bcl-xL expression was lower, thus increasing the Bax/Bcl-2 ratio at proestrus. Assessed by annexin V binding and flow cytometry, the percentage of apoptotic anterior pituitary cells was higher in rats at proestrus than at diestrus I. Chronic estrogen treatment in ovariectomized rats enhanced the Bax/Bcl-2 ratio and induced apoptosis. Moreover, incubation of cultured anterior pituitary cells from ovariectomized rats with 17beta-estradiol for 24 h increased the Bax/Bcl-2 ratio, decreased Bcl-xL expression and induced apoptosis. Our results demonstrate that estradiol increases the ratio between proapoptotic and antiapoptotic proteins of the Bcl-2 family. This effect could participate in the sensitizing action of estrogens to proapoptotic stimuli and therefore be involved in the high apoptotic rate observed at proestrus in the anterior pituitary gland.

Immunohistochemistry of connexin 43 throughout anterior pituitary gland in a transgenic rat with green fluorescent protein-expressing folliculo-stellate cells.

PubMed

Horiguchi, Kotaro; Fujiwara, Ken; Kouki, Tom; Kikuchi, Motoshi; Yashiro, Takashi

2008-12-01

Folliculo-stellate (FS) cells in the anterior pituitary gland have been speculated to possess multifunctional properties. Because gap junctions (GJ) have been identified between FS cells, FS cells may be interconnected electrophysiologically by GJ and serve as signal transmission networks to modulate hormone release in the anterior pituitary gland. But whether GJ are localized among FS cells from the pars tuberalis through the pars distalis is unclear. The S100b-GFP transgenic rat has recently been generated, which expresses green fluorescent protein (GFP) specifically in FS cells in the anterior pituitary. This model is expected to be a powerful tool for studies of FS cells. The purpose of the present paper was therefore to examine the localization of GJ on connexin 43 immunohistochemistry throughout the anterior pituitary gland of S100b-GFP rats under confocal laser microscopy. The localization patterns of FS cells was also observed in primary culture of anterior pituitary cells and the question of whether GJ between FS cells are reconstructed in vitro was investigated. In vivo studies showed that GJ were present specifically between FS cells from the pars tuberalis to the pars distalis in the anterior pituitary gland. The appearance of FS cells was distinguished into two types, with localization of GJ differing between types. In vitro, it was observed for the first time that FS cells in primary culture could be categorized into two types. In vivo localization of GJ between FS cells was reconstructed in vitro. These morphological observations are consistent with the hypothesis that FS cells form an electrophysiological network throughout the anterior pituitary for signal transmission.

Is there any relationship between the frontal cell and the Agger nasi cell and the localization of the anterior ethmoid artery?

PubMed

Aydoğan, Filiz; Demir, Selda; Aydın, Emine; Taştan, Eren; Kavuzlu, Ali

2011-01-01

In this article, we examined the effect of the presence or absence of a frontal cell or an Agger nasi cell on the localization of the anterior ethmoid artery. Coronal paranasal sinus computed tomography scans on 110 sides of 61 patients (35 males, 26 females; mean age 35.6 ± 12.7 years; range 15 to 72 years) who underwent surgery for septal deviation, concha bullosa, antrochoanal polyp between September 2006 and February 2008 were retrospectively evaluated and the anterior ethmoid foramen localization was measured according to the anterior nasal spine. The correlations of these measurements with the presence and absence of a frontal cell and an Agger nasi cell were investigated. The measurement of the anterior ethmoidal foramen according to anterior nasal spine was 18.2 ± 8.8 mm in the absence of an Agger nasi cell and was 20.3 ± 6.6 mm in the presence of an Agger nasi cell. This distance was measured as 20.0 ± 7.3 mm when the frontal cell was not determined. This measurement was 20.2 ± 6.5 mm in the presence of a frontal cell. According to the frontal cell types the results of the measurements were 20.5 ± 5.9 mm, 18.9 ± 8 mm, 20.6 ± 7.3 mm, for type 1, type 2 and type 3, respectively. Our results revealed that there were no significant relationship between the presence or absence of a frontal cell and an Agger nasi cell and the localization of the anterior ethmoidal foramen. The results of this study showed that the presence or absence of these cells does not affect localization of the anterior ethmoid artery.

The role of anterior hyaloid face integrity on retinal complications during Nd: YAG laser capsulotomy.

PubMed

Ozyol, Erhan; Ozyol, Pelin; Doğanay Erdoğan, Beyza; Onen, Mehmet

2014-01-01

This study evaluated anterior hyaloid damage (AHD), AHD-related Nd:YAG laser parameters, and retinal complications in subjects that underwent Nd:YAG laser posterior capsulotomy for cataracts. In this prospective, cross-sectional study, 277 pseudophakic eyes of 216 patients treated with Nd:YAG laser capsulotomy for posterior capsule opacification were enrolled. Pulse number, pulse energy, and total energy were noted for each eye. All procedures were performed with a sense of anterior hyaloid protection. Anterior hyaloid faces were assessed during procedure and 1 day after the procedure. Eyes with biomicroscopically invisible anterior hyaloid face were excluded from statistical analysis. Eyes with and without AHD were compared according to Nd:YAG laser parameters. Retinal complications were evaluated at day 1, week 1, month 1, and month 3. In 22 eyes (7.9 % of 277 eyes), the anterior hyaloid face couldn't be assessed biomicroscopically. Anterior hyaloid damage was observed in 49 eyes (19.2 % of 255 eyes). The pulse number, pulse energy, and total energy were observed to be higher in eyes with AHD (P < .001, P = .024, P < .001, respectively). Cystoid macular edema was detected in five eyes (three with AHD) at 1-week examination. Localized retinal detachment occurred in one eye with AHD. Occurrence of retinal complication in the AHD(+) group was 12.7 times higher than in the AHD(-) group, adjusted for total energy used (P < 0.001). The risk of AHD may increase with high pulse number, pulse energy, and total energy. Anterior hyaloid face integrity should be considered for YAG laser-related retinal complications.

Biomechanical testing of anterior and posterior thoracolumbar instrumentation in the cadaveric spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

PubMed

Eichholz, Kurt M; Hitchon, Patrick W; From, Aaron; Rubenbauer, Paige; Nakamura, Satoshi; Lim, Tae Hong; Torner, James

2004-07-01

Thoracolumbar burst fractures frequently require surgical intervention. Although the use of either anterior or posterior instrumentation has advantages and disadvantages, there have been few studies in which these two approaches have been compared biomechanically. Ten human cadaveric spines were subjected to subtotal L-3 corpectomy. In five spines placement of L-3 wooden strut grafts with lateral L2-4 dual rod and screw instrumentation was performed. Five other spines underwent L1-5 pedicle screw fixation. The spines were fatigued between steps of the experiment. The spines were load tested with pure moments of 1.5, 3, 4.5, and 6 Nm in the intact state and after placement of instrumentation in six degrees of freedom (flexion, extension, right and left lateral bending, and right and left axial rotation). In axial rotation posterior instrumentation significantly increased spinal rigidity compared with that of the intact state, whereas anterior instrumentation did not. Combined anterior-posterior instrumentation did not significantly increase the rigidity of the spine when compared with anterior or posterior instrumentation alone. Posterior instrumentation alone provided a greater reduction in angular rotation compared with anterior instrumentation alone in all degrees of freedom; however, statistical significance was achieved only in extension at 6 Nm. The increased rigidity provided by pedicle screw instrumentation compared with the intact state or with anterior instrumentation is due to the longer construct spanning five levels and the three-column engagement of the pedicle screws. The decision to use anterior or posterior instrumentation should be based on the clinical necessity of canal decompression and correction of angulation.

Measurement of glenohumeral joint translation using real-time ultrasound imaging: A physiotherapist and sonographer intra-rater and inter-rater reliability study.

PubMed

Rathi, Sangeeta; Taylor, Nicholas F; Gee, Jamie; Green, Rodney A

2016-12-01

Ultrasonography is an economical and non-invasive method for measuring real-time joint movements. Although physiotherapists are increasingly using ultrasound imaging for rotator cuff disorders, there is a lack of evidence on their reliability in using ultrasonography to measure glenohumeral translation. The aim of this study was to evaluate the reliability of a physiotherapist in measuring anterior and posterior glenohumeral joint translation with ultrasound. Study design: within day reliability. Anterior and posterior glenohumeral translations were measured at rest, in response to passive accessory motion testing force, and with isometric internal and external rotation in 12 young healthy adults. All the measurements were made in real time by a physiotherapist and an experienced sonographer in two positions (neutral and abducted) and in two views (anterior and posterior). Intra-rater and inter-rater reliability were expressed using intraclass correlation coefficients (ICC) and measurement error (mm). Intra-rater reliability was good for both raters (ICC P : 0.86-0.98; ICC S : 0.85-0.96). The inter-rater reliability between the physiotherapist and sonographer was moderate to good for posterior measurements (ICC 0.50-0.75) and poor to moderate for anterior measurements (ICC 0.31-0.53). For both intra-rater and inter-rater measurements, posterior translation was more reliable than the anterior translation with smaller measurement errors (posterior: 0.1-0.2 mm, anterior: 0.2-0.3 mm). A physiotherapist with minimal training was reliable in measuring glenohumeral joint translations. The ultrasound method was reliable for repeated measurement of both anterior and posterior glenohumeral translations with posterior measurements being more reliable than anterior. This method is recommended for future research to investigate the stabilising role of rotator cuff muscles. Copyright © 2016 Elsevier Ltd. All rights reserved.

Changes in ocular biometry and anterior chamber parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects.

PubMed

Razeghinejad, Mohammad Reza; Lashkarizadeh, Hamid; Nowroozzadeh, Mohammad Hossein; Yazdanmehr, Mohammad

2016-01-01

The aim of this study was to evaluate the effects of pharmacologic mydriasis and Peripheral Iridotomy (PI) on ocular biometry and anterior chamber parameters in primary angle closure suspects. In this prospective interventional case series, 21 primary angle closure suspects were enrolled. Intraocular pressure, refraction, ocular biometry (Lenstar, LS900), and anterior chamber parameters (Pentacam HR) were measured at four occasions: before PI (before and after mydriasis with phenylephrine) and two weeks after PI (before and after mydriasis). The study was conducted on both eyes and only one eye per patient, in random, was included in the analysis. The mean age of the participants was 60±7 years and 17 (81%) were female. There were no significant differences in intraocular pressure, refraction, keratometry, biometric and anterior chamber parameters between groups, except for anterior chamber volume, which showed increments with PI and mydriasis. The corresponding values for anterior chamber volume were as follows: 88.2±13.7mm(3) before PI, undilated; 106.3±18.8 before PI, dilated; 99.0±14.6 after PI, undilated, and 107.4±16.5 after PI, dilated (P<0.001). This study showed no change in the ocular biometric and anterior chamber parameters including iridocorneal angle after PI and/or pharmacologic mydriasis except for increments in anterior chamber volume. This factor has the potential to be used as a numerical proxy for iris position in evaluating and monitoring patients with primary angle closure suspects after PI. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Activation of biceps femoris long head reduces tibiofemoral anterior shear force and tibial internal rotation torque in healthy subjects

PubMed Central

Azmi, Nur Liyana; Ding, Ziyun; Xu, Rui

2018-01-01

The anterior cruciate ligament (ACL) provides resistance to tibial internal rotation torque and anterior shear at the knee. ACL deficiency results in knee instability. Optimisation of muscle contraction through functional electrical stimulation (FES) offers the prospect of mitigating the destabilising effects of ACL deficiency. The hypothesis of this study is that activation of the biceps femoris long head (BFLH) reduces the tibial internal rotation torque and the anterior shear force at the knee. Gait data of twelve healthy subjects were measured with and without the application of FES and taken as inputs to a computational musculoskeletal model. The model was used to investigate the optimum levels of BFLH activation during FES gait in reducing the anterior shear force to zero. This study found that FES significantly reduced the tibial internal rotation torque at the knee during the stance phase of gait (p = 0.0322) and the computational musculoskeletal modelling revealed that a mean BFLH activation of 20.8% (±8.4%) could reduce the anterior shear force to zero. At the time frame when the anterior shear force was zero, the internal rotation torque was reduced by 0.023 ± 0.0167 Nm/BW, with a mean 188% reduction across subjects (p = 0.0002). In conclusion, activation of the BFLH is able to reduce the tibial internal rotation torque and the anterior shear force at the knee in healthy control subjects. This should be tested on ACL deficient subject to consider its effect in mitigating instability due to ligament deficiency. In future clinical practice, activating the BFLH may be used to protect ACL reconstructions during post-operative rehabilitation, assist with residual instabilities post reconstruction, and reduce the need for ACL reconstruction surgery in some cases. PMID:29304102

An anterior signaling center patterns and sizes the anterior neuroectoderm of the sea urchin embryo.

PubMed

Range, Ryan C; Wei, Zheng

2016-05-01

Anterior signaling centers help specify and pattern the early anterior neuroectoderm (ANE) in many deuterostomes. In sea urchin the ANE is restricted to the anterior of the late blastula stage embryo, where it forms a simple neural territory comprising several types of neurons as well as the apical tuft. Here, we show that during early development, the sea urchin ANE territory separates into inner and outer regulatory domains that express the cardinal ANE transcriptional regulators FoxQ2 and Six3, respectively. FoxQ2 drives this patterning process, which is required to eliminate six3 expression from the inner domain and activate the expression of Dkk3 and sFRP1/5, two secreted Wnt modulators. Dkk3 and low expression levels of sFRP1/5 act additively to potentiate the Wnt/JNK signaling pathway governing the positioning of the ANE territory around the anterior pole, whereas high expression levels of sFRP1/5 antagonize Wnt/JNK signaling. sFRP1/5 and Dkk3 levels are rigidly maintained via autorepressive and cross-repressive interactions with Wnt signaling components and additional ANE transcription factors. Together, these data support a model in which FoxQ2 initiates an anterior patterning center that implements correct size and positions of ANE structures. Comparisons of functional and expression studies in sea urchin, hemichordate and chordate embryos reveal striking similarities among deuterostome ANE regulatory networks and the molecular mechanism that positions and defines ANE borders. These data strongly support the idea that the sea urchin embryo uses an ancient anterior patterning system that was present in the common ambulacrarian/chordate ancestor. © 2016. Published by The Company of Biologists Ltd.

The avian prechordal head region: a morphological study.

PubMed Central

Seifert, R; Jacob, M; Jacob, H J

1993-01-01

The axial mesoderm of the anterior head region was investigated in young chick and quail embryos by light and electron microscopy. Semithin sections showed that the axial head mesoderm consists of the head process and prechordal mesoderm. At the anterior end of the prechordal mesoderm, a group of columnar epithelial cells formed a pit-like structure. The bases of these columnar cells extended to the neural plate, thus limiting the prechordal mesoderm anteriorly. The cells lining the pit-like structure at its anterior end joined a cell accumulation made up of cells of mesenchymal character. Electron microscopy revealed that the columnar cells forming the pit-like structure were covered by a basal lamina which was discontinuous on its anterior aspect. No basal lamina was recognisable between the columnar epithelial cells and mesenchymal cells joining them anteriorly. The columnar epithelial cells bordering the prechordal mesoderm anteriorly were therefore assumed to be part of the endodermal germ layer. In agreement with the findings of other authors, it is proposed to term these axially located columnar cells of the endoderm the prechordal plate and to distinguish them from the prechordal mesoderm arising during gastrulation. For the mesenchymal cell accumulation anterior to the prechordal plate, participation in the formation of the prosencephalic mesenchyme is assumed. This implies that the definitive endodermal germ layer, like the ectodermal one represented by the neural crest, may also be able to contribute to mesenchyme formation in the head. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 PMID:8270478

Inactivation of the Huntington's disease gene (Hdh) impairs anterior streak formation and early patterning of the mouse embryo.

PubMed

Woda, Juliana M; Calzonetti, Teresa; Hilditch-Maguire, Paige; Duyao, Mabel P; Conlon, Ronald A; MacDonald, Marcy E

2005-08-18

Huntingtin, the HD gene encoded protein mutated by polyglutamine expansion in Huntington's disease, is required in extraembryonic tissues for proper gastrulation, implicating its activities in nutrition or patterning of the developing embryo. To test these possibilities, we have used whole mount in situ hybridization to examine embryonic patterning and morphogenesis in homozygous Hdh(ex4/5) huntingtin deficient embryos. In the absence of huntingtin, expression of nutritive genes appears normal but E7.0-7.5 embryos exhibit a unique combination of patterning defects. Notable are a shortened primitive streak, absence of a proper node and diminished production of anterior streak derivatives. Reduced Wnt3a, Tbx6 and Dll1 expression signify decreased paraxial mesoderm and reduced Otx2 expression and lack of headfolds denote a failure of head development. In addition, genes initially broadly expressed are not properly restricted to the posterior, as evidenced by the ectopic expression of Nodal, Fgf8 and Gsc in the epiblast and T (Brachyury) and Evx1 in proximal mesoderm derivatives. Despite impaired posterior restriction and anterior streak deficits, overall anterior/posterior polarity is established. A single primitive streak forms and marker expression shows that the anterior epiblast and anterior visceral endoderm (AVE) are specified. Huntingtin is essential in the early patterning of the embryo for formation of the anterior region of the primitive streak, and for down-regulation of a subset of dynamic growth and transcription factor genes. These findings provide fundamental starting points for identifying the novel cellular and molecular activities of huntingtin in the extraembryonic tissues that govern normal anterior streak development. This knowledge may prove to be important for understanding the mechanism by which the dominant polyglutamine expansion in huntingtin determines the loss of neurons in Huntington's disease.

Effects of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: Finite element modeling of cadaver specimens.

PubMed

Lewis, Gregory S; Conaway, William K; Wee, Hwabok; Kim, H Mike

2017-02-28

A novel technique of "anterior offsetting" of the humeral head component to address posterior instability in total shoulder arthroplasty has been proposed, and its biomechanical benefits have been previously demonstrated experimentally. The present study sought to characterize the changes in joint mechanics associated with anterior offsetting with various amounts of glenoid retroversion using cadaver specimen-specific 3-dimensional finite element models. Specimen-specific computational finite element models were developed through importing digitized locations of six musculotendinous units of the rotator cuff and deltoid muscles based off three cadaveric shoulder specimens implanted with total shoulder arthroplasty in either anatomic or anterior humeral head offset. Additional glenoid retroversion angles (0°, 10°, 20°, and 30°) other than each specimen׳s actual retroversion were modeled. Contact area, contact force, peak pressure, center of pressure, and humeral head displacement were calculated at each offset and retroversion for statistical analysis. Anterior offsetting was associated with significant anterior shift of center of pressure and humeral head displacement upon muscle loading (p<0.05). Although statistically insignificant, anterior offsetting was associated with increased contact area and decreased peak pressure (p > 0.05). All study variables showed significant differences when compared between the 4 different glenoid retroversion angles (p < 0.05) except for total force (p < 0.05). The study finding suggests that the anterior offsetting technique may contribute to joint stability in posteriorly unstable shoulder arthroplasty and may reduce eccentric loading on glenoid components although the long term clinical results are yet to be investigated in future. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical commissioning of an in vivo range verification system for prostate cancer treatment with anterior and anterior oblique proton beams

NASA Astrophysics Data System (ADS)

Hoesl, M.; Deepak, S.; Moteabbed, M.; Jassens, G.; Orban, J.; Park, Y. K.; Parodi, K.; Bentefour, E. H.; Lu, H. M.

2016-04-01

The purpose of this work is the clinical commissioning of a recently developed in vivo range verification system (IRVS) for treatment of prostate cancer by anterior and anterior oblique proton beams. The IRVS is designed to perform a complete workflow for pre-treatment range verification and adjustment. It contains specifically designed dosimetry and electronic hardware and a specific software for workflow control with database connection to the treatment and imaging systems. An essential part of the IRVS system is an array of Si-diode detectors, designed to be mounted to the endorectal water balloon routinely used for prostate immobilization. The diodes can measure dose rate as function of time from which the water equivalent path length (WEPL) and the dose received are extracted. The former is used for pre-treatment beam range verification and correction, if necessary, while the latter is to monitor the dose delivered to patient rectum during the treatment and serves as an additional verification. The entire IRVS workflow was tested for anterior and 30 degree inclined proton beam in both solid water and anthropomorphic pelvic phantoms, with the measured WEPL and rectal doses compared to the treatment plan. Gafchromic films were also used for measurement of the rectal dose and compared to IRVS results. The WEPL measurement accuracy was in the order of 1 mm and after beam range correction, the dose received by the rectal wall were 1.6% and 0.4% from treatment planning, respectively, for the anterior and anterior oblique field. We believe the implementation of IRVS would make the treatment of prostate with anterior proton beams more accurate and reliable.

Anterior Medial Prefrontal Cortex Exhibits Activation during Task Preparation but Deactivation during Task Execution

PubMed Central

Koshino, Hideya; Minamoto, Takehiro; Ikeda, Takashi; Osaka, Mariko; Otsuka, Yuki; Osaka, Naoyuki

2011-01-01

Background The anterior prefrontal cortex (PFC) exhibits activation during some cognitive tasks, including episodic memory, reasoning, attention, multitasking, task sets, decision making, mentalizing, and processing of self-referenced information. However, the medial part of anterior PFC is part of the default mode network (DMN), which shows deactivation during various goal-directed cognitive tasks compared to a resting baseline. One possible factor for this pattern is that activity in the anterior medial PFC (MPFC) is affected by dynamic allocation of attentional resources depending on task demands. We investigated this possibility using an event related fMRI with a face working memory task. Methodology/Principal Findings Sixteen students participated in a single fMRI session. They were asked to form a task set to remember the faces (Face memory condition) or to ignore them (No face memory condition), then they were given 6 seconds of preparation period before the onset of the face stimuli. During this 6-second period, four single digits were presented one at a time at the center of the display, and participants were asked to add them and to remember the final answer. When participants formed a task set to remember faces, the anterior MPFC exhibited activation during a task preparation period but deactivation during a task execution period within a single trial. Conclusions/Significance The results suggest that the anterior MPFC plays a role in task set formation but is not involved in execution of the face working memory task. Therefore, when attentional resources are allocated to other brain regions during task execution, the anterior MPFC shows deactivation. The results suggest that activation and deactivation in the anterior MPFC are affected by dynamic allocation of processing resources across different phases of processing. PMID:21829668

Use of a Zero-Profile Device for Contiguous 2-Level Anterior Cervical Diskectomy and Fusion: Comparison with Cage with Plate Construct.

PubMed

Yun, Dong-Ju; Lee, Sang-Jin; Park, Sang-Joon; Oh, Hyeong Seok; Lee, Young Jae; Oh, Hyun Min; Lee, Sang-Ho

2017-01-01

A new zero-profile, standalone device (Zero P) was recently developed and has shown a lower incidence rate of complications and competitive clinical outcomes compared with anterior cervical cage with plate construct (CP) in single and multilevel anterior cervical diskectomy and fusion (ACDF). However, there is still concern whether Zero P is appropriate for multilevel ACDF. In addition, there have been few reports of contiguous 2-level ACDF used in conjunction with Zero P. We reviewed contiguous 2-level ACDF performed from December 2006 to February 2015. A total of 63 patients met inclusion criteria for the study (CP group = 32 cases; Zero P group = 31 cases). All preoperative and postoperative clinical and radiologic parameters were recorded. These parameters were compared between both groups. The postoperative change of Cobb S over time in the Zero P group was significantly different from that in the CP group. The maintenance of Cobb S in the Zero P group was better than that in the CP group (P < 0.05). The maintenance of anterior intervertebral disk height (IDH) at postoperative assessment for the Zero P group was significantly better than that in the CP group (P < 0.05). Within-group comparison of the postoperative change of anterior and posterior IDH over time revealed that the anterior IDH was significantly lower than the posterior IDH in the Zero P group (P < 0.05). For 2-level contiguous ACDF, the use of a zero-profile device has the capacity to show compatible outcomes in correction and maintenance of segmental angle if the anterior titanium alloy plate is properly positioned at the anterior vertebral line. Copyright © 2016 Elsevier Inc. All rights reserved.

Anterior cervical spine surgery-associated complications in a retrospective case-control study

PubMed Central

Giannis, Theofanis; Brotis, Alexandros G.; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N.

2017-01-01

Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier’s disease. Mean follow-up time was 42.5 months (range, 6–78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients’ overall functional outcome. PMID:29057356

Radiographic Response to Yttrium-90 Radioembolization in Anterior Versus Posterior Liver Segments

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

Ibrahim, Saad M.; Lewandowski, Robert J.; Ryu, Robert K.

2008-11-15

The purpose of our study was to determine if preferential radiographic tumor response occurs in tumors located in posterior versus anterior liver segments following radioembolization with yttrium-90 glass microspheres. One hundred thirty-seven patients with chemorefractory liver metastases of various primaries were treated with yttrium-90 glass microspheres. Of these, a subset analysis was performed on 89 patients who underwent 101 whole-right-lobe infusions to liver segments V, VI, VII, and VIII. Pre- and posttreatment imaging included either triphasic contrast material-enhanced CT or gadolinium-enhanced MRI. Responses to treatment were compared in anterior versus posterior right lobe lesions using both RECIST and WHO criteria.more » Statistical comparative studies were conducted in 42 patients with both anterior and posterior segment lesions using the paired-sample t-test. Pearson correlation was used to determine the relationship between pretreatment tumor size and posttreatment tumor response. Median administered activity, delivered radiation dose, and treatment volume were 2.3 GBq, 118.2 Gy, and 1,072 cm{sup 3}, respectively. Differences between the pretreatment tumor size of anterior and posterior liver segments were not statistically significant (p = 0.7981). Differences in tumor response between anterior and posterior liver segments were not statistically significant using WHO criteria (p = 0.8557). A statistically significant correlation did not exist between pretreatment tumor size and posttreatment tumor response (r = 0.0554, p = 0.4434). On imaging follow-up using WHO criteria, for anterior and posterior regions of the liver, (1) response rates were 50% (PR = 50%) and 45% (CR = 9%, PR = 36%), and (2) mean changes in tumor size were -41% and -40%. In conclusion, this study did not find evidence of preferential radiographic tumor response in posterior versus anterior liver segments treated with yttrium-90 glass microspheres.« less

Radiographic response to yttrium-90 radioembolization in anterior versus posterior liver segments.

PubMed

Ibrahim, Saad M; Lewandowski, Robert J; Ryu, Robert K; Sato, Kent T; Gates, Vanessa L; Mulcahy, Mary F; Kulik, Laura; Larson, Andrew C; Omary, Reed A; Salem, Riad

2008-01-01

The purpose of our study was to determine if preferential radiographic tumor response occurs in tumors located in posterior versus anterior liver segments following radioembolization with yttrium-90 glass microspheres. One hundred thirty-seven patients with chemorefractory liver metastases of various primaries were treated with yttrium-90 glass microspheres. Of these, a subset analysis was performed on 89 patients who underwent 101 whole-right-lobe infusions to liver segments V, VI, VII, and VIII. Pre- and posttreatment imaging included either triphasic contrast material-enhanced CT or gadolinium-enhanced MRI. Responses to treatment were compared in anterior versus posterior right lobe lesions using both RECIST and WHO criteria. Statistical comparative studies were conducted in 42 patients with both anterior and posterior segment lesions using the paired-sample t-test. Pearson correlation was used to determine the relationship between pretreatment tumor size and posttreatment tumor response. Median administered activity, delivered radiation dose, and treatment volume were 2.3 GBq, 118.2 Gy, and 1,072 cm(3), respectively. Differences between the pretreatment tumor size of anterior and posterior liver segments were not statistically significant (p = 0.7981). Differences in tumor response between anterior and posterior liver segments were not statistically significant using WHO criteria (p = 0.8557). A statistically significant correlation did not exist between pretreatment tumor size and posttreatment tumor response (r = 0.0554, p = 0.4434). On imaging follow-up using WHO criteria, for anterior and posterior regions of the liver, (1) response rates were 50% (PR = 50%) and 45% (CR = 9%, PR = 36%), and (2) mean changes in tumor size were -41% and -40%. In conclusion, this study did not find evidence of preferential radiographic tumor response in posterior versus anterior liver segments treated with yttrium-90 glass microspheres.

Effect of number and position of intraocular lens haptics on anterior capsule contraction: a randomized, prospective trial.

PubMed

Choi, Mihyun; Lazo, Marjorie Z; Kang, Minji; Lee, Jeehye; Joo, Choun-Ki

2018-03-20

The present study aimed to evaluate the degree of anterior capsule contraction (capsulorhexis contraction) with three different single-piece, hydrophilic acrylic intraocular lenses (IOLs). Patients were prospectively randomized to be implanted with one of three types of IOLs during cataract surgery: the Ophtec Precizon (IOL A), the Lucid Korea Microflex (IOL B), and the Carl Zeiss Asphina (IOL C). One week, 2 weeks, and 6 months after surgery, the area of the anterior capsule opening was measured using digital retro-illumination images after dilation of the pupil. The data were then evaluated using POCOman software. The study included 236 eyes of 202 patients. The area of the anterior capsule opening reduced by 3.53 ± 3.31 mm (17.06% ± 15.99%) between 1 week and 2 months post-operatively in the IOL A group, by 0.62 ± 1.32 mm (2.87% ± 6.03%) in the IOL B group, and by 1.09 ± 1.53 mm (4.72% ± 6.10%) in the IOL C group. The IOL B group showed minimal anterior capsule contraction 2 months after surgery (p < 0.001). IOLs with a four-plate haptic design (IOL B) showed more anterior capsular stability than those with a two-loop plate haptic (IOL A) or two-plate haptic (IOL C) design. The number and position of haptics in a capsular bag may affect anterior capsule contraction. We assume that supporting the zonules evenly may play a role in anterior capsular stability. Current Controlled Trials ISRCTN76566080 , Retrospectively registered (Date of registration: 14 Feb 2018).

Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features.

PubMed

Tykocki, Tomasz; Kostkiewicz, Bogusław

2014-09-01

Intracranial aneurysms (IAs) located in the posterior circulation are considered to have higher annual bleed rates than those in the anterior circulation. The aim of the study was to compare the morphometric factors differentiating between IAs located in the anterior and posterior cerebral circulation. A total number of 254 IAs diagnosed between 2009 and 2012 were retrospectively analyzed. All patients qualified for diagnostic, three-dimensional rotational angiography. IAs were assigned to either the anterior or posterior cerebral circulation subsets for the analysis. Means were compared with a t-test. The univariate and stepwise logistic regression analyses were used to determine the predictors of morphometric differences between the groups. For the defined predictors, ROC (receiver-operating characteristic) curves and interactive dot diagrams were calculated with the cutoff values of the morphometric factors. The number of anterior cerebral circulation IAs was 179 (70.5 %); 141 (55.5 %) aneurysms were ruptured. Significant differences between anterior and posterior circulation IAs were found for: the parent artery size (5.08 ± 1.8 mm vs. 3.95 ± 1.5 mm; p < 0.05), size ratio (2.22 ± 0.9 vs. 3.19 ± 1.8; p < 0.045) and aspect ratio (AR) (1.91 ± 0.8 vs. 2.75 ± 1.8; p = 0.02). Predicting factors differentiating anterior and posterior circulation IAs were: the AR (OR = 2.20; 95 % CI 1.80-270; Is 270 correct or should it be 2.70 and parent artery size (OR = 0.44; 95 % CI 0.38-0.54). The cutoff point in the ROC curve was 2.185 for the AR and 4.89 mm for parent artery size. Aspect ratio and parent artery size were found to be predictive morphometric factors in differentiating between anterior and posterior cerebral IAs.

Anatomical versus non-anatomical single bundle anterior cruciate ligament reconstruction: a cadaveric study of comparison of knee stability.

PubMed

Lim, Hong-Chul; Yoon, Yong-Cheol; Wang, Joon-Ho; Bae, Ji-Hoon

2012-12-01

The purpose of this study was to compare the initial stability of anatomical and non-anatomical single bundle anterior cruciate ligament (ACL) reconstruction and to determine which would better restore intact knee kinematics. Our hypothesis was that the initial stability of anatomical single bundle ACL reconstruction would be superior to that of non-anatomical single bundle ACL reconstruction. Anterior tibial translation (ATT) and internal rotation of the tibia were measured with a computer navigation system in seven pairs of fresh-frozen cadaveric knees under two testing conditions (manual maximum anterior force, and a manual maximum anterior force combined with an internal rotational force). Tests were performed at 0, 30, 60, and 90 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either anatomical or non-anatomical single bundle ACL reconstruction. Under manual maximal anterior force, both reconstruction techniques showed no significant difference of ATT when compared to ACL intact knee state at 30° of knee flexion (p > 0.05). Under the combined anterior and internal rotatory force, non-anatomical single-bundle ACL reconstruction showed significant difference of ATT compared to those in ACL intact group (p < 0.05). In contrast, central anatomical single bundle ACL reconstruction showed no significant difference of ATT compared to those in ACL intact group (p > 0.05). Internal rotation of the tibia showed no significant difference in the ACL intact, the ACL transected, non-anatomical reconstructed and anatomical reconstructed knees. Anatomical single bundle ACL reconstruction restored the initial stability closer to the native ACL under combined anterior and internal rotational forces when compared to non-anatomical ACL single bundle reconstruction.

Activation of biceps femoris long head reduces tibiofemoral anterior shear force and tibial internal rotation torque in healthy subjects.

PubMed

Azmi, Nur Liyana; Ding, Ziyun; Xu, Rui; Bull, Anthony M J

2018-01-01

The anterior cruciate ligament (ACL) provides resistance to tibial internal rotation torque and anterior shear at the knee. ACL deficiency results in knee instability. Optimisation of muscle contraction through functional electrical stimulation (FES) offers the prospect of mitigating the destabilising effects of ACL deficiency. The hypothesis of this study is that activation of the biceps femoris long head (BFLH) reduces the tibial internal rotation torque and the anterior shear force at the knee. Gait data of twelve healthy subjects were measured with and without the application of FES and taken as inputs to a computational musculoskeletal model. The model was used to investigate the optimum levels of BFLH activation during FES gait in reducing the anterior shear force to zero. This study found that FES significantly reduced the tibial internal rotation torque at the knee during the stance phase of gait (p = 0.0322) and the computational musculoskeletal modelling revealed that a mean BFLH activation of 20.8% (±8.4%) could reduce the anterior shear force to zero. At the time frame when the anterior shear force was zero, the internal rotation torque was reduced by 0.023 ± 0.0167 Nm/BW, with a mean 188% reduction across subjects (p = 0.0002). In conclusion, activation of the BFLH is able to reduce the tibial internal rotation torque and the anterior shear force at the knee in healthy control subjects. This should be tested on ACL deficient subject to consider its effect in mitigating instability due to ligament deficiency. In future clinical practice, activating the BFLH may be used to protect ACL reconstructions during post-operative rehabilitation, assist with residual instabilities post reconstruction, and reduce the need for ACL reconstruction surgery in some cases.

A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery.

PubMed

Hayashi, Ken; Ogawa, Soichiro; Manabe, Shin-Ichi; Hirata, Akira; Yoshimura, Koichi

2016-03-01

The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p < 0.0001). Major complications included a marked elevation in intraocular pressure (7.8 %), pupillary capture (6.5 %), and vitreous hemorrhage (2.6 %). Based on the classification system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.

Temperature in the anterior chamber during phacoemulsification.

PubMed

Suzuki, Hisaharu; Oki, Kotaro; Igarashi, Tsutomu; Shiwa, Toshihiko; Takahashi, Hiroshi

2014-05-01

To evaluate changes in the aqueous humor temperature using 2 phacoemulsification units (Stellaris 28.5 kHz device and Whitestar Signature 40 kHz device). Nippon Medical School, Musashikosugi Hospital, Kawasaki City, Kanagawa, Japan. Experimental study. Aqueous humor temperatures were measured with a temperature probe set in the anterior chamber during ultrasound (US) oscillation in porcine eyes under 5 conditions. Continuous longitudinal oscillation caused a rapid rise in aqueous humor temperature, while the pulse and elliptical modes suppressed temperature elevation. Reducing the number of US tip vibrations did not reduce the temperature in the anterior chamber. However, raising the vacuum setting allowed the aspirations to rise to the set value, thereby lowering the temperature in the anterior chamber. Because differences in the phacoemulsification settings can lead to temperature elevations in the anterior chamber, surgeons must carefully monitor these settings to prevent corneal tissue damage. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Sex Differences in Gray Matter Volume of the Right Anterior Hippocampus Explain Sex Differences in Three-Dimensional Mental Rotation

PubMed Central

Wei, Wei; Chen, Chuansheng; Dong, Qi; Zhou, Xinlin

2016-01-01

Behavioral studies have reported that males perform better than females in 3-dimensional (3D) mental rotation. Given the important role of the hippocampus in spatial processing, the present study investigated whether structural differences in the hippocampus could explain the sex difference in 3D mental rotation. Results showed that after controlling for brain size, males had a larger anterior hippocampus, whereas females had a larger posterior hippocampus. Gray matter volume (GMV) of the right anterior hippocampus was significantly correlated with 3D mental rotation score. After controlling GMV of the right anterior hippocampus, sex difference in 3D mental rotation was no longer significant. These results suggest that the structural difference between males’ and females’ right anterior hippocampus was a neurobiological substrate for the sex difference in 3D mental rotation. PMID:27895570

Passage of an Anterior Odontoid Screw through Gastrointestinal Tract.

PubMed

Leitner, L; Brückmann, C I; Gilg, M M; Bratschitsch, G; Sadoghi, P; Leithner, A; Radl, R

2017-01-01

Purpose . Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods . We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results . A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion . Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

[Dilemmas and controversies related to cancers of the anterior laryngeal commissure].

PubMed

Djukić, V; Stanković, P; Stevandić, N; Janosević, Lj; Pavlović, B

2004-01-01

From diagnostic and therapeutical aspect, the cancers of the anterior laryngeal commissure are the separate category in glottic cancers. But, they have not been individually classified in the majority of statistical reports, and, therefore, the incidence of the anterior commissural cancer should be taken with precaution. The issue of therapeutical strategy is controversial, considering the options and limitations of resections of the anterior commissural tumors, within the conception of oncological radicalism. Dilemmas are being especially faced with in radiotherapy, given the failures and unsatisfactory radiotherapeutical results. The prospective clinical study included the analysis of the incidence of primary and secondary cancers of the anterior commissure of the larynx. The follow-up of five-year survivals allowed for the establishment of efficiency of the applied therapeutical methods. The results of five-year survival in patients treated by primary surgery were highly more significant in relation to results obtained by radiotherapy of patients.

Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review.

PubMed

Yin, Dan-Hui; Yang, Xin-Ming; Huang, Qi; Yang, Mi; Tang, Qin-Lai; Wang, Shu-Hui; Wang, Shuang; Liu, Jia-Jia; Yang, Tao; Li, Shi-Sheng

2015-08-01

Pharyngoesophageal perforation after anterior cervical spine surgery is rare and the delayed cases were more rarely reported but potentially life-threatening. We report a case of pharyngoesophageal perforation 3 years after anterior cervical spine surgery. The patient presented with dysphagia, fever, left cervical mass and developing dyspnea 3 years after cervical spine surgery for trauma. After careful examinations, he underwent an emergency tracheostomy, neck exploration, hardware removal, abscess drainage and infected tissue debridement. 14 days after surgery, CT of the neck with oral contrast demonstrated no contrast extravasation from the esophagus. Upon review of literature, only 14 cases of pharyngoesophageal perforation more than 1 year after anterior cervical spine surgery were found. We discussed possible etiology, diagnosis and management and concluded that in cases of dysphagia, dyspnea, cervical pain, swelling and edema of the cervical area even long time after anterior cervical spine surgery, potential pharyngoesophageal damage should be considered.

Assessment of anterior shoulder instability by CT arthrography.

PubMed

Yang, S O; Cho, K J; Kim, M J; Ro, I W

1987-09-01

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.

Glenohumeral instability: evaluation with MR arthrography.

PubMed

Beltran, J; Rosenberg, Z S; Chandnani, V P; Cuomo, F; Beltran, S; Rokito, A

1997-01-01

Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.

Minimally invasive surgery of the anterior skull base: transorbital approaches

PubMed Central

Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl-Michael

2016-01-01

Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. PMID:27453759

Pigment dispersion syndrome masquerading as acute anterior uveitis.

PubMed

Gonzalez-Gonzalez, Luis Alonso; Rodríguez-García, Alejandro; Foster, C Stephen

2011-06-01

Signs and symptoms of pigment dispersion may be confused with those of acute anterior uveitis. This case series is intended to aid the ophthalmologist in the clinical differentiation between these two disorders. The authors present a series of 6 patients with pigment dispersion who were initially diagnosed as having acute anterior uveitis and treated with anti-inflammatory medication, including corticosteroids. The patients were referred for a second opinion due to poor or no response to therapy and were found to have pigment dispersion instead of uveitis. Symptoms of pigment dispersion may consist of blurred vision, redness, ocular pain, and photophobia, all of which are also symptoms of acute anterior uveitis. These symptoms, plus the fact that pigment floating in the aqueous humor can be mistaken for inflammation, make diagnosis challenging. Moreover, the possible co-existence of true anterior uveitis and pigment dispersion makes the diagnosis and treatment more difficult.

A conservative approach for restoring anterior guidance: a case report.

PubMed

Pontons-Melo, Juan Carlos; Pizzatto, Eduardo; Furuse, Adilson Yoshio; Mondelli, José

2012-06-01

One of the most common dental problems in today's clinics is tooth wear, specifically when related to bruxism. In such cases, the esthetics of anterior teeth may be compromised when excessive wear to the incisal surfaces occurs. Anterior tooth wear resulting from parafunctional bruxism can be conservatively treated with the use of direct resin composite restorations. This restorative approach has the advantages of presenting good predictability, load resistance, acceptable longevity, preservation of healthy dental tissues, and lower cost when compared with indirect restorations. The use of resin composites to solve esthetic problems, however, requires skill and practice. Thus, the present article demonstrates a conservative approach for restoring the esthetics and function of worn anterior teeth with the aid of direct resin composite restorations and selective occlusal adjustment. A conservative approach to restore anterior teeth with excessive wear is possible with direct resin composites. © 2011 Wiley Periodicals, Inc.

bicoid mRNA localises to the Drosophila oocyte anterior by random Dynein-mediated transport and anchoring

PubMed Central

Trovisco, Vítor; Belaya, Katsiaryna; Nashchekin, Dmitry; Irion, Uwe; Sirinakis, George; Butler, Richard; Lee, Jack J; Gavis, Elizabeth R; St Johnston, Daniel

2016-01-01

bicoid mRNA localises to the Drosophila oocyte anterior from stage 9 of oogenesis onwards to provide a local source for Bicoid protein for embryonic patterning. Live imaging at stage 9 reveals that bicoid mRNA particles undergo rapid Dynein-dependent movements near the oocyte anterior, but with no directional bias. Furthermore, bicoid mRNA localises normally in shot2A2, which abolishes the polarised microtubule organisation. FRAP and photo-conversion experiments demonstrate that the RNA is stably anchored at the anterior, independently of microtubules. Thus, bicoid mRNA is localised by random active transport and anterior anchoring. Super-resolution imaging reveals that bicoid mRNA forms 110–120 nm particles with variable RNA content, but constant size. These particles appear to be well-defined structures that package the RNA for transport and anchoring. DOI: http://dx.doi.org/10.7554/eLife.17537.001 PMID:27791980

Surgical Treatments on Patients with Anterior Cervical Hyperostosis-Derived Dysphagia

PubMed Central

Song, Ah Rom; Byun, Eunjin; Kim, Youngbae; Park, Kwan Ho; Kim, Kyung Lyul

2012-01-01

Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight loss, another complained of dysphagia only when swallowing pills, and the third experienced recurrence symptom with reossification. All patients reported gradual improvement of dysphagia immediately after their cervical osteophytes were resected through the anterior approach. In relation to postoperative improvement, however, they expressed different degrees of satisfaction according to severity of symptoms. Surgical treatment, performed for the anterior cervical hyperostosis-derived dysphagia, can immediately relieve symptoms of difficulty in swallowing. This might especially be considered as an appropriate treatment option for severe dysphagia. PMID:23185741

Variaciones seculares de período en las RR Lyrae de ω~Centauri

NASA Astrophysics Data System (ADS)

Marraco, H. G.; Milesi, G. E.

Utilizando 689 observaciones de 35 estrellas RR Lyrae del cúmulo globular ω Centauri hemos obtenido nuevas determinaciones de sus períodos y sus correspondientes variaciones seculares. Las observaciones fueron obtenidas de la literatura con la excepción de un grupo 66 determinaciones que se presentan por vez primera aquí. Utilizando el parámetro testigo σ descripto en Marraco & Muzzio (Publ. Astron. Soc. Pacific 92, 700, 1980), hemos realizado un ajuste bidimensional en P y β (donde β es la variación secular del período). Con este fin la totalidad de las 689 observaciones fueron llevadas a un sistema fotométrico común. Para esto se realizó un cuidadoso análisis de los numerosos errores en la identificación de las estrellas de las series de comparación. Los resultados de los ajustes bidimensionales fueron analizados utilizando técnicas de procesamiento de imágenes. Con este fin el parámetro de ajuste σ fue representado como función de P y β. En las imágenes resultantes se buscaron los mínimos y al menor de ellos se lo aceptó como período instantáneo verdadero y su variación secular β. La determinación precisa de cada parámetro se realizó mediante ajuste de gaussianas y se determinaron sus errores. A modo de ejemplo la variable #8 fue analizada en una matriz de 501 × 501 elementos representando el parámetro σ para valores comprendidos entre 0,521034 < P < 0,521534 dias y -150×10-10 < β < +150×10-10 dias/dia. El mejor período instantáneo (correspondiente a la época DJ=2.426.908) y su variación secular son P = 0,5212859±0,0000001 días y β 14,012±,010×10-10 días/día respectivamente. Con estos valores el parámetro testigo resulta σ= 0,127 . Si no se tiene en cuenta la variación secular del período y se busca aquél de mejor ajuste para β = 0, se obtiene P = 0,5212960 días, pero entonces el parámetro de ajuste resulta tan alto como σ = 0,23 .

Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results.

PubMed

Poehling-Monaghan, Kirsten L; Kamath, Atul F; Taunton, Michael J; Pagnano, Mark W

2015-02-01

Although some surgeons strongly advocate for one approach over the other, there are few data directly comparing the direct anterior approach with a miniposterior approach for total hip arthroplasty (THA). Using the same advanced pain and rapid rehabilitation protocols for both groups, we compared the direct anterior and miniposterior approaches with respect to (1) return to activities of daily living at 2 days, 2 weeks, or 2 months; (2) risk of intraoperative or early postoperative complications; and (3) component position. Over a 1-year period we identified all consecutive, primary direct anterior and miniposterior THAs performed by two surgeons at our institution, totaling 242 patients. Of those, 20 did not meet inclusion criteria as a result of prior trauma or surgery about the hip. A total of 222 patients, 126 direct anterior and 96 miniposterior, were retrospectively evaluated. All cases were done by one of two surgeons, one of whom performs THA exclusively through the direct anterior approach and the other who only uses the miniposterior approach. Groups did not differ demographically with mean±SD age 64±12 years, mean body mass index 30±5.7 kg/m2, and 50% female. The same rapid rehabilitation protocols were used with no postoperative hip positioning precautions. No differences were seen between the two groups in mean length of stay (2.2 days; range, 1-9 days), operative or in-hospital complications, intravenous breakthrough analgesia, stairs, maximum feet walked in-hospital, or percent discharged to home (80% [177 of 222]; all p>0.2). The direct anterior patients had longer mean operative times (114 minutes; range, 60-251 minutes) than the miniposterior patients (mean, 60 minutes; range, 41-113 minutes; p<0.001). The direct anterior group had a higher maximum visual analog scale pain score (5.3 direct anterior; ±2, versus 3.8 MP; ±2; p<0.0001). At 2 weeks, more direct anterior patients required gait aids (92% [116 of 126]) than miniposterior (68% [62 of 96]; p<0.0001). At 8 weeks, direct anterior patients had higher mean Harris hip scores (95 versus 89) but a lower return to work and driving with no difference in their use of gait aids, narcotics, activities of daily living, or walking 0.5 mile. More wound problems occurred in the miniposterior group (p<0.01). With the numbers available, component alignment was not different between the study groups (p>0.05 for all comparisons). There was no systematic advantage of direct anterior THA versus miniposterior THA. Contrary to conventional belief and somewhat surprising were the fewer minor wound problems in the direct anterior group and the higher proportion of patients free of gait aids at 2 weeks and back to driving and working at 8 weeks in the miniposterior group. Factors other than surgical approach, perhaps including attentive pain management, patient selection, surgical volume and experience, careful preoperative templating, and rapid rehabilitation protocols, may be more important in terms of influencing early recovery after THA. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Extrarticular hip impingement.

PubMed

Marin-Peña, Óliver; Sierra-Madrid, Pablo; Lax-Pérez, Raquel; Ferrero-Manzanal, Francisco

2016-05-14

Extrarticular causes of impingement have a current, interesting role in the complaint of groin pain in athletes. Subspine impingement is related to a prominent anterior inferior iliac spine (AIIS) and is actually described as a frequent cause of groin pain. Ischiofemoral impingement is described when the space between the lesser trochanter is decreased. Psoas impingement appears between the psoas tendon and the anterior labrum and anterior acetabular rim.

Tension band plating of a nonunion anterior tibial stress fracture in an athlete.

PubMed

Merriman, Jarrad A; Villacis, Diego; Kephart, Curtis J; Rick Hatch, George F

2013-07-01

The authors present a rare technique of tension band plating of the anterior tibia in the setting of a nonunion stress fracture. Surgical management with an intramedullary nail is a viable and proven option for treating such injuries. However, in treating elite athletes, legitimate concerns exist regarding the surgical disruption of the extensor mechanism and the risk of anterior knee pain associated with intramedullary nail use. The described surgical technique demonstrates the use of tension band plating as an effective treatment of delayed union and nonunion anterior tibial stress fractures in athletes without the potential risks of intramedullary nail insertion. Copyright 2013, SLACK Incorporated.

Intravital multiphoton imaging of mouse tibialis anterior muscle

PubMed Central

Lau, Jasmine; Goh, Chi Ching; Devi, Sapna; Keeble, Jo; See, Peter; Ginhoux, Florent; Ng, Lai Guan

2016-01-01

ABSTRACT Intravital imaging by multiphoton microscopy is a powerful tool to gain invaluable insight into tissue biology and function. Here, we provide a step-by-step tissue preparation protocol for imaging the mouse tibialis anterior skeletal muscle. Additionally, we include steps for jugular vein catheterization that allow for well-controlled intravenous reagent delivery. Preparation of the tibialis anterior muscle is minimally invasive, reducing the chances of inducing damage and inflammation prior to imaging. The tibialis anterior muscle is useful for imaging leukocyte interaction with vascular endothelium, and to understand muscle contraction biology. Importantly, this model can be easily adapted to study neuromuscular diseases and myopathies. PMID:28243520

Cognitive control and the anterior cingulate cortex: how conflicting stimuli affect attentional control in the rat

PubMed Central

Newman, Lori A.; Creer, David J.; McGaughy, Jill A.

2014-01-01

Converging evidence supports the hypothesis that the prefrontal cortex is critical for cognitive control. One prefrontal subregion, the anterior cingulate cortex, is hypothesized to be necessary to resolve response conflicts, disregard salient distractors and alter behavior in response to the generation of an error. These situations all involve goal-oriented monitoring of performance in order to effectively adjust cognitive processes. Several neuropsychological disorders, e.g., schizophrenia, attention deficit hyperactivity and obsessive compulsive disorder, are accompanied by morphological changes in the anterior cingulate cortex. These changes are hypothesized to underlie the impairments on tasks that require cognitive control found in these subjects. A novel conflict monitoring task was used to assess the effects on cognitive control of excitotoxic lesions to anterior cingulate cortex in rats. Prior to surgery all subjects showed improved accuracy on the second of two consecutive, incongruent trials. Lesions to the anterior cingulate cortex abolished this. Lesioned animals had difficulty in adjusting cognitive control on a trial-by-trial basis regardless of whether cognitive changes were increased or decreased. These results support a role for the anterior cingulate cortex in adjustments in cognitive control. PMID:25051488

Diminished rostral anterior cingulate activity in response to threat-related events in posttraumatic stress disorder.

PubMed

Kim, Minue J; Chey, Jeanyung; Chung, Ain; Bae, Soojeong; Khang, Hyunsoo; Ham, Byungjoo; Yoon, Sujung J; Jeong, Do-Un; Lyoo, In Kyoon

2008-03-01

Previous brain imaging studies have reported hyperactivation of the amygdala and hypoactivation of the anterior cingulate in posttraumatic stress disorder (PTSD) patients, which is believed to be an underlying neural mechanism of the PTSD symptoms. The current study specifically focuses on the abnormal activity of the rostral anterior cingulate, using a paradigm which elicits an unexpected processing conflict caused by salient emotional stimuli. Twelve survivors (seven men and five women) of the Taegu subway fire in 2003, who later developed PTSD, agreed to participate in this study. Twelve healthy volunteers (seven men and five women) were recruited for comparison. Functional brain images of all participants were acquired using functional magnetic resonance imaging while performing a same-different judgment task, which was modified to elicit an unexpected emotional processing conflict. PTSD patients, compared to comparison subjects, showed a decreased rostral anterior cingulate functioning when exposed to situations which induce an unexpected emotional processing conflict. Moreover, PTSD symptom severity was negatively correlated to the level of decrease in the rostral anterior cingulate activity. The results of this study provide evidence that the rostral anterior cingulate functioning is impaired in PTSD patients during response-conflict situations that involve emotional stimuli.

Regulating mechanical tension at compartment boundaries in Drosophila.

PubMed

Michel, Marcus; Dahmann, Christian

2016-10-01

During animal development, cells with similar function and fate often stay together and sort out from cells with different fates. In Drosophila wing imaginal discs, cells of anterior and posterior fates are separated by a straight compartment boundary. Separation of anterior and posterior cells requires the homeodomain-containing protein Engrailed, which is expressed in posterior cells. Engrailed induces the expression of the short-range signaling molecule Hedgehog in posterior cells and confines Hedgehog signal transduction to anterior cells. Transduction of the Hedgehog signal in anterior cells is required for the separation of anterior and posterior cells. Previous work showed that this separation of cells involves a local increase in mechanical tension at cell junctions along the compartment boundary. However, how mechanical tension was locally increased along the compartment boundary remained unknown. A recent paper now shows that the difference in Hedgehog signal transduction between anterior and posterior cells is necessary and sufficient to increase mechanical tension. The local increase in mechanical tension biases junctional rearrangements during cell intercalations to maintain the straight shape of the compartment boundary. These data highlight how developmental signals can generate patterns of mechanical tension important for tissue organization.

Innervation of the Anterior Sacroiliac Joint.

PubMed

Cox, Marcus; Ng, Garrett; Mashriqi, Faizullah; Iwanaga, Joe; Alonso, Fernando; Tubbs, Kevin; Loukas, Marios; Oskouian, Rod J; Tubbs, R Shane

2017-11-01

Sacroiliac joint pain can be disabling and recalcitrant to medical therapy. The innervation of this joint is poorly understood, especially its anterior aspect. Therefore, the present cadaveric study was performed to better elucidate this anatomy. Twenty-four cadaveric sides underwent dissection of the anterior sacroiliac joint, with special attention given to any branches from regional nerves to this joint. No femoral, obturator, or lumbosacral trunk branches destined to the anterior sacroiliac joint were identified in the 24 sides. In 20 sides, one or two small branches (less than 0.5 mm in diameter) were found to arise from the L4 ventral ramus (10%), the L5 ventral ramus (80%), or simultaneously from both the L4 and L5 ventral rami (10%). The length of the branches ranged from 5 to 31 mm (mean, 14 mm). All these branches arose from the posterior part of the nerves and traveled to the anterior surface of the sacroiliac joint. No statistical significance was found between sides or sexes. An improved knowledge of the innervation of the anterior sacroiliac joint might decrease suffering in patients with chronic sacroiliac joint pain. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain.

PubMed

Kwak, Yoon-Hae; Lim, Jae-Young; Oh, Min-Kyung; Kim, Woo-Jin; Park, Kun-Bo

2015-06-01

Skeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view. Patients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included. The initial and 4 weeks' follow-up ankle series and additional anterior talofibular ligament view suggested by Haraguchi were evaluated. Twenty patients were diagnosed with occult distal fibular avulsion fracture. Ten patients were diagnosed in anterior talofibular ligament view and others were diagnosed in the follow-up radiography. Displacement was highest on the anterior talofibular ligament view. This study found 20 (26%) of 78 ankle sprain show occult avulsion fracture in the anterior talofibular ligament view or follow-up radiography. The anterior talofibular ligament view is an appropriate radiologic view for the diagnosis of distal fibular avulsion fracture. Level IV--diagnostic study.

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture.

PubMed

Li, Xinning; Cusano, Antonio; Eichinger, Josef

2017-01-01

Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape. Given his marked dysfunction, weakness, pain, and recurrent instability in the absence of glenohumeral arthritis, he underwent an open Eden-Hybinette procedure (iliac crest autograft), a pectoralis major transfer, and an anterior capsule repair. The patient returned to his previous work activities without limitations. To the authors' knowledge, this is the first report describing a combination of anterior glenoid bone grafting with a full pectoralis major muscle transfer for a patient with chronic subscapularis rupture and anterior-superior escape after a failed Latarjet procedure with minimum glenoid bone loss. Furthermore, the authors provide a biomechanical rationale for the reconstruction used for this problem. [Orthopedics. 2017; 40(1):e182-e187.]. Copyright 2016, SLACK Incorporated.

The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

PubMed

Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G

2017-02-01

Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

One-stage posterior approaches for treatment of thoracic spinal infection: Transforaminal and costotransversectomy, compared with anterior approach with posterior instrumentation.

PubMed

Kao, Fu-Cheng; Tsai, Tsung-Ting; Niu, Chi-Chien; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer

2017-10-01

Treating thoracic infective spondylodiscitis with anterior surgical approaches carry a relatively high risk of perioperative and postoperative complications. Posterior approaches have been reported to result in lower complication rates than anterior procedures, but more evidence is needed to demonstrate the safety and efficacy of 1-stage posterior approaches for treating infectious thoracic spondylodiscitis.Preoperative and postoperative clinical data, of 18 patients who underwent 2 types of 1-stage posterior procedures, costotransversectomy and transforaminal thoracic interbody debridement and fusion and 7 patients who underwent anterior debridement and reconstruction with posterior instrumentation, were retrospectively assessed.The clinical outcomes of patients treated with 1-stage posterior approaches were generally good, with good infection control, back pain relief, kyphotic angle correction, and either partial or solid union for fusion status. Furthermore, they achieved shorter surgical time, fewer postoperative complications, and shorter hospital stay than the patients underwent anterior debridement with posterior instrumentation.The results suggested that treating thoracic spondylodiscitis with a single-stage posterior approach might prevent postoperative complications and avoid respiratory problems associated with anterior approaches. Single-stage posterior approaches would be recommended for thoracic spine infection, especially for patients with medical comorbidities.

The anterior approach for the fixation of displaced talar neck fractures--a cadaveric study.

PubMed

Mullen, Michael; Pillai, Anand; Fogg, Quentin A; Kumar, C Senthil

2013-01-01

Talar neck fractures are rare and are associated with high complication rates. Adequate surgical exposure is essential in the operative management of these challenging injuries. The anterior approach is an alternative to the more commonly described and utilized anterolateral and anteromedial approaches. The main objective was to compare the surface area of talus visible and quality of exposure via the anterior approach, with the anteromedial and anterolateral approaches. An anterior approach was performed on five fresh frozen cadaveric specimens. The surface area of talus visible was measured using an Immersion Digital Microscribe and analyzed with the Rhinoceros 3D graphics package. Standard anterolateral and anteromedial approaches were performed in the same specimens and areas visible measured using the same method. The talar surface area visible using the anterior approach is significantly greater than that visible using the anterolateral approach or anteromedial, without and with medial malleolar osteotomy, as well as combination approaches. The anterior approach offers excellent visualization in the fixation of displaced talar neck fractures. Greater talar surface area is visible using this approach compared to traditional approaches. Copyright © 2013 Elsevier Ltd. All rights reserved.

Changes in Gait with Anteriorly Added Mass: A Pregnancy Simulation Study

PubMed Central

Ogamba, Maureen I.; Loverro, Kari L.; Laudicina, Natalie M.; Gill, Simone V.; Lewis, Cara L.

2016-01-01

During pregnancy, the female body experiences structural changes, such as weight gain. As pregnancy advances, most of the additional mass is concentrated anteriorly on the lower trunk. The purpose of this study is to analyze kinematic and kinetic changes when load is added anteriorly to the trunk, simulating a physical change experienced during pregnancy. Twenty healthy females walked on a treadmill while wearing a custom made pseudo-pregnancy sac (1 kg) under three load conditions: sac only, 10 pound condition (4.535 kg added anteriorly), and 20 pound condition (9.07 kg added anteriorly), used to simulate pregnancy, in the second trimester and at full term pregnancy, respectively. The increase in anterior mass resulted in kinematic changes at the knee, hip, pelvis, and trunk in the sagittal and frontal planes. Additionally, ankle, knee, and hip joint moments normalized to baseline mass increased with increased load; however, these moments decreased when normalized to total mass. These kinematic and kinetic changes may suggest that women modify gait biomechanics to reduce the effect of added load. Furthermore, the increase in joint moments increases stress on the musculoskeletal system and may contribute to musculoskeletal pain. PMID:26958743

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web.

PubMed

Xiao, Yang; Wang, Jun; Han, Demin; Ma, Lijing; Ye, Jingying; Xu, Wen

2014-01-01

Anterior glottic web is one type of laryngeal stenosis. Previous surgical methods had some drawbacks, such as large surgical trauma, long postoperative recovery time, and multiple-stage surgery. This study aimed to explore better treatment to repair anterior glottis web. We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs. All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope. All 32 patients completed surgery in one stage, without postoperative laryngeal edema, difficulty in breathing, or other complications. After the surgery, the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however, in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords, accompanied by scar appearance of bilateral vocal cords. The GRB score, voice handicap index scores, and maximum phonation time score significantly improved in all patients after the surgery. There was no evidence of recurrent laryngeal webbing in the 6-month follow-up. Vocal cords mucosal flap repair surgery has the advantages of less trauma, quick recovery, and significant improvement of the voice in the treatment of laryngeal webs.

Evaluation of white-to-white distance and anterior chamber depth measurements using the IOL Master, slit-lamp adapted optical coherence tomography and digital photographs in phakic eyes.

PubMed

Wilczyński, Michał; Pośpiech-Zabierek, Aleksandra

2015-01-01

The accurate measurement of the anterior chamber internal diameter and depth is important in ophthalmic diagnosis and before some eye surgery procedures. The purpose of the study was to compare the white-to-white distance measurements performed using the IOL-Master and photography with internal anterior chamber diameter determined using slit lamp adapted optical coherence tomography in healthy eyes, and to compare anterior chamber depth measurements by IOL-Master and slit lamp adapted optical coherence tomography. The data were gathered prospectively from a non-randomized consecutive series of patients. The examined group consisted of 46 eyes of 39 patients. White-to-white was measured using IOL-Master and photographs of the eye were taken with a digital camera. Internal anterior chamber diameter was measured with slit-lamp adapted optical coherence tomography. Anterior chamber depth was measured using the IOL Master and slit-lamp adapted optical coherence tomography. Statistical analysis was performed using parametric tests. A Bland-Altman plot was drawn. White-to-white distance by the IOL Master was 11.8 +/- 0.40 mm, on photographs it was 11.29 +/- 0.58 mm and internal anterior chamber diameter by slit-lamp adapted optical coherence tomography was 11.34?0.54 mm. A significant difference was found between IOL-Master and slit-lamp adapted optical coherence tomography (p<0.01), as well as between IOL Master and digital photographs (p<0.01). There was no difference between SL-OCT and digital photographs (p>0.05). All measurements were correlated (Spearman p<0.001). Mean anterior chamber depth determined using the IOL-Master was 2.99 +/- 0.50 mm and by slit-lamp adapted optical coherence tomography was 2.56 +/- 0.46 mm. The difference was statistically significant (p<0.001). The correlation between the values was also statistically significant (Spearman, p<0.001). Automated measurements using IOL-Master yield constantly higher values than measurements based on direct eye visualization slit-lamp adapted optical coherence tomography and digital photographs. In order to obtain accurate measurements of the internal anterior chamber diameter and anterior chamber depth, a method involving direct visualization of intraocular structures should be used.

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps.

PubMed

Archer, Jacob B; Sun, Hai; Bonney, Phillip A; Zhao, Yan Daniel; Hiebert, Jared C; Sanclement, Jose A; Little, Andrew S; Sughrue, Michael E; Theodore, Nicholas; James, Jeffrey; Safavi-Abbasi, Sam

2016-03-01

This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients' mean age was 33 years (range 11-79 years). The mean overall length of follow-up was 14 months (range 5-45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)--1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

Anatomic distribution of nerves and microvascular density in the human anterior vaginal wall: prospective study.

PubMed

Li, Ting; Liao, Qinping; Zhang, Hong; Gao, Xuelian; Li, Xueying; Zhang, Miao

2014-01-01

The presence of the G-spot (an assumed erotic sensitive area in the anterior wall of the vagina) remains controversial. We explored the histomorphological basis of the G-spot. Biopsies were drawn from a 12 o'clock direction in the distal- and proximal-third areas of the anterior vagina of 32 Chinese subjects. The total number of protein gene product 9.5-immunoreactive nerves and smooth muscle actin-immunoreactive blood vessels in each specimen was quantified using the avidin-biotin-peroxidase assay. Vaginal innervation was observed in the lamina propria and muscle layer of the anterior vaginal wall. The distal-third of the anterior vaginal wall had significantly richer small-nerve-fiber innervation in the lamina propria than the proximal-third (p = 0.000) and in the vaginal muscle layer (p = 0.006). There were abundant microvessels in the lamina propria and muscle layer, but no small vessels in the lamina propria and few in the muscle layer. Significant differences were noted in the number of microvessels when comparing the distal- with proximal-third parts in the lamina propria (p = 0.046) and muscle layer (p = 0.002). Significantly increased density of nerves and microvessels in the distal-third of the anterior vaginal wall could be the histomorphological basis of the G-spot. Distal anterior vaginal repair could disrupt the normal anatomy, neurovascular supply and function of the G-spot, and cause sexual dysfunction.

Laparoscopic Heller Myotomy with Anterior Fundoplication Improves Frequency and Severity of Symptoms of Achalasia, Regardless of Preoperative Severity Determined by Esophagography.

PubMed

Rosemurgy, Alexander; Downs, Darrell; Luberice, Kenneth; Rodriguez, Christian; Swaid, Forat; Patel, Krishen; Toomey, Paul; Ross, Sharona

2018-02-01

This study was undertaken to determine whether postoperative outcomes after laparoscopic Heller myotomy with anterior fundoplication could be predicted by preoperative findings on esophagography. Preoperative barium esophagograms of 135 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were reviewed. The number of esophageal curves, esophageal width, and angulation of the gastroesophageal junction (GEJ) were determined; correlations between these determined parameters and symptoms were assessed using linear regression analysis. The number of esophageal curves correlated with the preoperative frequency of dysphagia, vomiting, chest pain, regurgitation, and heartburn. The width of the esophagus negatively correlated with the preoperative frequency of regurgitation. The angulation of the GEJ did not correlate with preoperative symptoms. Laparoscopic Heller myotomy with anterior fundoplication significantly reduced the frequency and severity of all symptoms, regardless of the number of esophageal curves, esophageal width, or angulation of the GEJ. Laparoscopic Heller myotomy with anterior fundoplication provides dramatic palliation for achalasia. More esophageal curves on preoperative esophagography correlate well with the frequency of a broad range of preoperative symptoms, including the frequency of dysphagia and regurgitation. Patients experience dramatically improved frequency and severity of symptoms after laparoscopic Heller myotomy with anterior fundoplication for achalasia regardless of the number of esophageal curves, esophageal width, or the angulation of the GEJ. Findings on barium esophagogram, in evaluating achalasia, should not deter the application of laparosocopic Heller myotomy with anterior fundoplication.

In vivo confocal microscopic analysis of normal human anterior limbal stroma

PubMed Central

Mathews, Saumi; Chidambaram, Jaya Devi; Lanjewar, Shruti; Mascarenhas, Jeena; Prajna, Namperumalsamy Venkatesh; Muthukkaruppan, Veerappan; Chidambaranathan, Gowri Priya

2015-01-01

Purpose To characterize the microarchitecture of the anterior limbal stroma in healthy individuals using in vivo confocal microscopy (IVCM) and to correlate it with mesenchymal stem cells (MSCs), a component of the limbal-niche. Methods The corneal side of the superior limbus was scanned in 30 eyes of 17 normal subjects beyond the basal epithelium, deep into the stroma using a HRT III laser scanning microscope. The IVCM findings were correlated with the immunohistochemical features of MSCs in the anterior limbal stroma. Results Clusters of hyperreflective structures were observed in the anterior limbal stroma, subjacent to the basal epithelium (depth: 50.2±8.7 - 98±12.8 μm), but not in the corneal stroma. The structures showed unique morphology compared to epithelial cells, keratocytes, neurons and dendritic cells. In parallel, confocal analysis of immunostained sections showed clusters of cells, double positive for MSC specific markers (CD90 and CD105) in the anterior limbal stroma at a depth of 55.3±12.7 μm to 72±37.6 μm. The organization and distribution of the MSC clusters locates them within the hyperreflective region in the anterior limbal stroma. Conclusions The hyperreflective structures, demonstrated for the first time in the human anterior limbal stroma, probably represent an important component of the limbal-niche. Our approach of in vivo imaging may pave the way for assessing the limbal stromal health. PMID:25742388

Effect of Fasting on Corneal Biomechanical and Structural Parameters.

PubMed

Sarici, Ahmet M; Yuksel Elgin, Cansu; Dikkaya, Funda

2016-07-01

To evaluate the effects of hunger and thirst on corneal biomechanical and structural parameters during Ramadan fasting. Corneal biomechanical properties and intraocular pressures of 29 eyes of 29 healthy subjects were evaluated by Reichert ocular response analyzer; and structural and anatomical properties of cornea and anterior eye chamber of same eyes were scanned with Oculus Pentacam anterior segment analyzer. Each eye has been evaluated at 8 am and 4 pm both during and 1 month after Ramadan. Changes of subjects' weight were calculated and their relationship with corneal biomechanical and structural parameters was assessed. Intraday changes in horizontal corneal astigmatism (p = 0.02), anterior chamber volume (p = 0.01), intraocular pressure associated with the Goldmann IOPg (p = 0.02) and corneal resistance factor (CRF) (p = 0.04) were significantly different when measured during the fasting period in Ramadan and 1 month thereafter. Moreover, when we compared 8 am measurements taken during and after Ramadan, we observed significant differences for anterior chamber volume (p = 0.04) and anterior chamber angle values (p = 0.03). Similarly, for 4 pm measurements, there were significant differences for IOPg (p = 0.01) and CRF values (p = 0.00). Fasting lasting for more than 12 h during Ramadan creates an important window of opportunity to investigate the response of anterior chamber of eye to hunger and thirst. The current study contributes to the existing literature on the effects of dietary habits and water intake on corneal and anterior chamber properties.

Effect of bracket slot and archwire dimensions on anterior tooth movement during space closure in sliding mechanics: a 3-dimensional finite element study.

PubMed

Tominaga, Jun-ya; Ozaki, Hiroya; Chiang, Pao-Chang; Sumi, Mayumi; Tanaka, Motohiro; Koga, Yoshiyuki; Bourauel, Christoph; Yoshida, Noriaki

2014-08-01

It has been found that controlled movement of the anterior teeth can be obtained by attaching a certain length of power arm onto an archwire in sliding mechanics. However, the impact of the archwire/bracket play on anterior tooth movement has not been clarified. The purpose of this study was to compare the effect of the power arm on anterior tooth movements with different dimensions of bracket slots and archwires. A 3-dimensional finite element method was used to simulate en-masse anterior tooth retraction in sliding mechanics. Displacements of the maxillary central incisor and the archwire deformation were calculated when applying retraction forces from different lengths of power arms. When a 0.017 × 0.022-in archwire was engaged into the 0.018-in slot bracket, bodily movement of the incisor was obtained with 9.1-mm length of the power arm. When a 0.022-in slot system was coupled with a 0.019 × 0.025-in archwire, bodily movement was observed with a power arm length of 11.6 mm. Archwire/bracket play has a remarkable impact on anterior tooth movement. An effective torque application to the anterior teeth becomes clinically difficult in sliding mechanics combined with power arms when the archwire/bracket play is large. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

[Changes of structures of anterior chamber angle in rabbit chronic high intraocular pressure model].

PubMed

Lei, Xun-wen; Wei, Ping; Li, Xiao-lin; Yang, Kan; Lei, Jian-zhen

2009-10-01

To observe the anterior chamber angle changes occurred in compound Carbomer-induced chronic high intraocular pressure (IOP) model in rabbit eyes. It was an experimental study. Thirty two rabbits were randomly divided into eight groups. Compound Carbomer (0.3%, 0.3 ml) was injected into the left anterior chamber. A group of rabbits were randomly killed after 1, 2, 3, 4, 6, 8, 10 and 12 weeks. The anterior chamber of the rabbit eye specimens was observed. IOP increased slowly following the application of the drug, high IOP lasted for 3 months. The drug-induced changes of anterior chamber angle consisted of early inflammatory response and late fibrous changes. Inflammatory response occurred in early stage and reduced or disappeared after 3 weeks. Fibrous degeneration and adhesion obstruction occurred in the anterior chamber angle after 4 weeks. Under the electron microscope, the trabecular was expanded and deformed, with hyperplasia of collagen and elastic fibers. Endothelial cells were separated from the trabecular, and showed the morphology of lymphocytes, with the function similar to the macrophages. Phagocytized Carbomer particles were transported through the vacuoles of Schlemm's canal endothelial cells. Large vacuoles gradually reduced. Excessive Carbomer particles were accumulated in the endothelial cells and obstructed the Schlemm's canal. This induced the fibrous proliferation and the destruction of anterior chamber angle structures. The obstruction of aqueous humor outflow induced by compound Carbomer in rabbit high IOP model is caused mainly by the changes in trabecular endothelial cells.

Xwnt-8 and lithium can act upon either dorsal mesodermal or neurectodermal cells to cause a loss of forebrain in Xenopus embryos

NASA Technical Reports Server (NTRS)

Fredieu, J. R.; Cui, Y.; Maier, D.; Danilchik, M. V.; Christian, J. L.

1997-01-01

When Xenopus gastrulae are made to misexpress Xwnt-8, or are exposed to lithium ions, they develop with a loss of anterior structures. In the current study, we have characterized the neural defects produced by either Xwnt-8 or lithium and have examined potential cellular mechanisms underlying this anterior truncation. We find that the primary defect in embryos exposed to lithium at successively earlier stages during gastrulation is a progressive rostral to caudal deletion of the forebrain, while hindbrain and spinal regions of the CNS remain intact. Misexpression of Xwnt-8 during gastrulation produces an identical loss of forebrain. Our results demonstrate that lithium and Wnts can act upon either prospective neural ectodermal cells, or upon dorsal mesodermal cells, to cause a loss of anterior pattern. Specifically, ectodermal cells isolated from lithium- or Wnt-exposed embryos are unable to form anterior neural tissue in response to inductive signals from normal dorsal mesoderm. In addition, although dorsal mesodermal cells from lithium- or Wnt-exposed embryos are specified properly, and produce normal levels of the anterior neural inducing molecules noggin and chordin, they show a greatly reduced capacity to induce anterior neural tissue in conjugated ectoderm. Taken together, our results are consistent with a model in which Wnt- or lithium-mediated signals can induce either mesodermal or ectodermal cells to produce a dominant posteriorizing morphogen which respecifies anterior neural tissue as posterior.

Anterior segment parameters of rabbits with rotating Scheimpflug camera.

PubMed

Yüksel, Harun; Türkcü, Fatih M; Ari, Şeyhmus; Çinar, Yasin; Cingü, Abdullah K; Şahin, Muhammed; Şahin, Alparslan; Özkurt, Zeynep; Çaça, İhsan

2015-05-01

Rabbit is one of the most commonly used experimental animals for corneal studies due to similarity of size to human cornea and ease of manipulation. In this study, we assessed anterior segment parameters of the healthy rabbit eyes with Pentacam HR (Oculus, Wetzlar, Germany). Six-month-old, approximately 2.5-3 kg weighted, 30 female New Zealand rabbits were used in the study. Right eye of the each rabbit was imaged with Pentacam HR under intramuscular ketamine hydrochloride (Ketalar; Eczacibasi, Turkey) anesthesia (50 mg/kg). After the imaging, the rabbits with blinking errors, which results in low-quality images, were excluded from the study. Keratometric readings, central corneal thickness (CCT), anterior chamber depth (ACD), and anterior and posterior elevation values, and lens density were noted. In this study, the flattest and the steepest keratometric values were found as 43.34 ± 1.86, 42.7 ± 2.0, and 43.9 ± 1.9 diopters, respectively. The mean CCT and ACD of rabbits were found as 388 ± 39 μm and 2.08 ± 0.16 mm, respectively. Mean of the anterior and posterior elevation at thinnest point was found as 1.29 ± 4.28 and 3.91 ± 6.17 μm, respectively. Keratometric readings and anterior and posterior elevation values of rabbits were similar to human; however, corneal thickness and anterior chamber depth (ACD) values were lower than humans. © 2014 American College of Veterinary Ophthalmologists.

Treating autism by targeting the temporal lobes.

PubMed

Chi, Richard P; Snyder, Allan W

2014-11-01

Compelling new findings suggest that an early core signature of autism is a deficient left anterior temporal lobe response to language and an atypical over-activation of the right anterior temporal lobe. Intriguingly, our recent results from an entirely different line of reasoning and experiments also show that applying cathodal stimulation (suppressing) at the left anterior temporal lobe together with anodal stimulation (facilitating) at the right anterior temporal lobe, by transcranial direct current stimulation (tDCS), can induce some autistic-like cognitive abilities in otherwise normal adults. If we could briefly induce autistic like cognitive abilities in healthy individuals, it follows that we might be able to mitigate some autistic traits by reversing the above stimulation protocol, in an attempt to restore the typical dominance of the left anterior temporal lobe. Accordingly, we hypothesize that at least some autistic traits can be mitigated, by applying anodal stimulation (facilitating) at the left anterior temporal lobe together with cathodal stimulation (suppressing) at the right anterior temporal lobe. Our hypothesis is supported by strong convergent evidence that autistic symptoms can emerge and later reverse due to the onset and subsequent recovery of various temporal lobe (predominantly the left) pathologies. It is also consistent with evidence that the temporal lobes (especially the left) are a conceptual hub, critical for extracting meaning from lower level sensory information to form a coherent representation, and that a deficit in the temporal lobes underlies autistic traits. Copyright © 2014 Elsevier Ltd. All rights reserved.

Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract.

PubMed

Jang, Sung Ho; Kwon, Hyeok Gyu

2013-05-29

The anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT). A 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct. It appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

Effect of primary iris and ciliary body cyst on anterior chamber angle in patients with shallow anterior chamber*

PubMed Central

Wang, Bing-hong; Yao, Yu-feng

2012-01-01

Objective: To evaluate the prevalence of primary iris and/or ciliary body cysts in eyes with shallow anterior chamber and their effect on the narrowing of the anterior chamber angle. Methods: Among the general physical check-up population, subjects with shallow anterior chambers, as judged by van Herick technique, were recruited for further investigation. Ultrasound biomicroscope (UBM) was used to detect and measure the cysts located in the iris and/or ciliary body, the anterior chamber depth (ACD), the angle opening distance at 500 μm (AOD500), and the trabecular-iris angle (TIA). A-scan ultrasonography was used to measure the ocular biometry, including lens thickness, axial length, lens/axial length factor (LAF), and relative lens position (RLP). The effect of the cyst on narrowing the corresponding anterior chamber angle and the entire angle was evaluated by the UBM images, ocular biometry, and gonioscopic grading. The eye with unilateral cyst was compared with the eye without the cyst for further analysis. Results: Among the 727 subjects with shallow anterior chamber, primary iris and ciliary body cysts were detected in 250 (34.4%) patients; among them 96 (38.4%) patients showed unilateral single cyst, 21 (8.4%) patients had unilateral double cysts, and 42 (16.8%) patients manifested unilateral multiple and multi-quadrants cysts. Plateau iris configuration was found in 140 of 361 (38.8%) eyes with cysts. The mean size of total cysts was (0.6547±0.2319) mm. In evaluation of the effect of the cyst size and location on narrowing the corresponding angle to their position, the proportion of the cysts causing corresponding angle narrowing or closure among the cysts larger than 0.8 mm (113/121, 93.4%) was found to be significantly higher than that of the cysts smaller than 0.8 mm (373/801, 46.6%), and a significant higher proportion was also found in the cysts located at iridociliary sulcus (354/437, 81.0%) than in that at the pars plicata (131/484, 27.1%). In evaluating the effect of the cyst on the entire anterior chamber angle, the eyes with multiple and multi-quadrants cysts manifested significant narrowing of the entire anterior chamber angle as compared with the eyes without cysts, based on the data analysis in comparison of TIA, AOD500, and gonioscopic grading evaluation. The unilateral single or double cysts in the eyes had no significant effect on narrowing of anterior chamber angle as compared with eyes without cysts. The iris and/or ciliary body cysts did not seem to affect the axial length, ACD, lens thickness, RLP, LAF. Conclusions: The prevalence of primary iris and ciliary body cyst was 34.4% in the subjects with shallow anterior chamber. The cysts larger than 0.8 mm, locating at iridociliary sulcus, or multiple and extensive cysts were inclined to cause the angle narrowing or closure. PMID:22949363

An overlay partial denture to restore worn mandibular anterior teeth.

PubMed

Samant, Asha; DeSciscio, Peter

2014-01-01

Restoring worn anterior mandibular teeth is a challenge, especially when teeth are small, esthetics are a concern, the long-term prognosis is questionable, and/or patient finances are an issue. This article describes an alternate treatment for a patient with a collapsed bite, missing posterior mandibular teeth, an ill-fitting complete maxillary denture with poor esthetics, and irregular, worn mandibular anterior teeth.

Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review.

PubMed

Tan, Tze P; Govindarajulu, Arun P; Massicotte, Eric M; Venkatraghavan, Lashmi

2014-07-01

Vocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied. To conduct a systematic review to identify the incidence, risk, and interventions for VCP after anterior cervical spine surgery. This is a qualitative systematic literature review. Prospective and retrospective trials of patients undergoing anterior cervical spine surgery that reported on postoperative VCP or recurrent laryngeal nerve palsy. Primary: incidence of VCP after anterior cervical spine surgery; secondary: risk factors and interventions for prevention of VCP after anterior cervical spine surgery. Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews for clinical studies reporting VCP in anterior cervical spine surgery, limited to studies published between 1995 and June 2013 in English and French languages. After selection of studies independently by two review authors, data on incidence, risk, and interventions were extracted. Qualitative analysis was performed on three domains: quality of studies, strength of evidence, and impact of interventions. Our search has identified 187 abstracts, and 34 studies met our inclusion criteria. The incidence of VCP ranges from 2.3% to 24.2%. Significant heterogeneity in study design and definition of VCP were used in the published studies. There is good evidence that reoperation increases the risk of VCP. One study of moderate strength suggests that operating from the right side may increase the risk of VCP. Among the interventions studied, endotracheal tube (ETT) cuff pressure monitoring with deflation during retraction has shown to reduce the incidence from 6% to 2%, but this result was not confirmed by randomized control trials. Limited evidence exists for other interventions of intraoperative electromyographic monitoring and methylprednisolone. Vocal cord palsy is a significant morbidity after anterior cervical surgery with incidence up to 24.2% in the immediate postoperative period, with a higher risk in reoperation of the anterior cervical spine. Moderate evidence exists for ETT cuff pressure adjustment in preventing this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes.

PubMed

Zbeda, Robert M; Sculco, Peter K; Urch, Ekaterina Y; Lazaro, Lionel E; Borens, Olivier; Williams, Riley J; Lorich, Dean G; Wellman, David S; Helfet, David L

2015-07-01

Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures. Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing. Case series; Level of evidence, 4. Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition. Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion. Anterior tension band plating for chronic tibial stress fractures provides a reliable alternative to intramedullary nailing with excellent results. Compression plating avoids the anterior knee pain associated with intramedullary nailing but may result in symptomatic hardware requiring subsequent removal. © 2015 The Author(s).

Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis.

PubMed

LaPrade, Christopher M; Ellman, Michael B; Rasmussen, Matthew T; James, Evan W; Wijdicks, Coen A; Engebretsen, Lars; LaPrade, Robert F

2014-10-01

While the biomechanical importance of the meniscal roots has been demonstrated, the anatomy of the anterior meniscal roots remains largely unknown. Defining the quantitative anatomy of the anterior meniscal root attachments is essential for developing improved diagnostic and surgical techniques. The anterior medial (AM) and anterior lateral (AL) meniscal roots could be quantitatively defined relative to open and arthroscopic surgical landmarks. Descriptive laboratory study. Twelve nonpaired human cadaveric knees were used (average age, 51.3 years). A coordinate measuring device quantified the anatomic relationships of the AM and AL root attachments to open and arthroscopic surgical landmarks. The tibial attachments of both anterior roots were defined and quantified by categorizing the fibers of the root as either central, dense attachments or peripheral, supplemental attachments. The center of the tibial tuberosity and the medial tibial eminence apex were 27.0 mm lateral and distal and 27.5 mm posterior to the center of the AM root, respectively. The center of the anterior cruciate ligament (ACL) and the lateral tibial eminence apex were 5.0 mm posteromedial and 14.4 mm posterolateral to the center of the AL root, respectively. The AM root attachment had a mean area of 110.4 mm(2) (95% CI, 92.2-128.5) with a central attachment of 56.3 mm(2) (95% CI, 46.9-65.8). The AL root attachment had a mean area of 140.7 mm(2) (95% CI, 121.6-159.8) and inserted deeply beneath the ACL in all specimens. The overlap of the ACL on the AL root averaged 88.9 mm(2) (95% CI, 63.3-114.6), comprising 63.2% of the AL root attachment. The anterior meniscal roots were identified in relation to pertinent open and arthroscopic landmarks. The extended overlap between the AL root and ACL attachment revealed a more intimate tibial attachment relationship than previously recognized. Quantitative descriptions of the anterior meniscal roots elucidate the relationship between the root attachments and pertinent surgical landmarks. In addition, the supplemental attachments of both menisci may contribute to native meniscal function, and further investigation is recommended. © 2014 The Author(s).

Factors Expressed in an Animal Model of Anteroinferior Glenohumeral Instability

PubMed Central

Mulcahey, Mary K.; Marshall, Mindy; Gallacher, Stacey E.; Kaback, Lee A.; Blaine, Theodore A.

2015-01-01

Background: There is little information on the molecular factors important in healing and changes that occur in the glenoid labrum in response to injury. Using a novel animal model of acute anterior shoulder dislocation, this study characterizes the factors expressed in the glenoid labrum in response to injury and correlates their expression to glenohumeral stability. Purpose: To study the response of the glenoid labrum to injury both biomechanically and with immunohistochemical testing. Methods: An injury to the anteroinferior labrum was surgically induced in 50 male Lewis rats. Rats were sacrificed at 3, 7, 14, 28, or 42 days. Immunolocalization experiments were performed to localize the expression of growth factors and cytokines. For biomechanical testing, dynamic stiffness for anterior and posterior laxity, load to failure, stiffness, and maximum load were recorded. Statistical differences were determined at P < .05. Study Design: Descriptive laboratory study. Results: Expression of interleukin–1 beta (IL-1β), transforming growth factor–beta 1 (TGF-β1), matrix metalloproteinase 3 (MMP3), and matrix metalloproteinase 13 (MMP13) were increased in injured compared with uninjured specimens. Collagen III expression was increased early and decreased with time. Biomechanical testing verified instability by demonstrating increased anterior displacement and decreased stiffness in injured shoulders at all time points. Conclusion: This novel animal model of acute anterior shoulder dislocation showed increased expression of IL-1β, TGF-β1, MMP3, MMP13, and collagen III in the injured labral tissue at early time points. Increased anterior laxity and decreased stiffness and maximum load to failure were seen after anterior labral injury, supporting the model’s ability to re-create anterior glenohumeral instability. These data provide important information on the temporal changes occurring in a rat model of anterior glenohumeral dislocation. Clinical Relevance: Identification of factors expressed in the anterior capsule and glenoid labrum in response to injury may lead to the development of novel agents that can be used to augment glenoid labrum healing and ultimately improve both surgical and nonsurgical treatment of this common shoulder injury. PMID:26535392

Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.

PubMed

Akoh, Craig C; Dibbern, Kevin; Amendola, Annuziato; Sittapairoj, Tinnart; Anderson, Donald D; Phisitkul, Phinit

2017-10-01

Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P < .01) and posterior = 10.6 ± 3.7 ( P < .05). Frequency data showed that the posterior third of the plafond was completely inaccessible in 33% of ankles during anterior arthroscopy. The frequency of inaccessible anterior plafond during posterior arthroscopy was 12%. Intra-articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. OLTPs are often encountered in tandem with talar lesions, and safely achieving intra-articular working space through noninvasive distraction greatly improved arthroscopic accessibility.

Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases

PubMed Central

Chaudhary, Kshitij; Sharma, Amit; Laheri, Vinod

2008-01-01

This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol based on POC and determine its efficacy. Average follow-up period was 2.8 years. Following POCs were identified: POC I: one or two levels of anterior cord compression. POC II: one or two levels of anterior and posterior compression. POC III: three levels of anterior compression. POC III variant: similar to POC III, associated with significant medical morbidity. POC IV: three or more levels of anterior compression in a developmentally narrow canal or with multiple posterior compressions. POC IV variant: similar to POC IV with one or two levels, being more significant than the others. POC V: three or more levels of compression in a kyphotic spine. Anterior decompression and reconstruction was chosen for POC I, II and III. Posterior decompression was chosen in POC III variant because they had more incidences of preoperative morbidity, in spite of being radiologically similar to POC III. Posterior surgery was also performed for POC IV and IV variant. For POC IV variant a targeted anterior decompression was considered after posterior decompression. The difference in the mJOA score before and after surgery for patients in each POC group was statistically significant. Anterior surgery in MCM had better result (mJOA = 15.9) versus posterior surgery (mJOA = 14.96), the difference being statistically significant. No major graft-related complications occurred in multilevel groups. The better surgical outcome of anterior surgery in MCM may make a significant difference in surgical outcome in younger and fitter patients like those of POC III whose expectations out of surgery are more. Judicious choice of anterior or posterior approach should be made after individualizing each case. PMID:18946692

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.

Memory reorganization following anterior temporal lobe resection: a longitudinal functional MRI study

PubMed Central

Bonelli, Silvia B.; Thompson, Pamela J.; Yogarajah, Mahinda; Powell, Robert H. W.; Samson, Rebecca S.; McEvoy, Andrew W.; Symms, Mark R.; Koepp, Matthias J.

2013-01-01

Anterior temporal lobe resection controls seizures in 50–60% of patients with intractable temporal lobe epilepsy but may impair memory function, typically verbal memory following left, and visual memory following right anterior temporal lobe resection. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated the reorganization of memory function in patients with temporal lobe epilepsy before and after left or right anterior temporal lobe resection and the efficiency of postoperative memory networks. We studied 46 patients with unilateral medial temporal lobe epilepsy (25/26 left hippocampal sclerosis, 16/20 right hippocampal sclerosis) before and after anterior temporal lobe resection on a 3 T General Electric magnetic resonance imaging scanner. All subjects had neuropsychological testing and performed a functional magnetic resonance imaging memory encoding paradigm for words, pictures and faces, testing verbal and visual memory in a single scanning session, preoperatively and again 4 months after surgery. Event-related analysis revealed that patients with left temporal lobe epilepsy had greater activation in the left posterior medial temporal lobe when successfully encoding words postoperatively than preoperatively. Greater pre- than postoperative activation in the ipsilateral posterior medial temporal lobe for encoding words correlated with better verbal memory outcome after left anterior temporal lobe resection. In contrast, greater postoperative than preoperative activation in the ipsilateral posterior medial temporal lobe correlated with worse postoperative verbal memory performance. These postoperative effects were not observed for visual memory function after right anterior temporal lobe resection. Our findings provide evidence for effective preoperative reorganization of verbal memory function to the ipsilateral posterior medial temporal lobe due to the underlying disease, suggesting that it is the capacity of the posterior remnant of the ipsilateral hippocampus rather than the functional reserve of the contralateral hippocampus that is important for maintaining verbal memory function after anterior temporal lobe resection. Early postoperative reorganization to ipsilateral posterior or contralateral medial temporal lobe structures does not underpin better performance. Additionally our results suggest that visual memory function in right temporal lobe epilepsy is affected differently by right anterior temporal lobe resection than verbal memory in left temporal lobe epilepsy. PMID:23715092

Convex Hemiepiphysiodesis: Posterior/anterior in-situ Versus Posterior-only With Pedicle Screw Instrumentation: An Experimental Simulation in Immature Pigs.

PubMed

Bekmez, Senol; Demirkiran, Halil G; Yilmaz, Guney; Akel, Ibrahim; Atilla, Pergin; Muftuoglu, Sevda Fatma; Yazici, Muharrem; Alanay, Ahmet

2016-12-01

Experimental study. Convex growth arrest (CGA) has been commonly used in the treatment of long-sweeping congenital deformities of the immature spine. As there are major drawbacks about the anterior procedure in the conventional CGA method, a new modification has been documented that using only posterior spinal approach with pedicle screw instrumentation. The aim of the study was to compare posterior-only CGA using pedicle screws with combined anterior/posterior in-situ CGA for the findings in histologic, radiologic, and manual palpation examinations in an immature pig model. Twelve 10-weeks old pigs were grouped into 2. In group 1, posterior-only, pedicle screw instrumented CGA was performed on the left side of L1-L4 vertebrae. In group 2, conventional combined posterior and anterior CGA was performed to the left side of L1-L4 vertebrae without instrumentation. All animals were killed twelve weeks after surgery. T11-L5 segments were en-bloc resected and radiologic, histologic, and manual palpation examinations were done. Marked scoliotic (12.2±2.5 and 9.2±1.3 in group 1 and 2, respectively) and kyphotic (11.2±1.0 degrees for the group 1 and 12±5.2 degrees for the group 2, respectively) deformities were noted in both groups, which were caused by hemiepiphysiodesis effect. Anterior and posterior parts of group 2 and posterior part of group 1 demonstrated fusion in histologic and radiologic analyzes. In anterior part of the group 1, marked narrowing on the disk spaces and thinning of growth plates were noted in radiologicg examination, chondrocyte degeneration, and newly-formed bone trabeculae in disk-space were noted in histological examination. In manual palpation, no motion was detected in group 1 and motion was detected in only one segment of one animal in group 2. Anterior growth of the vertebrae can be controlled by application of posterior transpedicular screws and rod. Such an effect can eliminate the need for anterior surgical intervention in convex hemiepiphysiodesis procedures. The instrumented CGA technique provides a satisfactory epiphysiodesis effect both anteriorly and posteriorly, as previously demonstrated by clinical studies.

Prevendo a atividade solar através de redes neurais nebulosas

NASA Astrophysics Data System (ADS)

Martin, V. A. F.; Poppe, P. C. R.

2003-08-01

Atualmente, a integração de redes neurais com técnicas da Matemática Nebulosa (Fuzzy Sets), tem sido usada robustamente para fazer previsões em vários sistemas físicos. Este trabalho representa uma continuidade da contribuição apresentada anteriormente durante a XXVIIa Reunião Anual da SAB, onde exploramos a aplicação de redes neurais para previsões futuras de séries temporais. Para este, enfatizamos o uso da técnica ANFIS (Adaptative Neuro-Fuzzy Inference System), que consiste em uma rede do tipo back-propagation, onde os dados são processados em uma camada intermediária, tendo numa camada de saída, os dados numéricos. Para que a previsão seja feita com sucesso utilizando-se técnicas matemáticas adequadas, é fundamental a existência de uma série razoavelmente longa de modo que a dinâmica contida nesta possa ser melhor extraída pela rede neural. Nesse sentido, foram utilizados novamente os dados históricos das manchas do Sol (1818-2002) afim de verificar o comportamento futuro da atividade solar (Ciclos de Schawbe) a partir da técnica descrita acima. Previsões realizadas para o ciclo anterior (n.22, máximo de 158,5 em julho de 1989), bem como para o atual (n.23, máximo de 153 em setembro de 2000), apontam valores bastante coerentes com os publicados na literatura, levando em consideração, respectivamente, as barras de erros associadas: 166+/-18 e 160+/-14. Para o próximo ciclo de Schawbe (2006-2017), nossa previsão aponta o valor de 172+/-23 como máximo para o primeiro semestre de 2011 (Abril +/- 3 meses). A ANFIS acompanha de maneira satisfatória o movimento das séries estudadas durante o treinamento e durante a verificação (menor dispersão das funções de pertinência), com erro absoluto inferior a 20 por cento.

Evolução química de galáxias HII anãs

NASA Astrophysics Data System (ADS)

Ferraresi, M., Jr.; Cuisinier, F.; Telles, E.

2003-08-01

Galáxias HII anãs são galáxias de baixa massa, com alto conteúdo de gás, e se encontram em uma fase intensa de formação estelar. A taxa de formação estelar está tão alta nestas galáxias que não pode ter se mantido durante sua vida inteira. O tempo máximo de duração do episódio atual de formação estelar deve ser no máximo de algumas dezenas de milhões de anos, bem inferior à idade destas galáxias. Isto leva naturalmente a idéia de que já aconteceram surtos anteriores. Abundâncias químicas oferecem uma ferramenta poderosa para investigar a história evolutiva destas galáxias, porque aumentam de geração em geração estelar. O hidrogênio, o oxigênio, o nitrogênio produzem algumas das linhas mais importantes em um gás foto-ionizado, permitindo a determinação das abundâncias destes elementos facilmente. A dispersão das abundâncias em oxigênio e nitrogênio é significativa, sendo maior que os erros observacionais. O oxigênio é produzido em estrelas massivas, que explodem quase instâneamente, enquanto o nitrogênio é produzido em estrelas de massa intermediária, que só o liberam depois de um atraso de @ 500 mihões de anos. Construímos um modelo de evolução química semi-analítico, utilizando rendimentos empíricos baseados nas abundâncias observadas destes dois elementos. Conseguimos através deste modelo rudimentar explicar nas galáxias de mais baixas metalicidades as abundâncias de oxigênio e de nitrogênio, assim como a dispersão dos dados observacionais devida a formação estelar descontínua, e isto com um número baixo de surtos (1 ou 2, no máximo 3).

Preparation and characterization of novel nanocomposites of inorganic/polysaccharide type =

NASA Astrophysics Data System (ADS)

Oliveira, Fabiane Costa

O uso de polimeros naturais no ambito da preparacao de nanocompositos nao tem sido tao amplamente estudado quando comparado com os polimeros sinteticos. Assim, esta tese tem como objectivo estudar metodologias para a preparacao de novos materiais nanocompositos sob a forma de dispersoes e filmes utilizando polissacarideos como matriz. A tese esta dividida em cinco capitulos sendo o ultimo capitulo dedicado as conclusoes gerais e a sugestoes para trabalhos futuros. Inicialmente e apresentada uma breve revisao bibliografica sobre os principais temas colocando esta tese em contexto. Consideracoes sobre o uso de polimeros naturais e a sua combinacao com a utilizacao de nanoparticulas inorganicas para a fabricacao de novos bionanocomposites sao descritas e os objectivos e outline da tese sao tambem apresentados. No segundo capitulo, a preparacao de particulas de silica puras ou modificadas bem como a sua caracterizacao por FTIR, SEM, TEM, TGA, DLS (tamanho e potencial zeta) e medicoes de angulo de contacto sao discutidas. De modo a melhorar a compatibilidade da silica com os polissacarideos, as particulas SiO2 foram modificados com dois compostos do tipo organosilano: 3- metacril-oxipropil-trimetoxissilano (MPS) e 3-aminopropil-trimetoxissilano (APS). As particulas SiO2 MPS foram posteriormente encapsuladas com de poli(metacrilato de glicidilo) utilizando a tecnica de polimerizacao em emulsao. A utilizacao dos nanocompositos resultantes na preparacao de dispersoes de bionanocompositos nao foi bem sucedida e por esse motivo nao os estudos nao foram prosseguidos. O uso de SiO2 APS na preparacao de dispersoes bionanocomposite foi eficiente. No terceiro capitulo e apresentada uma revisao sobre dispersoes bionanocompositas e respectiva caracterizacao destacando aspectos fundamentais sobre reologia e microestrutura. Em seguida, e discutido o estudo sistematico realizado sobre o comportamento reologico de dispersoes de SiO2 utilizando tres polissacarideos distintos no que concerne a carga e as caracteristicas gelificantes: a goma de alfarroba (nao ionica), o quitosano (cationico) e a goma xantana (anionica) cujas propriedades reologicas sao amplamente conhecidas. Os estudos reologicos realizados sob diferentes condicoes demonstraram que a formacao de geis frageis e/ou bem estruturados depende do tamanho SiO2, da concentracao, do pH e da forca ionica. Estes estudos foram confirmados por analises microestruturais usando a microscopia electronica a baixas temperaturas (Cryo-SEM). No quarto capitulo, sao apresentados os estudos relativos a preparacao e caracterizacao de filmes bionanocompositos utilizando quitosano como matriz. Primeiramente e apresentada uma revisao sobre filmes de bionanocompositos e os aspectos fundamentais das tecnicas de caracterizacao utilizadas. A escolha do plasticizante e da sua concentracao sao discutidas com base nas propriedades de filmes de quitosano preparados. Em seguida, o efeito da concentracao de silica e dos metodos utilizados para a dispersar na matriz de polissacarideo, bem como o efeito da modificacao da superficie da silica e avaliado. As caracteristicas da superficie e as propriedades de barreira, mecanicas e termicas sao discutidas para cada conjunto de filmes preparados antes e apos a sua neutralizacao. Os resultados obtidos mostraram que a dispersao das cargas no plasticizante e posterior adicao a matriz polissacaridica resultaram apenas em pequenas melhorias ja que o problema da agregacao de silica nao foi ultrapassado. Por esse motivo foram preparados filmes com SiO2 APS os quais apresentaram propriedades melhores apesar da agregacao das particulas nao ter sido completamente impedida. Tal pode estar relacionado com o processo de secagem dos filmes. Finalmente, no capitulo 5, sao apresentadas as principais conclusoes obtidas e algumas sugestoes para trabalho futuro.

ACL reconstruction - discharge

MedlinePlus

Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge ... had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of ...

Anterior open bite treated with myofunctional therapy and palatal crib.

PubMed

Asiry, Moshabab A

2015-03-01

This case report demonstrates the treatment effects of palatal crib combined with the myofunctional therapy in a child with anterior open bite (AOB) due to thumb sucking and habitual anterior and low tongue position. The patient, an 11-year-old boy, had an anterior open bite and flared and spaced upper and lower incisors. Palatal cribs in conjunction with myofunctional therapy were used to discourage sucking habit and to adapt normal tongue position. Successful correction of the AOB with adequate overjet and overbite were achieved with total treatment time of 7 months. The importance of myofunctional therapy in adopting normal tongue position and in maintaining the stability of open bite correction is emphasized.

Amelogenesis imperfecta and anterior open bite: Etiological, classification, clinical and management interrelationships

PubMed Central

Alachioti, Xanthippi Sofia; Dimopoulou, Eleni; Vlasakidou, Anatoli; Athanasiou, Athanasios E

2014-01-01

Although amelogenesis imperfecta is not a common dental pathological condition, its etiological, classification, clinical and management aspects have been addressed extensively in the scientific literature. Of special clinical consideration is the frequent co-existence of amelogenesis imperfecta with the anterior open bite. This paper provides an updated review on amelogenesis imperfecta as well as anterior open bite, in general, and documents the association of these two separate entities, in particular. Diagnosis and treatment of amelogenesis imperfecta patients presenting also with anterior open bite require a lengthy, comprehensive and multidisciplinary approach, which should aim to successfully address all dental, occlusal, developmental, skeletal and soft tissue problems associated with these two serious clinical conditions. PMID:24987656

Combined Anterolateral, Anterior, and Anteromedial Ankle Impingement in an Adolescent Soccer Player-A Case Report and Review of the Literature.

PubMed

Cosma, Dan I; Vasilescu, Dana E; Corbu, Andrei; Todor, Adrian; Valeanu, Madalina; Ulici, Alexandru

2018-01-24

A unique case of combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player is presented in this article. To the best of our knowledge, this is the only report of circumferential, massive, anterior ankle impingement in children described in the literature. The importance of proper diagnosis and treatment of such a lesion is illustrated in this case report. We also emphasize that clinical examination combined with 3D computed tomography scan reconstruction is an excellent and cost-effective imaging modality that can help with the diagnosis of anterior ankle impingement. Finally, open surgical treatment showed excellent results in an elite athlete.

Go ahead, grow a head! A planarian's guide to anterior regeneration

PubMed Central

2016-01-01

Abstract The unique ability of some planarian species to regenerate a head de novo, including a functional brain, provides an experimentally accessible system in which to study the mechanisms underlying regeneration. Here, we summarize the current knowledge on the key steps of planarian head regeneration (head‐versus‐tail decision, anterior pole formation and head patterning) and their molecular and cellular basis. Moreover, instructive properties of the anterior pole as a putative organizer and in coordinating anterior midline formation are discussed. Finally, we highlight that regeneration initiation occurs in a two‐step manner and hypothesize that wound‐induced and existing positional cues interact to detect tissue loss and together determine the appropriate regenerative outcomes. PMID:27606065

Orthodontic Treatment Timing and Modalities in Anterior Open Bite: Case Series Study

PubMed Central

Al Hamadi, Wisam; Saleh, Fayez; Kaddouha, Mohamad

2017-01-01

Objective: The purpose of this study was to present early and adult cases of anterior open bite that were treated efficiently using different treatment approaches and mechanics. Materials and Methods: Five patients of different age groups (from 7 to 27 years), suffering from a clear Anterior open bite deformity, were properly diagnosed and relevant treatment modality for each was selected. Results: Positive overbite was efficiently achieved for all patients. Conclusion: Patient compliance is a key factor in using removable habit breakers. However, fixed palatal crib gave the same results but in shorter time. Anterior open bite of skeletal components should be thoroughly evaluated before selecting camouflage or orthognathic surgery treatment modality. PMID:29299074

Amelogenesis imperfecta and anterior open bite: Etiological, classification, clinical and management interrelationships.

PubMed

Alachioti, Xanthippi Sofia; Dimopoulou, Eleni; Vlasakidou, Anatoli; Athanasiou, Athanasios E

2014-01-01

Although amelogenesis imperfecta is not a common dental pathological condition, its etiological, classification, clinical and management aspects have been addressed extensively in the scientific literature. Of special clinical consideration is the frequent co-existence of amelogenesis imperfecta with the anterior open bite. This paper provides an updated review on amelogenesis imperfecta as well as anterior open bite, in general, and documents the association of these two separate entities, in particular. Diagnosis and treatment of amelogenesis imperfecta patients presenting also with anterior open bite require a lengthy, comprehensive and multidisciplinary approach, which should aim to successfully address all dental, occlusal, developmental, skeletal and soft tissue problems associated with these two serious clinical conditions.

Gross, Arthroscopic, and Radiographic Anatomies of the Anterior Cruciate Ligament: Foundations for Anterior Cruciate Ligament Surgery.

PubMed

Irarrázaval, Sebastián; Albers, Marcio; Chao, Tom; Fu, Freddie H

2017-01-01

The anterior cruciate ligament (ACL) is one of the more studied structures in the knee joint. It is not a tubular structure, but is much narrower in its midsubstance and broader at its ends, producing an hourglass shape. The ACL is composed of 2 functional bundles, the anteromedial and posterolateral bundles, that are named for their location of insertion on the anterior surface of the tibial plateau. Although the relative contribution in terms of total cross-sectional area of the ACL has been noted to be equal in regards to each bundle, dynamically these bundles demonstrate different properties for knee function. Copyright © 2016 Elsevier Inc. All rights reserved.

Bilateral blindness following anterior nasal packing in a case of nasopharyngeal angiofibroma.

PubMed

Sahoo, A K; Preetam, C; Kumar, R; Samal, D K

2016-11-01

Epistaxis is the most common ENT emergency encountered in the Emergency Department. Most cases can be managed by simple anterior nasal packing. This is usually a safe and very effective option in an emergency situation, requiring minimal expertise and infrastructure. This paper describes a rare instance of a serious complication following anterior nasal packing in a case of nasopharyngeal angiofibroma. A 27-year-old man diagnosed with nasopharyngeal angiofibroma presented to the Emergency Department with bilateral epistaxis. The patient was stabilised and anterior nasal packing was performed, which controlled the bleeding. Three hours later, the patient developed complete blindness in both eyes. Aggressive medical management was initiated immediately, but failed to restore the patient's vision. Anterior nasal packing is a simple and minimally invasive procedure practised regularly in an Emergency Department setting. However, it can occasionally lead to serious complications such as blindness. Thus, obtaining informed consent is essential to avoid medico-legal consequences in high-risk cases.

Olfactory preservation during anterior interhemispheric approach for anterior skull base lesions: technical note.

PubMed

Matano, Fumihiro; Murai, Yasuo; Mizunari, Takayuki; Tateyama, Kojiro; Kobayashi, Shiro; Adachi, Koji; Kamiyama, Hiroyasu; Morita, Akio; Teramoto, Akira

2016-01-01

Anosmia is not a rare complication of surgeries that employ the anterior interhemispheric approach. Here, we present a fibrin-gelatin fixation method that provides reinforcement and moisture to help preserve the olfactory nerve when using the anterior interhemispheric approach and describe the results and outcomes of this technique. We analyze the outcomes with this technique in 45 patients who undergo surgery for aneurysms, brain tumors, or other pathologies via the anterior interhemispheric approach. Anosmia occurred in 4 patients (8.8%); it was transient in 2 (4.4%) and permanent in the remaining 2 (4.4%). Brain tumors clearly attached to the olfactory nerve were resected in the patients with permanent anosmia. We found a significant difference in the presence of anosmia between patients with or without lesions that were attaching the olfactory nerve (p = 0.011). Our results suggested that fibrin-gelatin fixation method can reduce the reported risk of anosmia. However, the possibility of olfactory nerve damage is relatively high when operating on brain tumors attaching olfactory nerve.

Delayed management of traumatic bilateral cervical facet dislocation: surgical strategy. Report of three cases.

PubMed

Bartels, Ronald H M A; Donk, Roland

2002-10-01

Postinjury cervical spine instability typically requires surgical treatment in the acute or semiacute stage. The authors, however, report on three patients with older (> 8 weeks) untreated bilateral cervical facet dislocation. In two patients they attempted a classic anterior-posterior-anterior approach but failed. The misalignment in the second stage of the procedure could not be corrected, and they had to add a fourth, posterior, stage. To avoid the fourth stage, thereby reducing operating time and risk of neurological damage while turning the patient, they propose the following sequence: 1) a posterior approach to perform a complete facetectomy bilaterally with no attempt to reduce the dislocation; 2) an anterior microscopic discectomy with reduction of the dislocation and anterior fixation; and 3) posterior fixation. This sequence of procedures was successfully performed in the third patient. Based on this experience, they suggest that in cases of nonacute bilateral cervical facet dislocations the operating sequence should be posterior-anterior-posterior.

Arthroscopic Triple Labral Repair in an Adolescent.

PubMed

Cotter, Eric J; Frank, Rachel M; Trenhaile, Scott W

2017-10-01

Traumatic glenohumeral dislocations often result in significant injury to the anterior-inferior labrum, most commonly leading to recurrent anterior instability. While in skeletally immature patients, shoulder trauma more commonly results in fracture versus a true dislocation, shoulder instability does occur and can be difficult to manage in the setting of open physes. In any event, the goal of treatment is to reduce the risk of recurrence and allow full participation in activities, including sports. Arthroscopic stabilization has been shown to be an effective treatment option for young patients, with good return to sport rates; however, the vast majority of literature on shoulder instability in the youth patient population focuses on anterior instability. Concomitant lesions of the anterior, posterior, and superior labrum have been rarely described in youth athletes and present a formidable clinical challenge, particularly in skeletally immature patients. In this Technical Note, we describe the authors' preferred technique for arthroscopic repair of a traumatic triple labral tear, including anterior, posterior, and type IV SLAP components, in adolescent patients.

Modified protrusion arch for anterior crossbite correction - a case report.

PubMed

Roy, Abhishek Singha; Singh, Gulshan Kr; Tandon, Pradeep; Chaudhary, Ramsukh

2013-01-01

Borderline and mild skeletal Class III relationships in adult patients are usually treated by orthodontic camouflage. Reasonably rood results have been achieved with nonsurgical teatment of anterior crossbite. Class III malocclusion may be associated with mandibular prognathism, maxillary retrognathism, or both. Class III maxillary retrognathism generally involves anterior crossbite, which must be opened if upper labial brackets are to be bonded. If multiple teeth are in crossbite, after opening the bite usual step is to ligate forward or advancement arch made of 0.018" or 0.020" stainless steel or NiTi wire main arch that must be kept separated 2 mm from the slot ofupper incisor braces. Two stops or omegas are made 1 mm mesial to the tubes of the molar bands that will impede main arch from slipping,and in this manner the arch will push the anterior teeth forward Here we have fabricated a modified multiple loop protrusion arch to correct an anterior crossbite with severe crowding that was not amenable to correct by advancement arches.

PT-12, a putative ras-activated proliferation-dependent gene, is expressed in patellar tendon and not in anterior cruciate ligament.

PubMed

Goomer, R S; Maris, T; Ostrander, R; Amiel, D

1999-09-01

We describe a gene (PT-12) that is expressed in the patellar tendon and not in the anterior cruciate ligament. We used a recently developed polymerase chain reaction-based subtractive cDNA analysis to discover genes that are overexpressed in the patellar tendon but not expressed in the anterior cruciate ligament; the long-term objective was to find genes that are central to the self-repair of the patellar tendon, in contrast with the inability of the anterior cruciate ligament to launch a repair response following injury. PT-12 is a homologue of human S2 or mouse LLRep3 ribosomal genes, which are known to be overexpressed in highly proliferating cells. This study opens a new vista to the development of techniques and reagents to study the differences between two periarticular tissues (i.e., the patellar tendon and anterior cruciate ligament) that differ primarily in their ability to self-repair.

Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy.

PubMed

Esmaeili, Alireza; Barazandeh, Behzad; Ahmadi, Sina; Haghi, Alireza; Ahmadi Hosseini, Seyed Mahdi; Abolbashari, Fereshteh

2013-01-01

To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect (PACS) before and after laser iridotomy (LI) using the Pentacam and gonioscopy. Forty-eight eyes of 48 PACS were included. Anterior chamber angle (ACA), central anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) were recorded from the Pentacam before and one month after LI. ACA was graded according to Shaffer classification using the Goldmann gonioscopy. ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees (P=0.009) and ACV changed from 85.97±16.07mm(3) to 99.25±15.83mm(3) (P=0.000). The changes in ACD, CCT and intraocular pressure were non-significant (P>0.05). Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants (P<0.001). Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Fractographic analysis of anterior bilayered ceramic crowns that failed by veneer chipping.

PubMed

Du, Qian; Swain, Michael V; Zhao, Ke

2014-05-01

To fractographically analyze the reasons for the chipping of veneering porcelain in clinically failed anterior lithium disilicate glass-ceramic (LDG) and glass-infi ltrated alumina (GIA) crowns. Five anterior bilayered ceramic crowns with clinical veneer chipping failure were retrieved, of which three were LDG crowns and two were GIA crowns. The fractured surfaces of the failed restorations were examined using stereomicroscopy and scanning electron microscopy (SEM). The principles of fractography were used to identify the location and dimensions of the critical crack and to estimate the stress at failure. All five anterior crowns failed by cohesive failure within the veneer on the labial surface. Fractography showed that the critical crack initiated at the incisal contact area and propagated gingivally. The estimated stresses at failure for veneer chipping were lower than the characteristic strength of the veneer materials. Within the limitations of this in-vivo study, the contact damage, fatigue, and processing fl aws within the veneer are important reasons leading to chipping of veneering porcelain in anterior LDG and GIA crowns.

Conservative management of idiopathic anterior atlantoaxial subluxation without neurological deficits in an 83-year-old female: A case report.

PubMed

Marchand, Andrée-Anne; Wong, Jessica J

2014-03-01

Atlantoaxial subluxation that is not related to traumatic, congenital, or rheumatological conditions is rare and can be a diagnostic challenge. This case report details a case of anterior atlantoaxial subluxation in an 83-year-old female without history of trauma, congenital, or rheumatological conditions. She presented to the chiropractor with insidious neck pain and headaches, without neurological deficits. Radiographs revealed a widened atlantodental space (measuring 6 mm) indicating anterior atlantoaxial subluxation and potential sagittal atlantoaxial instability. Prompt detection and appropriate conservative management resulted in favourable long-term outcome at 13-months follow-up. Conservative management included education, mobilizations, soft tissue therapy, monitoring for neurological progression, and co-management with the family physician. The purpose of this case report is to heighten awareness of the clinical presentation of idiopathic anterior atlantoaxial subluxation without neurological deficits. Discussion will focus on the incidence, mechanism, clinical presentation, and conservative management of a complex case of anterior atlantoaxial subluxation.

Anterior horn syndrome: A rare manifestation of primary Sjögren's syndrome.

PubMed

Zahlane, Safaa; Louhab, Nissrine; El Mellakh, Meriem; Kissani, Najib

2016-07-01

The authors report an exceptional case of an anterior horn syndrome associated with Sjögren's syndrome in a 58-year-old patient with a flaccid tetraparesis revealed by asymmetric atrophy and diffuse fasciculations associated with xerostomia and xerophthalmia. The electroneuromyography objectified a diffuse anterior horn syndrome. The brain MRI and spinal cord were normal. Laboratory tests revealed positive anti-SSA and anti-SSB antibody. The salivary glands biopsy objectified lymphocytic sialadenitis grade 3 of Chisholm. The Schirmer's test was abnormally low. Diagnosis of anterior horn syndrome as part of Sjögren's syndrome was retained. The methylprednisolone bolus allowed partial clinical improvement after 12 months of evolution. Therefore, in patients with isolated anterior horn involvement, a correct diagnosis of the underlying SS is often delayed or overlooked entirely; in these instances, standard clinicoserological assessment is recommendable. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Novel Strategies for Anterior Segment Ocular Drug Delivery

PubMed Central

Cholkar, Kishore; Patel, Sulabh P.; Vadlapudi, Aswani Dutt

2013-01-01

Abstract Research advancements in pharmaceutical sciences have led to the development of new strategies in drug delivery to anterior segment. Designing a new delivery system that can efficiently target the diseased anterior ocular tissue, generate high drug levels, and maintain prolonged and effective concentrations with no or minimal side effects is the major focus of current research. Drug delivery by traditional method of administration via topical dosing is impeded by ocular static and dynamic barriers. Various products have been introduced into the market that prolong drug retention in the precorneal pocket and to improve bioavailability. However, there is a need of a delivery system that can provide controlled release to treat chronic ocular diseases with a reduced dosing frequency without causing any visual disturbances. This review provides an overview of anterior ocular barriers along with strategies to overcome these ocular barriers and deliver therapeutic agents to the affected anterior ocular tissue with a special emphasis on nanotechnology-based drug delivery approaches. PMID:23215539

A Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative Comparisons.

PubMed

Phelps, Kevin D; Harmer, Luke S; Crickard, Colin V; Hamid, Nady; Sample, Katherine M; Andrews, Erica B; Seymour, Rachel B; Hsu, Joseph R

2018-06-01

Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing. Furthermore, a method to expose the entire humerus through an anterior extensile approach has not been described. Here, we illustrate and quantify a technique for connecting anterior humeral approaches in a stepwise fashion to form an aggregate anterior approach (AAA). We also describe a method for further distal extension to expose 100% of the length of the humerus and compare this approach with both the AAA and the lateral paratricipital in terms of access to critical bony landmarks, as well as the length and area of bone exposed.

Taking a Glance at Anterior Crossbite in Children: Case Series

PubMed Central

Ceyhan, Derya; Akdik, Canan

2017-01-01

Anterior crossbite is a malocclusion that takes place for various reasons, leads to major problems and may be fixed using various methods. This study aimed to provide an update regarding the methods used for anterior crossbite treatment presenting treatments of the removable active acrylic appliance with bite plane. Clinical examination of aged 9–15, seven healthy children who visited our clinic due to crowding and esthetic displeasure in anterior teeth indicated that one or more permanent maxillar incisor teeth were positioned behind of permanent mandibular incisor teeth. After clinical-radiographical examinations, removable active acrylic appliances with bite plane were decided to apply. Patients with adapted-activated appliances were called to follow-ups once a week. Treatments continued 4–6 weeks in mixed dentition, 7–8 weeks in permanent dentition. In choosing the method, advantages-disadvantages, indications-contraindications of methods should be discussed. Correct indication and suitable motivation are important for the success of anterior crossbite treatment. PMID:29326528

Relationship between facial morphology, anterior open bite and non-nutritive sucking habits during the primary dentition stage

PubMed Central

Fialho, Melissa Proença Nogueira; Pinzan-Vercelino, Célia Regina Maio; Nogueira, Rodrigo Proença; Gurgel, Júlio de Araújo

2014-01-01

Introduction Non-nutritive sucking habits (NNSHs) can cause occlusal alterations, including anterior open bite (AOB). However, not all patients develop this malocclusion. Therefore, the emergence of AOB does not depend on deleterious habits, only. Objective Investigate a potential association between non-nutritive sucking habits (NNSHs), anterior open bite (AOB) and facial morphology (FM). Methods 176 children in the primary dentition stage were selected. Intra and extraoral clinical examinations were performed and the children's legal guardians were asked to respond to a questionnaire comprising issues related to non-nutritive sucking habits (NNSHs). Results A statistically significant relationship was found between non-nutritive sucking habits (NNSHs) and anterior open bite (AOB). However, no association was found between these factors and children's facial morphology (FM). Conclusions Non-nutritive sucking habits (NNSHs) during the primary dentition stage play a key role in determining anterior open bite (AOB) malocclusion regardless of patient's morphological facial pattern (FM). PMID:25162574

A Guided, Conservative Approach for the Management of Localized Mandibular Anterior Tooth Wear.

PubMed

Mehta, Shamir B; Francis, Selar; Banerji, Subir

2016-03-01

The successful management of the worn mandibular anterior dentition may present an awkward challenge to the dental operator. The purpose of this article is to describe a case report illustrating the use of a guided, three-dimensional protocol for the ultra-conservative and predictable restoration of the worn lower anterior dentition using direct resin composite. This technique utilizes information based on established biomechanical and occlusal principles to fabricate a diagnostic wax-up, which is duplicated in dental stone. This is used to prepare a vacuum-formed modified stent, assisting the clinician to place directly bonded resin composite restorations to restore the worn lower anterior dentition. The technique, described in 2012 and referred to as 'injection moulding' has the potential to offer optimal form, function and an aesthetic outcome in an efficient manner. CPD/Clinical Relevance: This article aims to describe an alternative technique to simplify the processes involved with restoration of worn lower anterior teeth.

Anterior insular cortex mediates bodily sensibility and social anxiety

PubMed Central

Shibata, Midori; Moriguchi, Yoshiya; Umeda, Satoshi

2013-01-01

Studies in psychiatry and cognitive neuroscience have reported an important relationship between individual interoceptive accuracy and anxiety level. This indicates that greater attention to one’s bodily state may contribute to the development of intense negative emotions and anxiety disorders. We hypothesized that reactivity in the anterior insular cortex underlies the intensity of interoceptive awareness and anxiety. To elucidate this triadic mechanism, we conducted functional magnetic resonance imaging (fMRI) and mediation analyses to examine the relationship between emotional disposition and activation in the anterior insular cortex while participants evaluated their own emotional and bodily states. Our results indicated that right anterior insular activation was positively correlated with individual levels of social anxiety and neuroticism and negatively correlated with agreeableness and extraversion. The results of the mediation analyses revealed that activity in the right anterior insula mediated the activity of neural correlates of interoceptive sensibility and social fear. Our findings suggest that attention to interoceptive sensation affects personality traits through how we feel emotion subjectively in various situations. PMID:22977199

Flail anterior tricuspid valve leaflet in a neonate: association with maternal antiphospholipid syndrome.

PubMed

Tarca, Adrian J; Eckersley, Luke; Kothari, Darshan

2017-10-01

This brief report describes a case of flail anterior tricuspid valve leaflet in a neonate associated with maternal antiphospholipid syndrome. Fetal echocardiography at 27 weeks of gestation showed competent atrioventricular valves with biventricular echogenic chordae. Fetal distress was noted at delivery, and echocardiography showed a flail anterior leaflet of the tricuspid valve with severe regurgitation. Possible causation and implications of maternal antiphospholipid syndrome are discussed.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder.

PubMed

Kılıçaslan, Ömer Faruk; Acar, Baver; Atik, Aziz; Kose, Ozkan

2017-08-19

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder

PubMed Central

Acar, Baver; Atik, Aziz; Kose, Ozkan

2017-01-01

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively. PMID:29062614

A young Botswana patient with congenital iris ectropion uvea.

PubMed

Shifa, Jemal Zeberga; Nkomazana, Othokawa; Bekele, Negussie Alula; Kassa, Mamo Woldu

2016-01-01

Congenital iris ectropion is a rare condition; non-progressive anomaly characterised by the presence of iris pigment epithelium on the anterior surface of the iris stroma and is frequently associated with anterior iris insertion, dysgenesis of the drainage angle and glaucoma. This paper describes unusual case of bilateral case of congenital iris ectropion in adult patient with pupillary abnormality, normal anterior chamber angle structure and with no evidence of glaucoma.

Comparison of Amount of Primary Tooth Reduction Required for Anterior and Posterior Zirconia and Stainless Steel Crowns.

PubMed

Clark, Larkin; Wells, Martha H; Harris, Edward F; Lou, Jennifer

2016-01-01

To determine if aggressiveness of primary tooth preparation varied among different brands of zirconia and stainless steel (SSC) crowns. One hundred primary typodont teeth were divided into five groups (10 posterior and 10 anterior) and assigned to: Cheng Crowns (CC); EZ Pedo (EZP); Kinder Krowns (KKZ); NuSmile (NSZ); and SSC. Teeth were prepared, and assigned crowns were fitted. Teeth were weighed prior to and after preparation. Weight changes served as a surrogate measure of tooth reduction. Analysis of variance showed a significant difference in tooth reduction among brand/type for both the anterior and posterior. Tukey's honest significant difference test (HSD), when applied to anterior data, revealed that SSCs required significantly less tooth removal compared to the composite of the four zirconia brands, which showed no significant difference among them. Tukey's HSD test, applied to posterior data, revealed that CC required significantly greater removal of crown structure, while EZP, KKZ, and NSZ were statistically equivalent, and SSCs required significantly less removal. Zirconia crowns required more tooth reduction than stainless steel crowns for primary anterior and posterior teeth. Tooth reduction for anterior zirconia crowns was equivalent among brands. For posterior teeth, reduction for three brands (EZ Pedo, Kinder Krowns, NuSmile) did not differ, while Cheng Crowns required more reduction.

The digestive system of the "stick bug" Cladomorphus phyllinus (Phasmida, Phasmatidae): a morphological, physiological and biochemical analysis.

PubMed

Monteiro, Emiliano C; Tamaki, Fábio K; Terra, Walter R; Ribeiro, Alberto F

2014-03-01

This work presents a detailed morphofunctional study of the digestive system of a phasmid representative, Cladomorphus phyllinus. Cells from anterior midgut exhibit a merocrine secretion, whereas posterior midgut cells show a microapocrine secretion. A complex system of midgut tubules is observed in the posterior midgut which is probably related to the luminal alkalization of this region. Amaranth dye injection into the haemolymph and orally feeding insects with dye indicated that the anterior midgut is water-absorbing, whereas the Malpighian tubules are the main site of water secretion. Thus, a putative counter-current flux of fluid from posterior to anterior midgut may propel enzyme digestive recycling, confirmed by the low rate of enzyme excretion. The foregut and anterior midgut present an acidic pH (5.3 and 5.6, respectively), whereas the posterior midgut is highly alkaline (9.1) which may be related to the digestion of hemicelluloses. Most amylase, trypsin and chymotrypsin activities occur in the foregut and anterior midgut. Maltase is found along the midgut associated with the microvillar glycocalix, while aminopeptidase occurs in the middle and posterior midgut in membrane bound forms. Both amylase and trypsin are secreted mainly by the anterior midgut through an exocytic process as revealed by immunocytochemical data. Copyright © 2013 Elsevier Ltd. All rights reserved.

Predictors of proximal tibia anterior shear force during a vertical stop-jump.

PubMed

Sell, Timothy C; Ferris, Cheryl M; Abt, John P; Tsai, Yung-Shen; Myers, Joseph B; Fu, Freddie H; Lephart, Scott M

2007-12-01

Anterior cruciate ligament (ACL) continues to be a significant medical issue for athletes participating in sports and recreational activities. Biomechanical analyses have determined that anterior shear force is the most direct loading mechanism of the ACL and a probable component of noncontact ACL injury. The purpose of this study was to examine the biomechanical predictors of proximal tibia anterior shear force during a stop-jump task. A biomechanical and electromyographic (EMG) analysis of the knee was conducted while subjects performed a vertical stop-jump task. The task was chosen to simulate an athletic maneuver that included a landing with a sharp deceleration and a change in direction. The final regression model indicated that posterior ground reaction force, external knee flexion moment, knee flexion angle, integrated EMG activity of the vastus lateralis, and sex (female) would significantly predict proximal tibia anterior shear force (p < 0.0001, R2 = 0.8609). Knee flexion moment had the greatest influence on proximal tibia anterior shear force. The mathematical relationships elucidated in the current study support previous clinical and basic science research examining noncontact ACL injuries. This data provides important evidence for clinicians who are examining the risk factors for these injuries and developing/validating training programs to reduce the incidence of injury. Copyright 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Does disc space height of fused segment affect adjacent degeneration in ALIF? A finite element study.

PubMed

Tang, Shujie; Meng, Xueying

2011-01-01

The restoration of disc space height of fused segment is essential in anterior lumbar interbody fusion, while the disc space height in many cases decreased postoperatively, which may adversely aggravate the adjacent segmental degeneration. However, no literature available focused on the issue. A normal healthy finite element model of L3-5 and four anterior lumbar interbody fusion models with different disc space height of fused segment were developed. 800 N compressive loading plus 10 Nm moments simulating flexion, extension, lateral bending and axial rotation were imposed on L3 superior endplate. The intradiscal pressure, the intersegmental rotation, the tresca stress and contact force of facet joints in L3-4 were investigated. Anterior lumbar interbody fusion with severely decreased disc space height presented with the highest values of the four parameters, and the normal healthy model presented with the lowest values except, under extension, the contact force of facet joints in normal healthy model is higher than that in normal anterior lumbar interbody fusion model. With disc space height decrease, the values of parameters in each anterior lumbar interbody fusion model increase gradually. Anterior lumbar interbody fusion with decreased disc space height aggravate the adjacent segmental degeneration more adversely.

BBilateral Neglected Anterior Shoulder Dislocation with Greater Tuberosity Fractures

PubMed Central

Upasani, Tejas; Bhatnagar, Abhinav; Mehta, Sonu

2016-01-01

Introduction: Shoulder dislocations are a very common entity in routine orthopaedic practice. Chronic unreduced anterior dislocations of the shoulder are not very common. Neurological and vascular complications may occur as a result of an acute anterior dislocation of the shoulder or after a while in chronic unreduced shoulder dislocation. Open reduction is indicated for most chronic shoulder dislocations. We report a case of neglected bilateral anterior shoulder dislocation with bilateral displaced greater tuberosity fracture. To the best of our knowledge, only a handful cases have been reported in literature with bilateral anterior shoulder dislocation with bilateral fractures. Delayed diagnosis/reporting is a scenario which makes the list even slimmer and management all the more challenging. Case Report: We report a case of a 35-year-old male who had bilateral anterior shoulder dislocation and bilateral greater tuberosity fracture post seizure and failed to report it for a period of 30 days. One side was managed conservatively with closed reduction and immobilization and the other side with open reduction. No neurovascular complications pre or post reduction of shoulder were seen. Conclusion: Shoulder dislocations should always be suspected post seizures and if found should be treated promptly. Treatment becomes difficult for any shoulder dislocation that goes untreated for considerable period of time PMID:27703939

Individual differences in the anterior insula are associated with the likelihood of financially helping versus harming others.

PubMed

Greening, Steven; Norton, Loretta; Virani, Karim; Ty, Ambrose; Mitchell, Derek; Finger, Elizabeth

2014-03-01

The neural basis of individual differences in positive and negative social decisions and behaviors in healthy populations is yet undetermined. Recent work has focused on the potential role of the anterior insula in guiding social and nonsocial decision making, but the specific nature of its activation during such decision making remains unclear. To identify the neural regions mediating individual differences in helpful and harmful decisions and to assess the nature of insula activation during such decisions, in the present study we used a novel fMRI task featuring intentional and unintentional decisions to financially harm or help persons in need. Based on a whole-brain, unbiased approach, our findings indicate that individual differences in dorsal anterior insula, anterior cingulate cortex (ACC), and right temporo-parietal junction activation are associated with behavioral tendencies to financially harm or help another. Furthermore, activity in the dorsal anterior insula and ACC was greatest during unintended outcomes, whether these were gains or losses for a charity or for oneself, supporting models of the role of these regions in salience prediction error signaling. Together, the results suggest that individual differences in risk anticipation, as reflected in the dorsal anterior insula and dorsal ACC, guide social decisions to refrain from harming others.

Lateralization of affective processing in the insula.

PubMed

Duerden, Emma G; Arsalidou, Marie; Lee, Minha; Taylor, Margot J

2013-09-01

Evidence from electrophysiological and functional neuroimaging studies has suggested strong lateralization of affective processing within the insular cortices; however, little is known about the spatial location of these processes in these regions. Using quantitative meta-analytic methods the laterality of: (1) emotional processing; (2) stimulus valence (positive vs. negative); (3) perception vs. experience of emotion; and (4) sex-differences were assessed using the data from 143 functional magnetic resonance imaging studies. Activation in response to all emotional stimuli occurred in bilateral anterior and mid-insula, and the left posterior insula. Positive emotional stimuli were associated with activation in the left anterior and mid-insula, while negative emotional stimuli activated bilateral anterior and mid-insula. Activation in response to the perception and experience of emotions was highest in bilateral anterior insula, and within the mid and posterior insula it was left lateralized. In males, emotional stimuli predominantly activated the left anterior/mid-insula and right posterior insula, whereas females activated bilateral anterior insula and the left mid and posterior insula. Spatial distinctions observed in emotional processing and its subcategories can provide a comprehensive account of the role of the insular cortices in affect processing, which could aid in understanding deficits seen in psychiatric or developmental disorders. Copyright © 2013 Elsevier Inc. All rights reserved.

Anterior Shoulder Instability in the Military Athlete.

PubMed

Waterman, Brian; Owens, Brett D; Tokish, John M

Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability. A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability. Clinical review. Level 4. The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or "off-track" engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered. Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

Initial experience of a novel sheath guide for transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation.

PubMed

Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito; Mizokami, Koji

2013-03-01

The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery. To report our initial experiences of coil embolization of cerebral aneurysms in the anterior cerebral circulation with a novel sheath guide for transbrachial carotid cannulation. A sheath guide designed specifically for transbrachial carotid cannulation was developed; transbrachial coil embolization for cerebral aneurysms began in May 2011. Included for analysis were patients who underwent transbrachial coil embolization for cerebral aneurysms in the anterior cerebral circulation from May 2011 to January 2012. Adjuvant techniques, angiographic results, procedural success, and periprocedural complications were investigated. Ten patients underwent transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation. All procedures were successful using the brachial route. No periprocedural complications occurred. Patients were permitted to get seated immediately after coil embolization even during hemostasis. The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.

What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

PubMed

Scheuerlein, Hubert; Thiessen, Andreas; Schug-Pass, Christine; Köckerling, Ferdinand

2018-01-01

The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.

Altered Resting State Effective Connectivity of Anterior Insula in Depression.

PubMed

Kandilarova, Sevdalina; Stoyanov, Drozdstoy; Kostianev, Stefan; Specht, Karsten

2018-01-01

Depression has been associated with changes in both functional and effective connectivity of large scale brain networks, including the default mode network, executive network, and salience network. However, studies of effective connectivity by means of spectral dynamic causal modeling (spDCM) are still rare and the interaction between the different resting state networks has not been investigated in detail. Thus, we aimed at exploring differences in effective connectivity among eight right hemisphere brain areas-anterior insula, inferior frontal gyrus, middle frontal gyrus (MFG), frontal eye field, anterior cingulate cortex, superior parietal lobe, amygdala, and hippocampus, between a group of healthy controls ( N  = 20) and medicated depressed patients ( N  = 20). We found that patients not only had significantly reduced strength of the connection from the anterior insula to the MFG (i.e., dorsolateral prefrontal cortex) but also a significant connection between the amygdala and the anterior insula. Moreover, depression severity correlated with connectivity of the hippocampal node. In conclusion, the results from this resting state spDCM study support and enrich previous data on the role of the right anterior insula in the pathophysiology of depression. Furthermore, our findings add to the growing evidence of an association between depression severity and disturbances of the hippocampal function in terms of impaired connectivity with other brain regions.

Altered Resting State Effective Connectivity of Anterior Insula in Depression

PubMed Central

Kandilarova, Sevdalina; Stoyanov, Drozdstoy; Kostianev, Stefan; Specht, Karsten

2018-01-01

Depression has been associated with changes in both functional and effective connectivity of large scale brain networks, including the default mode network, executive network, and salience network. However, studies of effective connectivity by means of spectral dynamic causal modeling (spDCM) are still rare and the interaction between the different resting state networks has not been investigated in detail. Thus, we aimed at exploring differences in effective connectivity among eight right hemisphere brain areas—anterior insula, inferior frontal gyrus, middle frontal gyrus (MFG), frontal eye field, anterior cingulate cortex, superior parietal lobe, amygdala, and hippocampus, between a group of healthy controls (N = 20) and medicated depressed patients (N = 20). We found that patients not only had significantly reduced strength of the connection from the anterior insula to the MFG (i.e., dorsolateral prefrontal cortex) but also a significant connection between the amygdala and the anterior insula. Moreover, depression severity correlated with connectivity of the hippocampal node. In conclusion, the results from this resting state spDCM study support and enrich previous data on the role of the right anterior insula in the pathophysiology of depression. Furthermore, our findings add to the growing evidence of an association between depression severity and disturbances of the hippocampal function in terms of impaired connectivity with other brain regions. PMID:29599728

New congenital coronary artery anomaly - double supply of single left anterior descending coronary artery from the left and right coronary sinuses: a case report.

PubMed

Daralammouri, Yunis; Ghannam, Malik; Lauer, Bernward

2016-08-02

A normal anatomy of coronary arteries is important to have adequate cardiac muscle blood supply especially during extraneous physical activities. This case report describes a rare coronary anomaly in which the accessory coronary artery arose from the right coronary artery, reentered the left anterior descending coronary artery, and then ran as a single vessel. We present a case of a coronary anomaly in a 47-year-old white man who presented with atypical angina. Computed tomographic angiography and coronary angiography showed a variant of dual left anterior descending coronary artery not previously described. Our patient's accessory coronary artery arose from his right coronary artery. It took an intramuscular course beneath the right ventricular outflow tract in the interventricular septal area to the anterior interventricular sulcus, giving off septal perforators that reentered his medial left anterior descending coronary artery. Both vessels ran after the anastomosis in the anterior interventricular sulcus as a single vessel. We propose that this anomaly represents a new variant of coronary artery anomaly. This coronary artery anomaly does not cause ischemia. Recognition of this coronary anomaly is important in patients undergoing percutaneous coronary intervention or coronary artery bypass graft operations.

Analysis of Msx1; Msx2 double mutants reveals multiple roles for Msx genes in limb development.

PubMed

Lallemand, Yvan; Nicola, Marie-Anne; Ramos, Casto; Bach, Antoine; Cloment, Cécile Saint; Robert, Benoît

2005-07-01

The homeobox-containing genes Msx1 and Msx2 are highly expressed in the limb field from the earliest stages of limb formation and, subsequently, in both the apical ectodermal ridge and underlying mesenchyme. However, mice homozygous for a null mutation in either Msx1 or Msx2 do not display abnormalities in limb development. By contrast, Msx1; Msx2 double mutants exhibit a severe limb phenotype. Our analysis indicates that these genes play a role in crucial processes during limb morphogenesis along all three axes. Double mutant limbs are shorter and lack anterior skeletal elements (radius/tibia, thumb/hallux). Gene expression analysis confirms that there is no formation of regions with anterior identity. This correlates with the absence of dorsoventral boundary specification in the anterior ectoderm, which precludes apical ectodermal ridge formation anteriorly. As a result, anterior mesenchyme is not maintained, leading to oligodactyly. Paradoxically, polydactyly is also frequent and appears to be associated with extended Fgf activity in the apical ectodermal ridge, which is maintained up to 14.5 dpc. This results in a major outgrowth of the mesenchyme anteriorly, which nevertheless maintains a posterior identity, and leads to formation of extra digits. These defects are interpreted in the context of an impairment of Bmp signalling.

Thinking about thinking: Neural mechanisms and effects on memory.

PubMed

Bonhage, Corinna; Weber, Friederike; Exner, Cornelia; Kanske, Philipp

2016-02-15

It is a well-established finding that memory encoding is impaired if an external secondary task (e.g. tone discrimination) is performed simultaneously. Yet, while studying we are also often engaged in internal secondary tasks such as planning, ruminating, or daydreaming. It remains unclear whether such a secondary internal task has similar effects on memory and what the neural mechanisms underlying such an influence are. We therefore measured participants' blood oxygenation level dependent responses while they learned word-pairs and simultaneously performed different types of secondary tasks (i.e., internal, external, and control). Memory performance decreased in both internal and external secondary tasks compared to the easy control condition. However, while the external task reduced activity in memory-encoding related regions (hippocampus), the internal task increased neural activity in brain regions associated with self-reflection (anterior medial prefrontal cortex), as well as in regions associated with performance monitoring and the perception of salience (anterior insula, dorsal anterior cingulate cortex). Resting-state functional connectivity analyses confirmed that anterior medial prefrontal cortex and anterior insula/dorsal anterior cingulate cortex are part of the default mode network and salience network, respectively. In sum, a secondary internal task impairs memory performance just as a secondary external task, but operates through different neural mechanisms. Copyright © 2015 Elsevier Inc. All rights reserved.

Swedish Plectida (Nematoda). Part 9. The genus Leptolaimoides Vitiello, 1971.

PubMed

Holovachov, Oleksandr

2015-05-01

Three known and two new species of Leptolaimoides are described from bottom sediments collected in Skagerrak off the west coast of Sweden. The following known species are redescribed: Leptolaimoides haploopis Jensen, 1978, L. tubulosus Vitiello, 1971 and L. hexatubulosus Hoang Lai-Phu et al., 2009. Leptolaimoides filicaudatus sp. n. is characterised by the 431-543 µm long body; cephalic sensilla papilliform; amphid 23-26 µm long, located 9-10 µm from anterior end; first body pore located 35-37 µm from anterior end; lateral field simple along most of body, areolated on tail, arising 36-40 µm from anterior end; female without supplements, vagina without pars refringens, vulva midventral; male without tubular and without alveolar supplements; spicules arcuate and 16 µm long. Leptolaimoides leptomicron sp. n. is characterised by the 776-847 µm long body; cephalic sensilla papilliform; amphid 15-17 µm long, located 9-13 µm from anterior end; first body pore located 40-46 µm from anterior end; lateral field areolated, arising 26-28 µm from anterior end; female without supplements, vagina without pars refringens, vulva midventral; male with three tubular and without alveolar supplements, spicules arcuate and 28-29 µm long. The diagnosis of the genus Leptolaimoides is emended and a tabular compendium and dichotomous identification key to species of the genus Leptolaimoides are provided.

Features extraction in anterior and posterior cruciate ligaments analysis.

PubMed

Zarychta, P

2015-12-01

The main aim of this research is finding the feature vectors of the anterior and posterior cruciate ligaments (ACL and PCL). These feature vectors have to clearly define the ligaments structure and make it easier to diagnose them. Extraction of feature vectors is obtained by analysis of both anterior and posterior cruciate ligaments. This procedure is performed after the extraction process of both ligaments. In the first stage in order to reduce the area of analysis a region of interest including cruciate ligaments (CL) is outlined in order to reduce the area of analysis. In this case, the fuzzy C-means algorithm with median modification helping to reduce blurred edges has been implemented. After finding the region of interest (ROI), the fuzzy connectedness procedure is performed. This procedure permits to extract the anterior and posterior cruciate ligament structures. In the last stage, on the basis of the extracted anterior and posterior cruciate ligament structures, 3-dimensional models of the anterior and posterior cruciate ligament are built and the feature vectors created. This methodology has been implemented in MATLAB and tested on clinical T1-weighted magnetic resonance imaging (MRI) slices of the knee joint. The 3D display is based on the Visualization Toolkit (VTK). Copyright © 2015 Elsevier Ltd. All rights reserved.

Changes in anterior segment morphology in response to illumination and after laser iridotomy in Asian eyes: an anterior segment OCT study

PubMed Central

See, Jovina L S; Chew, Paul T K; Smith, Scott D; Nolan, Winifred P; Chan, Yiong‐Huak; Huang, David; Zheng, Ce; Foster, Paul J; Aung, Tin; Friedman, David S

2007-01-01

Aim Using the anterior segment optical coherence tomography (AS‐OCT) to quantify changes in anterior segment morphology going from light to dark and following laser iridotomy (LI). Methods Prospective observational study. 17 consecutive subjects without peripheral anterior synechiae undergoing LI were evaluated using gonioscopy and AS‐OCT. Angle configuration including angle opening distance (AOD) at 500 microns anterior to the scleral spur, AOD500, trabecular‐iris space area up to 750 microns from the scleral spur, TISA750 and the increase in angle opening going from dark to light conditions was determined. Results Both mean AOD500 and TISA750 increased nearly threefold going from dark to light. Both also significantly increased following LI (p<0.001) as did gonioscopic grading of the angle in all quadrants (p<0.001, McNemar's test). Angles were more than twice as wide on average in the dark after LI than before LI (p<0.05). Both the mean absolute change and the mean proportionate change in AOD500 and TISA750 when going from light to dark were greater after LI than before (p<0.05). Conclusion Increased illumination as well as LI resulted in significant widening of the anterior chamber angle. AS‐OCT (which does not require a water bath and can be performed with the patient at the slit lamp) identified similar magnitude changes as those previously reported using ultrasound biomicroscopy (UBM). Furthermore, the angle appears to open more both in absolute terms and and proportionate terms in response to illumination after LI. PMID:17504852

Vertical interincisal trespass assessment in children with speech disorders.

PubMed

Sahad, Marcelo de Gouveia; Nahás, Ana Carla Raphaelli; Scavone-Junior, Helio; Jabur, Luciana Badra; Guedes-Pinto, Eduardo

2008-01-01

Through a transversal epidemiological study, conducted with 333 Brazilian children, males (157) and females (176), aged 3 to 6 years old, enrolled in a public preschool, this study aimed to evaluate the prevalence of the different types of vertical interincisal trespass (VIT) and the relationship between these occlusal aspects and anterior lisping and/or anterior tongue thrust in the articulation of the lingua-alveolar phonemes /t/, /d/, /n/ and /l/. All children involved were submitted to a VIT examination and to a speech evaluation. Statistical significance was analyzed through the Qui-square test, at a significance level of 0.05 (95% confidence limit). The quantitative analysis of the data demonstrated the following prevalences: 1 - the different types of VIT: 48.3% for normal overbite (NO), 22.5% for deep overbite (DO), 9.3% for edge to edge (ETE) and 19.8% for open bite (OB); 2 - interdental lisping in relation to the different types of VIT: 42% for NO, 12.5% for DO, 12.5% for ETE, 32.9% for OB; and 3 - children with anterior tongue thrust in the articulation of lingua-alveolar phonemes in relation to the different types of VIT: 42.1% for NO, 14% for DO, 10.5% for ETE, 33.3% for OB. The results demonstrated that there was a significant relationship between open bite and anterior lisping and/or anterior tongue thrust in the articulation of the lingua-alveolar phonemes /t/, /d/, /n/ and /l/; and that there was a significant relationship between deep overbite and the absence of anterior lisping and anterior tongue thrust in the articulation of the lingua-alveolar phonemes.

Morphometric Study of the Anterior Thalamoperforating Arteries

PubMed Central

Kim, Sung-Ho; Yeo, Dong-Kyu; Shim, Jae-Joon; Yoon, Seok-Mann; Chang, Jae-Chil

2015-01-01

Objective To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). Methods A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. Results The anterior and middle segments of the ATPAs arose at mean intervals of 1.75±1.62 mm and 5.86±2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17±1.64 mm. The posterior segment arose at a mean interval of 2.43±1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45±1.39 mm. The mean numbers of perforators were 2.66±1.19, 3.03±1.84, and 1.67±0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. Conclusion Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa. PMID:26113962

Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.

PubMed

Sanchez, Leon D; Straszewski, Shannon; Saghir, Amina; Khan, Atif; Horn, Erin; Fischer, Christopher; Khosa, Faisal; Camacho, Marc A

2011-10-01

Recent research describes failed needle decompression in the anterior position. It has been hypothesized that a lateral approach may be more successful. The aim of this study was to identify the optimal site for needle decompression. A retrospective study was conducted of emergency department (ED) patients who underwent computed tomography (CT) of the chest as part of their evaluation for blunt trauma. A convenience sample of 159 patients was formed by reviewing consecutive scans of eligible patients. Six measurements from the skin surface to the pleural surface were made for each patient: anterior second intercostal space, lateral fourth intercostal space, and lateral fifth intercostal space on the left and right sides. The distance from skin to pleura at the anterior second intercostal space averaged 46.3 mm on the right and 45.2 mm on the left. The distance at the midaxillary line in the fourth intercostal space was 63.7 mm on the right and 62.1 mm on the left. In the fifth intercostal space the distance was 53.8 mm on the right and 52.9 mm on the left. The distance of the anterior approach was statistically less when compared to both intercostal spaces (p < 0.01). With commonly available angiocatheters, the lateral approach is less likely to be successful than the anterior approach. The anterior approach may fail in many patients as well. Longer angiocatheters may increase the chances of decompression, but would also carry a higher risk of damage to surrounding vital structures. © 2011 by the Society for Academic Emergency Medicine.

Central projections of the lateral line and eighth nerves in the bowfin, Amia calva.

PubMed

McCormick, C A

1981-03-20

The first-order connections of the anterior and posterior lateral line nerves and of the eighth nerve were determined in the bowfin, Amia calva, using experimental degeneration and anterograde HRP transport techniques. The termination sites of these nerves define a dorsal lateralis cell column and a ventral octavus cell column. The anterior and posterior lateralis nerves distribute ipsilaterally to two medullary nuclei-nucleus medialis and nucleus caudalis. Nucleus medialis comprises the rostral two-thirds of the lateralis column and contains large, Purkinje-like cells dorsally and polygonal, granule, and fusiform cells ventrally. Nucleus caudalis is located posterior to nucleus medialis and consists of small, granule cells. Anterior lateralis fibers terminate ventrally to ventromedially in both nucleus medialis and nucleus caudalis. Posterior lateralis fibers terminate dorsally to dorsolaterally within these two nuclei. A sparse anterior lateralis input may also be present on the dendrites of one of the nuclei within the octavus cell column, nucleus magnocellularis. In contrast, the anterior and posterior rami of the eighth nerve each terminate within four medullary nuclei which comprise the octavus cell column: the anterior, magnocellular, descending, and posterior octavus nuclei. An eighth nerve projection to the medial reticular formation is also present. Some fibers of the lateralis and eighth nerves terminate within the ipsilateral eminentia granularis of the cerebellum. Lateralis fibers distribute to approximately the lateral half of this structure with posterior lateral line fibers terminating laterally and anterior lateral line fibers terminating medially. Eighth nerve fibers distribute to the medial half of the eminentia granularis.

Can Diopatra neapolitana (Annelida: Onuphidae) regenerate body damage caused by bait digging or predation?

NASA Astrophysics Data System (ADS)

Pires, A.; Freitas, R.; Quintino, V.; Rodrigues, A. M.

2012-09-01

The regenerative ability of Diopatra neapolitana was evaluated under laboratory conditions following nine experimental amputation levels: before the beginning of the branchiae (chaetiger 3 or 4), in the branchial region, at chaetigers 10, 15, 20, 25, 30, 35 and 40 and after the branchiae, at chaetigers 45-55. Specimens amputated at the 20th chaetiger were not able to regenerate and did not survive. The posterior portion of the specimens amputated up to chaetiger 15, regenerated the anterior part but the anterior ends were unable to survive. The anterior end of the specimens amputated at and beyond the 25th chaetiger regenerated the posterior part but the posterior ends were not able to regenerate an anterior part. Percent survival was directly related to the number of branchial segments left in the regenerating specimen and reached 100% only when the specimens were amputated beyond the branchial region. These results indicate that the species has regenerative ability and should survive the loss of a few anterior chaetigers, namely caused by predation. However, the results also indicate that bait digging could impair the survival of the posterior part remaining in the tube, as usually more than 20 chaetigers are harvested by bait collectors. Regarding field-collected specimens, D. neapolitana was found regenerating a mean of 9.0 ± 2.51 chaetigers, and Diopatra marocensis 7.5 ± 1.93 chaetigers, at the anterior end. The higher percentage of field-collected specimens showing regeneration of the anterior end belonged to D. marocensis. Only very few specimens, for both species, were found regenerating the posterior part of the body.

Anterior wrist and medial malleolus as the novel sites of tissue selection: a retrospective study on electric shock death through the hand-to-foot circuit pathway.

PubMed

Xu, Guangtao; Su, Ruibing; Lv, Junyao; Hu, Bo; Gu, Huan; Li, Xianxian; Gu, Jiang; Yu, Xiaojun

2017-05-01

Our previous work demonstrated that characteristic changes could occur in the anterior wrist and medial malleolus in electric deaths through the hand-to-foot electric circuit pathway in an electric shock rat model. However, whether the same phenomenon occurs in humans is unknown. The aim of the present retrospective study was to ascertain whether the anterior wrist and medial malleolus could also be selected as the promising and significant sites in electric death through the hand-to-foot circuit pathway. Nineteen human cases from the autopsy and one clinical survivor who sustained a severe electric shock through the hand-to-foot circuit pathway were analyzed. Additional ten autopsy patients who died from traffic accidents and sudden cardiac attacks were used as the control group. Histopathological changes in the soft tissues of the anterior wrist and medial malleolus in all autopsy patients, as well as the electric current pathway of the survivor, were observed. The results showed that the nuclear polarizations in the anterior wrist and medial malleolus soft tissues of the electric death were extremely noticeable as compared with the controls. The most severe electrical injury in the survivor occurred in the anterior wrist. These findings suggest that the soft tissues of the anterior wrist and/or the medial malleolus as the narrowest parts of the limbs could be used as the complementary sites for tissue selection and considered as necessary locations for examinations to assess the electric death in medicolegal identification.

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

PubMed

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Zincergic innervation from the anterior olfactory nucleus to the olfactory bulb displays plastic responses after mitral cell loss.

PubMed

Airado, Carmen; Gómez, Carmela; Recio, Javier S; Baltanás, Fernando C; Weruaga, Eduardo; Alonso, José R

2008-12-01

Zinc ions are selectively accumulated in certain neurons (zinc-enriched neurons). The mouse olfactory bulb is richly innervated by zinc-enriched terminals. Here, the plasticity of the zincergic system was studied in the olfactory bulb of the Purkinje Cell Degeneration mutant mouse, an animal with specific postnatal neurodegeneration of the main projection neurons of the olfactory bulb. The analysis focused particularly on the anterior olfactory nucleus since most centrifugal afferents coming to the olfactory bulb arise from this structure. Zinc-enriched terminals in the olfactory bulb and zinc-enriched somata in the anterior olfactory nucleus were visualized after selenite injections. Immunohistochemistry against the vesicular zinc transporter was also carried out to confirm the distribution pattern of zinc-enriched terminals in the olfactory bulb. The mutant mice showed a clear reorganization of zincergic centrifugal projections from the anterior olfactory nucleus to the olfactory bulb. First, all zincergic contralateral neurons projecting to the olfactory bulb were absent in the mutant mice. Second, a significant increase in the number of stained somata was detected in the ipsilateral anterior olfactory nucleus. Since no noticeable changes were observed in the zinc-enriched terminals in the olfactory bulb, it is conceivable that mitral cell loss could induce a reorganization of zinc-enriched projections coming from the anterior olfactory nucleus, probably directed at balancing the global zincergic centrifugal modulation. These results show that zincergic anterior olfactory nucleus cells projecting to the olfactory bulb undergo plastic changes to adapt to the loss of mitral cells in the olfactory bulb of Purkinje Cell Degeneration mutant mice.

Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis.

PubMed

Ismail, Shiek Abdullah; Button, Kate; Simic, Milena; Van Deursen, Robert; Pappas, Evangelos

2016-06-01

Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effect of the arthroscopic augmentation of the subscapularis tendon on shoulder instability and range of motion: A biomechanical study.

PubMed

Schröter, S; Krämer, M; Welke, B; Hurschler, C; Russo, R; Herbst, M; Stöckle, U; Ateschrang, A; Maiotti, M

2016-10-01

Anterior shoulder dislocation is common. The treatment of recurrence with glenoid bone defect is still considered controversial. A new arthroscopic subscapularis augmentation has recently been described that functions to decrease the anterior translation of the humeral head. The purpose of the presented study was to examine the biomechanical effect on glenohumeral joint motion and stability. Eight fresh frozen cadaver shoulders were studied by use of a force guided industrial robot fitted with a six-component force-moment sensor to which the humerus was attached. The testing protocol includes measurement of glenohumeral translation in the anterior, anterior-inferior and inferior directions at 0°, 30° and 60° of glenohumeral abduction, respectively, with a passive humerus load of 30N in the testing direction. The maximum possible external rotation was measured at each abduction angle applying a moment of 1Nm. Each specimen was measured in a physiologic state, as well as after Bankart lesion with an anterior bone defect of 15-20% of the glenoid, after arthroscopic subscapularis augmentation and after Bankart repair. The arthroscopic subscapularis augmentation decreased the anterior and anterior-inferior translation. The Bankart repair did not restore the mechanical stability compared to the physiologic shoulder group. External rotation was decreased after arthroscopic subscapularis augmentation compared to the physiologic state, however, the limitation of external rotation was decreased at 60° abduction. The arthroscopic subscapularis augmentation investigated herein was observed to restore shoulder stability in an experimental model. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of severe anterior open-bite in an adult patient using miniscrews as skeletal anchorage.

PubMed

Rachala, Madhukar Reddy; Harikrishnan, Pandurangan

2010-01-01

Anterior open bite is often caused by a downward rotation of the mandible and/or by excessive eruption of the posterior teeth. In such cases, it is difficult to establish absolute anchorage for molar intrusion by traditional orthodontic mechanics. This is a case report of successful treatment of a severe anterior open bite using miniscrew anchorage. A female patient of 20 yrs presented with symmetrical frontal facial appearance, increased anterior facial height, convex profile and incompetent lips. Dentally, she had lost both mandibular first molars due to caries and both maxillary first molars were extruded. She had class II canine relationship, 5 mm overjet, 5 mm anterior open bite, 3 mm mandibular midline diastema and a spacing of 2 mm in the maxillary arch. The treatment objectives were to correct the anterior open bite and establish ideal overjet and overbite and to restore the mandibular first molars with fixed prosthesis. Titanium miniscrews (1.3 mm diameter and 9 mm length) were implanted bilaterally in the maxillary arch between the second premolar and the first molar, and an intrusion force was applied with NiTi closed coil springs for 8 months. After molar intrusion, the same screws were used for en masse retraction of the entire dentition (third molars were extracted) for 4 months. The results showed that, after an active treatment of 20 months, the maxillary molars were intruded about 4 mm each and good occlusion was achieved. In conclusion, the miniscrews were very useful in the non-surgical management of adult anterior open bite cases.

The Direct Anterior Approach Does Not Increase Return to Function Following Hemiarthroplasty for Femoral Neck Fracture.

PubMed

Carlson, Victor R; Ong, Alvin C; Orozco, Fabio R; Lutz, Rex W; Duque, Andres F; Post, Zachary D

2017-11-01

The purpose of this study was to evaluate functional outcomes for hemiarthroplasty using a direct anterior approach or a direct lateral approach for femoral neck fracture. This retrospective review used data collected from a single institution between 2006 and 2016. Eighty-five and 75 consecutive patients who underwent hemiarthroplasty via a direct anterior approach and a direct lateral approach, respectively, met inclusion criteria. All patients with femoral neck fractures were treated by 1 of 2 fellowship-trained orthopedic surgeons using the direct anterior approach or the direct lateral approach to hemiarthroplasty. Disposition, ambulation, and other perioperative surgical outcomes were compared between the cohorts. Compared with the direct lateral cohort, the direct anterior cohort had a shorter mean operative time (2.4 minutes, P<.01), a shorter mean length of hospital stay (2.7 days, P<.01), and a smaller mean decrease in hemoglobin postoperatively (0.7 g/dL, P<.01). No significant difference was observed between the cohorts for postoperative disposition, the number of feet ambulated on the second postoperative day, or the prevalence of ambulatory decline at 4- to 6-week and 4- to 6-month follow-up visits. Compared with the direct lateral approach, the direct anterior approach may benefit patients by small, but statistically significant, improvements in blood loss, surgical time, and length of hospital stay after hemiarthroplasty. However, the direct anterior approach does not appear to decrease the likelihood of transfer to a skilled nursing facility postoperatively or accelerate return to preoperative function. [Orthopedics. 2017; 40(6):e1055-e1061.]. Copyright 2017, SLACK Incorporated.

Orbscan II anterior elevation changes following corneal collagen cross-linking treatment for keratoconus.

PubMed

Tu, Kyaw Lin; Aslanides, Ioannis M

2009-08-01

To analyze anterior corneal elevation changes on Orbscan II following corneal collagen cross-linking (CXL) with riboflavin. This retrospective study included 8 patients (14 eyes) with keratoconus who underwent CXL, with a mean follow-up of 7 months (range: 5 to 10 months). Pre- and postoperative (at last clinic attendance) anterior elevation difference maps were examined for overall patterns of change. On preoperative maps, distances from maximum anterior elevation to pupil center and to topographic geometric center were compared between the two patterns identified. Pre- and postoperative topography, best spectacle-corrected visual acuity (BSCVA), and refraction were also compared between the two patterns. Two patterns of anterior elevation change were visually identified: (1) paracentral steepening, no change, or flattening centrally; and (2) central steepening. The preoperative maps of eyes that manifested pattern 1 had shorter mean distances for maximum anterior elevation to pupil center (1.70 vs. 2.27 mm) and maximum anterior elevation to geometric center (1.45 vs. 1.99 mm) than those that resulted in pattern 2. Mean maximum topographic simulated keratometry decreased (P = .004) and mean irregularity indices at 3 mm (P =.03) and 5 mm (P =.04) were reduced postoperatively in pattern 1 eyes; all increased in pattern 2 eyes. Mean BSCVA improved postoperatively for both patterns. Mean preoperative myopia decreased in pattern 1 eyes by 0.44 diopters (D), whereas it increased for pattern 2 eyes by 1.83 D. Corneal shape change influenced by anisotropy of collagen distribution is a factor in the outcome of CXL treatment for keratoconus.

Can standard anterior Smith-Robinson supramanubrial approach be utilized for approach down to T2 or T3?

PubMed

Singhatanadgige, Weerasak; Zebala, Lukas P; Luksanapruksa, Panya; Daniel Riew, K

2017-09-01

The aim of this study was to determine a plain radiographic criterion for determining the feasibility of using the standard anterior Smith-Robinson supramanubrial approach for anterior surgery down to T2 or T3. The surgical database (2002-2014) was searched to identify patients with anterior cervical surgery to T2 or T3. A method to determine whether a standard anterior Smith-Robinson approach can be used to operate on the upper thoracic levels was evaluated. The surgeon chose the surgical approach preoperatively using a lateral radiograph by determining if a line from the intended skin incision to the lower instrumented level (LIV) passed above the top of the manubrium. If so, a standard Smith-Robinson approach was selected. Another spine surgeon then analyzed all patients who had anterior thoracic fusion to T2 or below. The lateral radiographs were retrospectively reviewed. A total of 44 patients who underwent anterior surgery down to T2 or T3 vertebrae were identified. T2 was the LIV in 39 patients. T3 was the LIV in five patients. No surgery was abandoned or converted to a difference approach after making the standard Smith-Robinson approach. To increase visualization, T1 corpectomy was necessary in 4 of 39 patients when T2 was the LIV. T2 corpectomy was necessary in 2 of 5 patients when T3 was the LIV. If a line from the intended skin incision to the LIV passes over the top of the manubrium, a standard Smith-Robinson approach without sternotomy can be successfully used.

Evaluation of maxillary anterior teeth and their relation to the golden proportion in Malaysian population.

PubMed

Al-Marzok, Maan Ibrahim; Majeed, Kais Raad Abdul; Ibrahim, Ibrahim Khalil

2013-01-24

The maxillary anterior teeth are important in achieving pleasing dental aesthetics. Various methods are used to measure the size and form of them, including the golden proportion between their perceived widths, and the width-to-height ratio, referred to as the golden standard. The purpose of this study was conducted to evaluate whether consistent relationships exist between tooth width and height of the clinical crown dimensions; and to investigate the occurrence of the golden proportion of the maxillary anterior teeth. Dental casts of the maxillary arches were made in this cross-sectional study from MAHSA University College students who met the inclusion criteria. The 49 participants represented the Malaysian population main ethnics. The dimensions of the anterior teeth and the perceived width of anterior teeth viewed from front were measured using a digital caliper. Comparison of the perceived width ratio of lateral to central incisor and canine to lateral incisor with the golden proportion of 0.618 revealed there were a significant statistical difference (p < 0.05). The statistical difference was significant for the width-to-height ratio of central incisors to the golden standard of 80%. There was no significant difference in the comparison among ethnic groups for the golden proportion and the golden standard. The golden proportion was not found to exist between the perceived widths of maxillary anterior teeth. No golden standard were detected for the width-to-height proportions of maxillary incisors. Specific population characteristics and perception of beauty must be considered. However, ethnicity has no association with the proportions of maxillary anterior teeth.

Objective measurement of accommodative biometric changes using ultrasound biomicroscopy

PubMed Central

Ramasubramanian, Viswanathan; Glasser, Adrian

2015-01-01

PURPOSE To demonstrate that ultrasound biomicroscopy (UBM) can be used for objective quantitative measurements of anterior segment accommodative changes. SETTING College of Optometry, University of Houston, Houston, Texas, USA. DESIGN Prospective cross-sectional study. METHODS Anterior segment biometric changes in response to 0 to 6.0 diopters (D) of accommodative stimuli in 1.0 D steps were measured in eyes of human subjects aged 21 to 36 years. Imaging was performed in the left eye using a 35 MHz UBM (Vumax) and an A-scan ultrasound (A-5500) while the right eye viewed the accommodative stimuli. An automated Matlab image-analysis program was developed to measure the biometry parameters from the UBM images. RESULTS The UBM-measured accommodative changes in anterior chamber depth (ACD), lens thickness, anterior lens radius of curvature, posterior lens radius of curvature, and anterior segment length were statistically significantly (P < .0001) linearly correlated with accommodative stimulus amplitudes. Standard deviations of the UBM-measured parameters were independent of the accommodative stimulus demands (ACD 0.0176 mm, lens thickness 0.0294 mm, anterior lens radius of curvature 0.3350 mm, posterior lens radius of curvature 0.1580 mm, and anterior segment length 0.0340 mm). The mean difference between the A-scan and UBM measurements was −0.070 mm for ACD and 0.166 mm for lens thickness. CONCLUSIONS Accommodating phakic eyes imaged using UBM allowed visualization of the accommodative response, and automated image analysis of the UBM images allowed reliable, objective, quantitative measurements of the accommodative intraocular biometric changes. PMID:25804579

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.

Anteriorly located zonular fibres as a tool for fine regulation in accommodation

PubMed Central

Flügel-Koch, Cassandra; Croft, Mary Ann; Kaufman, Paul L.; Lütjen-Drecoll, Elke

2015-01-01

Purpose To describe an anteriorly located system of zonular fibres that could be involved in fine-tuning of accommodation Methods Forty six human and 28 rhesus monkey eyes were dissected and special preparations were processed for scanning electron microscopy and reflected-light microscopy. Additional series of frontal and sagittal histological and ultrathin sections were analysed in respect to the origin and insertion of anteriorly located zonules. The presence of sensory terminals at the site of the originating zonules within the connective tissue of the ciliary body was studied by immunohistochemistry. For in-vivo visualization ultrasound biomicroscopy (UBM) was performed on 12 human subjects. Results Fine zonular fibres originated from the valleys and lateral walls of the most anterior pars plicata that covers the anterior and inner circular ciliary muscle portion. These most anterior zonules (MAZ) showed attachments either to the anterior or posterior tines or they inserted directly onto the surface of the lens. At the site of origin, the course of the MAZ merged into the connective tissue fibres connecting the adjacent pigmented epithelium to the ciliary muscle. Numerous afferent terminals directly at the site of this MAZ-origin were connected to the intrinsic nervous network of the ciliary muscle. Conclusions A newly described set of zonular fibres features the capabilities to register the tensions of the zonular fork and lens capsule. The close location and neural connection towards the circular ciliary muscle portion could provide the basis for stabilization and readjustment of focusing that serves fast and fine-tuned accommodation and disaccommodation. PMID:26490669

Anterior segment morphology and morphometry in selected reptile species using optical coherence tomography.

PubMed

Rival, Franck; Linsart, Adeline; Isard, Pierre-François; Besson, Christian; Dulaurent, Thomas

2015-01-01

To provide new and original images of the anterior segment (AS) of the eye of selected Ophidian, Chelonian, and Saurian species and to compare the AS architecture among and within these three groups. 17 Saurians, 14 Ophidians, and 11 Chelonians with no concurrent systemic or eye disease were included in the study. Age, weight, nose-cloaca distance (NCD), and pupil shape were collected for each animal. The AS was examined by optical coherence tomography (OCT). After gross description of the appearance of the AS, the central and peripheral corneal thickness (CCT, PCT) and anterior chamber depth (ACD) were measured using the software provided with the OCT device. The ratio CCT/ACD was then calculated for each animal. Pupil shape was a vertical slit in all the crepuscular or nocturnal animals (except for 1 chelonian and 1 ophidian). Each group had its own particular AS architecture. Saurians had a regularly thin cornea with a flat anterior lens capsule and a deep anterior chamber. Ophidians had a thick cornea with a narrow anterior chamber due to a very anteriorly anchored spherical lens. The spectacle was difficult to identify in all ophidians except in Python molurus bivitattus in which it was more obvious. Chelonians displayed an intermediate architecture which more closely resembled the Saurian type than the Ophidian type. Despite grossly similar AS architecture, the three groups of reptiles in the study demonstrated differences that are suggestive of a link between anatomical disparities and variations in environment and lifestyle. © 2014 American College of Veterinary Ophthalmologists.

Electromechanical delay of the knee flexor muscles is impaired after harvesting hamstring tendons for anterior cruciate ligament reconstruction.

PubMed

Ristanis, Stavros; Tsepis, Elias; Giotis, Dimitrios; Stergiou, Nicholas; Cerulli, Guiliano; Georgoulis, Anastasios D

2009-11-01

Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay. This study was conducted to investigate whether harvesting of semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction will affect the electromechanical delay of the knee flexors. Case-control study; Level of evidence, 3. The authors evaluated 12 patients with anterior cruciate ligament reconstruction with a semitendinosus and gracilis autograft, 2 years after the reconstruction, and 12 healthy controls. Each participant performed 4 maximally explosive isometric contractions with a 1-minute break between contractions. The surface electromyographic activity of the biceps femoris and the semitendinosus was recorded from both legs during the contractions. The statistical comparisons revealed significant increases of the electromechanical delay of the anterior cruciate ligament-reconstructed knee for both investigated muscles. Specifically, the electromechanical delay values were increased for both the biceps femoris (P = .029) and the semitendinosus (P = .005) of the reconstructed knee when compared with the intact knee. Comparing the anterior cruciate ligament-reconstructed knee against healthy controls revealed similar significant differences for both muscles (semitendinosus, P = .011; biceps femoris, P = .024). The results showed that harvesting the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction significantly increased the electromechanical delay of the knee flexors. Increased hamstring electromechanical delay might impair knee safety and performance by modifying the transfer time of muscle tension to the tibia and therefore affecting muscle response during sudden movements in athletic activities. However, further investigation is required to identify whether the increased electromechanical delay of the hamstrings can actually influence optimal sports performance and increase the risk for knee injury in athletes with anterior cruciate ligament reconstructions.

Change of Lumbar Ligamentum Flavum after Indirect Decompression Using Anterior Lumbar Interbody Fusion.

PubMed

Ohtori, Seiji; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa; Furuya, Takeo; Koda, Masao

2017-02-01

Retrospective case series. The purpose of this study was to examine changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a 10-year follow-up. Extreme lateral interbody fusion provides minimally invasive treatment of the lumbar spine; this anterior fusion without direct posterior decompression, so-called indirect decompression, can achieve pain relief. Anterior fusion may restore disc height, stretch the flexure of the ligamentum flavum, and increase the spinal canal diameter. However, changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a long follow-up have not yet been reported. We evaluated 10 patients with L4 spondylolisthesis who underwent stand-alone anterior interbody fusion using the iliac crest bone. Magnetic resonance imaging was performed 10 years after surgery. The cross-sectional area (CSA) of the dural sac and the ligamentum flavum at L1-2 to L5-S1 was calculated using a Picture Archiving and Communication System. Spinal fusion with correction loss (average, 4.75 mm anterior slip) was achieved in all patients 10 years postsurgery. The average CSAs of the dural sac and the ligamentum flavum at L1-2 to L5-S1 were 150 mm 2 and 78 mm 2 , respectively. The average CSA of the ligamentum flavum at L4-5 (30 mm 2 ) (fusion level) was significantly less than that at L1-2 to L3-4 or L5-S1. Although patients had an average anterior slip of 4.75 mm, the average CSA of the dural sac at L4-5 was significantly larger than at the other levels. Spinal stability induced a lumbar ligamentum flavum change and a sustained remodeling of the spinal canal, which may explain the long-term pain relief after indirect decompression fusion surgery.

Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review.

PubMed

Chaudhry, Zaira S; Raikin, Steven M; Harwood, Marc I; Bishop, Meghan E; Ciccotti, Michael G; Hammoud, Sommer

2017-12-01

Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes. This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes. Systematic review; Level of evidence, 4. In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented. A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports. The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return to play in athletes, although the high complication rate and potential need for subsequent procedures are important considerations for surgeons and patients.

[The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine].

PubMed

Wu, Xiang-Yang; Zhang, Zhe; Wu, Jian; Lü, Jun; Gu, Xiao-Hui

2009-11-01

To investigate the "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine. From Jan. 2000 to July 2008, 5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman's fractures (type II ), 2 of C2.3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the "window" between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman's fractures underwent the C2,3 intervertebral disc discectomy, bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy, decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting. C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months (means 13.5 months). There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion. The "window" surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure, and can get minimally invasive surgery results and few and far between wound complication, that is safe if corresponding experience is achieved.

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.

Inactivation of the Huntington's disease gene (Hdh) impairs anterior streak formation and early patterning of the mouse embryo

PubMed Central

Woda, Juliana M; Calzonetti, Teresa; Hilditch-Maguire, Paige; Duyao, Mabel P; Conlon, Ronald A; MacDonald, Marcy E

2005-01-01

Background Huntingtin, the HD gene encoded protein mutated by polyglutamine expansion in Huntington's disease, is required in extraembryonic tissues for proper gastrulation, implicating its activities in nutrition or patterning of the developing embryo. To test these possibilities, we have used whole mount in situ hybridization to examine embryonic patterning and morphogenesis in homozygous Hdhex4/5 huntingtin deficient embryos. Results In the absence of huntingtin, expression of nutritive genes appears normal but E7.0–7.5 embryos exhibit a unique combination of patterning defects. Notable are a shortened primitive streak, absence of a proper node and diminished production of anterior streak derivatives. Reduced Wnt3a, Tbx6 and Dll1 expression signify decreased paraxial mesoderm and reduced Otx2 expression and lack of headfolds denote a failure of head development. In addition, genes initially broadly expressed are not properly restricted to the posterior, as evidenced by the ectopic expression of Nodal, Fgf8 and Gsc in the epiblast and T (Brachyury) and Evx1 in proximal mesoderm derivatives. Despite impaired posterior restriction and anterior streak deficits, overall anterior/posterior polarity is established. A single primitive streak forms and marker expression shows that the anterior epiblast and anterior visceral endoderm (AVE) are specified. Conclusion Huntingtin is essential in the early patterning of the embryo for formation of the anterior region of the primitive streak, and for down-regulation of a subset of dynamic growth and transcription factor genes. These findings provide fundamental starting points for identifying the novel cellular and molecular activities of huntingtin in the extraembryonic tissues that govern normal anterior streak development. This knowledge may prove to be important for understanding the mechanism by which the dominant polyglutamine expansion in huntingtin determines the loss of neurons in Huntington's disease. PMID:16109169

Avian binocular vision: It's not just about what birds can see, it's also about what they can't.

PubMed

Tyrrell, Luke P; Fernández-Juricic, Esteban

2017-01-01

With the exception of primates, most vertebrates have laterally placed eyes. Binocular vision in vertebrates has been implicated in several functions, including depth perception, contrast discrimination, etc. However, the blind area in front of the head that is proximal to the binocular visual field is often neglected. This anterior blind area is important when discussing the evolution of binocular vision because its relative length is inversely correlated with the width of the binocular field. Therefore, species with wider binocular fields also have shorter anterior blind areas and objects along the mid-sagittal plane can be imaged at closer distances. Additionally, the anterior blind area is of functional significance for birds because the beak falls within this blind area. We tested for the first time some specific predictions about the functional role of the anterior blind area in birds controlling for phylogenetic effects. We used published data on visual field configuration in 40 species of birds and measured beak and skull parameters from museum specimens. We found that birds with proportionally longer beaks have longer anterior blind areas and thus narrower binocular fields. This result suggests that the anterior blind area and beak visibility do play a role in shaping binocular fields, and that binocular field width is not solely determined by the need for stereoscopic vision. In visually guided foragers, the ability to see the beak-and how much of the beak can be seen-varies predictably with foraging habits. For example, fish- and insect-eating specialists can see more of their own beak than birds eating immobile food can. But in non-visually guided foragers, there is no consistent relationship between the beak and anterior blind area. We discuss different strategies-wide binocular fields, large eye movements, and long beaks-that minimize the potential negative effects of the anterior blind area. Overall, we argue that there is more to avian binocularity than meets the eye.

Anterior segment optical coherence tomography parameters in phacomorphic angle closure and mature cataracts.

PubMed

Mansouri, Mohammadreza; Ramezani, Farshid; Moghimi, Sasan; Tabatabaie, Ali; Abdi, Fatemeh; He, Mingguang; Lin, Shan C

2014-10-21

To describe anterior segment optical coherence tomography (AS-OCT) parameters in phacomorphic angle closure eyes, mature cataract eyes, and their fellow eyes, and identify those parameters that could be used to differentiate phacomorphic angle closure eyes from those with mature cataract and no phacomorphic angle closure. In this cross-sectional study, a total of 33 phacomorphic angle closure subjects and 34 control patients with unilateral mature cataracts were enrolled. All patients underwent AS-OCT imaging and A-scan biometry of both eyes. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris curvature, lens vault (LV), and angle parameters, including angle opening distance (AOD750) and trabecular-iris space area (TISA750), were measured in qualified images using customized software and compared among eyes with phacomorphic angle closure, mature cataract eyes, and their fellow eyes. There was no significant difference in axial length among the four groups. Phacomorphic angle closure had the smallest angle (AOD750, TISA750) and anterior chamber parameters (ACD, ACA, anterior chamber width) and the greatest LV among the groups. This pattern was similar when comparing fellow eyes of mature cataract patients and fellow eyes of phacomorphic angle closure. Anterior chamber area less than 18.62 mm(2), ACD less than 2.60 mm, LV greater than 532.0 μm, and AOD750 less than 0.218 mm had the highest odds ratios (ORs) for distinguishing fellow eyes of phacomorphic angle closure versus fellow eyes of mature cataracts, with OR values of 9.90, 8.31, 7.91, and 7.91, respectively. Logistic regression showed that ACA less than 18.62 was the major parameter associated with fellow eyes of phacomorphic angle closure (OR = 10.96, P < 0.001). Anterior chamber depth, ACA, AOD750, and LV are powerful indicators in differentiating phacomorphic angle closure eyes from those with mature cataract and their fellow eyes. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

The anterior interhemispheric approach: a safe and effective approach to anterior skull base lesions.

PubMed

Mielke, Dorothee; Mayfrank, Lothar; Psychogios, Marios Nikos; Rohde, Veit

2014-04-01

Many approaches to the anterior skull base have been reported. Frequently used are the pterional, the unilateral or bilateral frontobasal, the supraorbital and the frontolateral approach. Recently, endoscopic transnasal approaches have become more popular. The benefits of each approach has to be weighted against its complications and limitations. The aim of this study was to investigate if the anterior interhemispheric approach (AIA) could be a safe and effective alternative approach to tumorous and non-tumorous lesions of the anterior skull base. We screened the operative records of all patients with an anterior skull base lesion undergoing transcranial surgery. We have used the AIA in 61 patients. These were exclusively patients with either olfactory groove meningioma (OGM) (n = 43), ethmoidal dural arteriovenous fistula (dAVF) ( n = 6) or frontobasal fractures of the anterior midline with cerebrospinal fluid (CSF) leakage ( n = 12). Patient records were evaluated concerning accessibility of the lesion, realization of surgical aims (complete tumor removal, dAVF obliteration, closure of the dural tear), and approach related complications. The use of the AIA exclusively in OGMs, ethmoidal dAVFs and midline frontobasal fractures indicated that we considered lateralized frontobasal lesions not suitable to be treated successfully. If restricted to these three pathologies, the AIA is highly effective and safe. The surgical aim (complete tumor removal, complete dAVF occlusion, no rhinorrhea) was achieved in all patients. The complication rate was 11.5 % (wound infection (n = 2; 3.2 %), contusion of the genu of the corpus callosum, subdural hygroma, epileptic seizure, anosmia and asymptomatic bleed into the tumor cavity (n = 1 each). Only the contusion of the corpus callosum was directly related to the approach (1.6 %). Olfaction, if present before surgery, was preserved in all patients, except one (1.6 %). The AIA is an effective and a safe approach to tumorous, vascular and traumatic pathologies of the midline anterior skull base. This approach should be part of the armamentarium of skull base surgeons.

The Effects of Specialization and Sex on Anterior Y-Balance Performance in High School Athletes

PubMed Central

Miller, Madeline M.; Trapp, Jessica L.; Post, Eric G.; Trigsted, Stephanie M.; McGuine, Timothy A.; Brooks, M. Alison; Bell, David R.

2017-01-01

Background: Sport specialization and movement asymmetry have been separately discussed as potential risk factors for lower extremity injury. Early specialization may lead to the development of movement asymmetries that can predispose an athlete to injury, but this has not been thoroughly examined. Hypothesis: Athletes rated as specialized would exhibit greater between-limb anterior reach asymmetry and decreased anterior reach distance on the Y-balance test (YBT) as compared with nonspecialized high school athletes, and these differences would not be dependent on sex. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Two hundred ninety-five athletes (117 male, 178 female; mean age, 15.6 ± 1.2 years) from 2 local high schools participating in basketball, soccer, volleyball, and tennis responded to a questionnaire regarding sport specialization status and performed trials of the YBT during preseason testing. Specialization was categorized according to 3 previously utilized specialization classification methods (single/multisport, 3-point scale, and 6-point scale), and interactions between specialization and sex with Y-balance performance were calculated using 2-way analyses of variance. Results: Single-sport male athletes displayed greater anterior reach asymmetry than other interaction groups. A consistent main effect was observed for sex, with men displaying greater anterior asymmetry and decreased anterior reach distance than women. However, the interaction effects of specialization and sex on anterior Y-balance performance varied based on the classification method used. Conclusion: Single-sport male athletes displayed greater anterior reach asymmetry on the YBT than multisport and female athletes. Specialization classification method is important because the 6- and 3-point scales may not accurately identify balance abnormalities. Male athletes performed worse than female athletes on both of the Y-balance tasks. Clinical Relevance: Clinicians should be aware that single-sport male athletes may display deficits in dynamic balance, potentially increasing their risk of injury. PMID:28447871

Single-stage anterior high sacrectomy for locally recurrent rectal cancer.

PubMed

Fawaz, Khaled; Khaled, Fawaz; Smith, Myles J; Moises, Cukier; Smith, Andrew J; Yee, Albert J M

2014-03-01

A review of prospectively collected data on a consecutive series of patients undergoing single-stage anterior high sacrectomy for locally recurrent rectal carcinoma (LRRC). To determine the clinical outcome of patients who underwent anterior high sacrectomy for LRRC. High sacrectomy for oncological resection remains technically challenging. Surgery has the potential to achieve cure in carefully selected patients. Complete (R0) tumor excision in LRRC may require sacrectomy. High sacral resections (S3 and above) typically require a combined anterior/supine and posterior/prone procedure. We investigated our experience performing single-stage anterior high sacrectomy for LRRC. A consecutive series of patients with LRRC without systemic metastases who underwent resection with curative intent requiring high sacrectomy were identified. A review of a prospectively maintained colorectal and spine cancer database data was performed. An oblique dome high sacral osteotomy was performed during a single-stage anterior procedure. Outcome measures included surgical resection margin status, hospital length of stay, postoperative complications, physical functioning status, and overall survival. Nineteen consecutive patients were treated between 2002 and 2011. High sacrectomy was performed at sacral level S1-S2 in 4 patients, S2-S3 in 9 patients, and through S3 in 6 patients. An R0 resection margin was achieved histologically in all 19 cases. There was 1 early (<30 d) postoperative death (1/19, 5%). At median follow-up of 38 months, 13 patients had no evidence of residual disease, 1 was alive with disease, and 4 had died of disease. Morbidities occurred in 15 of the 19 patients (79%). Although high sacrectomy may require a combined anterior and posterior surgical approach, our series demonstrates the feasibility of performing single-stage anterior high sacrectomy in LRRC, with acceptable risks and outcomes compared with the literature. The procedure described by us for LRRC lessens the need for a simultaneous or staged prone posterior resection, with favorable R0 tumor resections, patient survival, and clinical outcomes. N/A.

Un Marco Abierto: Un Manual de Matematicas y Ciencas Utilizando Inteligencias Multiples Disenado para Estudiantes Bilingues de Educacion General y Especial (An Open Framework: A Math and Science Manual Utilizing Multiple Intelligences Designed for Bilingual Students in General and Special Education).

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Office of Bilingual Education.

This manual incorporates a Multiple Intelligences perspective into its presentation of themes and lesson ideas for Spanish-English bilingual elementary school students in grades 4-8 and is designed for both gifted and special education uses. Each unit includes practice activities, semantic maps to illustrate and help organize ideas as well as…

Evaluation of the lamina cribrosa in patients with diabetes mellitus using enhanced depth imaging spectral-domain optical coherence tomography.

PubMed

Akkaya, Serkan; Küçük, Bekir; Doğan, Hatice Karaköse; Can, Ertuğrul

2018-06-01

To compare the lamina cribrosa thickness and anterior lamina cribrosa depth between patients with and without diabetes mellitus and to investigate the effect of metabolic control and duration of diabetes mellitus on lamina cribrosa thickness and anterior lamina cribrosa depth using enhanced depth imaging spectral-domain optical coherence tomography. A total of 70 patients were enrolled in this cross-sectional study and were divided into the diabetes and control groups. Intraocular pressure, circumpapillary retinal nerve fibre layer thickness, anterior lamina cribrosa depth and lamina cribrosa thickness were compared between the groups. In the control group, the mean intraocular pressure was 14.6 ± 3.1 (mean ± standard deviation) mmHg, mean circumpapillary retinal nerve fibre layer thickness was 105.41 ± 5.86 μm, mean anterior lamina cribrosa depth was 420.3 ± 90.2 μm and mean lamina cribrosa thickness was 248.5 ± 5.4 μm. In the diabetes group, the mean intraocular pressure was 13.9 ± 2.2 mmHg, mean circumpapillary retinal nerve fibre layer thickness was 101.37 ± 10.97 μm, mean anterior lamina cribrosa depth was 351.4 ± 58.6 μm and mean lamina cribrosa thickness was 271.6 ± 33.9 μm. Lamina cribrosa thickness was significantly higher ( p < 0.001) and anterior lamina cribrosa depth was significantly lower ( p = 0.003) in the diabetes group. There was no statistical difference between the groups with regard to age, spherical equivalent, axial length, circumpapillary retinal nerve fibre layer thickness and intraocular pressure ( p  = 0.69, 0.26, 0.47, 0.06 and 0.46, respectively). Lamina cribrosa thickness and anterior lamina cribrosa depth were not significantly correlated with duration of diabetes mellitus (lamina cribrosa thickness: r = -0.078, p = 0.643; anterior lamina cribrosa depth: r = -0.062, p = 0.710) or HbA1c levels (lamina cribrosa thickness: r = -0.078, p = 0.596; anterior lamina cribrosa depth: r = -0.228, p = 0.169). The results of this study showed that the optical coherence tomography measurement of lamina cribrosa revealed thicker and more anteriorly positioned lamina cribrosa for patients with diabetes mellitus compared with those for healthy controls.

Bundled payment reimbursement for anterior and posterior approaches for cervical spondylotic myelopathy: an analysis of private payer and Medicare databases.

PubMed

Virk, Sohrab S; Phillips, Frank M; Khan, Safdar N

2018-03-01

OBJECTIVE Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that often requires surgery. Studies have shown the clinical equivalency of anterior versus posterior approaches for CSM surgery. The purpose of this study was to determine the amount and type of resources used for anterior and posterior surgical treatment of CSM by using large national databases of clinical and financial information from patients. METHODS This study consists of 2 large cohorts of patients who underwent either an anterior or posterior approach for treatment of CSM. These patients were selected from the Medicare 5% National Sample Administrative Database (SAF5) and the Humana orthopedic database (HORTHO), which is a database of patients with private payer health insurance. The outcome measures were the cost of a 90-day episode of care, as well as a breakdown of the cost components for each surgical procedure between 2005 and 2014. RESULTS A total of 16,444 patients were included in this analysis. In HORTHO, there were 10,332 and 1556 patients treated with an anterior or posterior approach for CSM, respectively. In SAF5, there were 3851 and 705 patients who were treated by an anterior or posterior approach for CSM, respectively. The mean ± SD reimbursements for anterior and posterior approaches in the HORTHO database were $20,863 ± $2014 and $23,813 ± $4258, respectively (p = 0.048). The mean ± SD reimbursements for anterior and posterior approaches in the SAF5 database were $18,219 ± $1053 and $25,598 ± $1686, respectively (p < 0.0001). There were also significantly higher reimbursements for a rehabilitation/skilled nursing facility and hospital/inpatient care for patients who underwent a posterior approach in both the private payer and Medicare databases. In all cohorts in this study, the hospital-related reimbursement was more than double the surgeon-related reimbursement. CONCLUSIONS This study provides resource utilization information for a 90-day episode of care for both anterior and posterior approaches for CSM surgery. There is a statistically significant higher resource utilization for patients undergoing the posterior approach for CSM, which is consistent with the literature. Understanding the reimbursement patterns for anterior versus posterior approaches for CSM will help providers design a bundled payment for patients requiring surgery for CSM, and this study suggests that a subset of patients who require the posterior approach for treatment also require greater resources. The data also suggest that hospital-related reimbursement is the major driver of payments.

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

PubMed Central

Liu, Tao; Xu, Wen; Cheng, Tao

2010-01-01

The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 0.83 [0.24, 1.43]) in the ‘follow-up time ≤5 years’ subgroup, but had no significant differences in the ‘follow-up time >5 years’ subgroup (p > 0.05). The recovery rate for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 10.08 [1.39, 18.78]) in the ‘follow-up time ≤5 years’ subgroup. No study reported the recovery rate for the follow-up time >5 years. For multilevel OPLL patients, the final follow-up JOA score and recovery rate for the anterior group were both significantly higher than the posterior group in the ‘follow-up time ≤5 years’ subgroup (p < 0.05, WMD 2.50 [0.16, 4.85]; p < 0.05, WMD 29.48 [29.09, 29.87], respectively). One study [31] which mean follow-up time was 6 years was enrolled in the ‘follow-up time >5 years’ subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL <60% (p > 0.05), while in patients with occupying ratio ≥60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p < 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the ‘follow-up time ≤5 years’ subgroup (p < 0.05, OR 7.33 [2.96, 18.20] for CSM patients; p < 0.05, OR 4.44 [1.80, 10.98] for OPLL patients), but were similar to the posterior group in the ‘follow-up time >5 years’ subgroup (p > 0.05). In conclusion, anterior surgery had better clinical outcomes and more complications at the early stage after operation for both multilevel CSM and OPLL patients. At the late stage, posterior surgery had similar clinical outcomes and complications to anterior surgery for CSM patients, and OPLL patients with occupying ratio of OPLL <60%. While for OPLL patients with occupying ratio ≥60%, anterior surgery had superior clinical outcome to posterior surgery. PMID:20582710

The effect of a Hill-Sachs defect on glenohumeral translations, in situ capsular forces, and bony contact forces.

PubMed

Sekiya, Jon K; Jolly, John; Debski, Richard E

2012-02-01

Hill-Sachs defects have been associated with failed repairs for anterior shoulder instability. However, the biomechanical consequences of these defects are not well understood because of the complicated interaction between the passive soft tissue and bony stabilizers. The creation of a 25% Hill-Sachs defect would not significantly alter the glenohumeral translations but would increase the in situ forces in the glenohumeral capsule as well as the glenohumeral bony contact forces. Controlled laboratory study. A robotic/universal force-moment sensor (UFS) testing system was used to apply joint compression (22 N) and an anterior or posterior load (44 N) to cadaveric shoulders (n = 9) with the skin and deltoid removed (intact) at 3 glenohumeral joint positions (abduction/external rotation): 0°/0°, 30°/30°, and 60°/60° (corresponds to 90°/90° of shoulder abduction/external rotation). A 25% bony defect on the posterolateral humeral head (defect) was then created in the most common position of anterior shoulder dislocation (90°/90°), and the loading protocol was repeated. A nonparametric repeated-measures Friedman test with a Wilcoxon signed-rank post hoc test was performed to compare translations, in situ forces in the capsule, and bony contact forces between each state (P < .05). At 0°/0°, anterior translation significantly increased from 15.3 ± 8.2 mm to 16.6 ± 9.0 mm (P < .05) in response to an anterior load. At 30°/30°, anterior and posterior translations, respectively, significantly increased in response to both anterior (intact: 13.6 ± 7.1 mm vs defect: 14.2 ± 7 mm; P < .05) and posterior loads (intact: 15.7 ± 5.8 mm vs defect: 17.7 ± 5.1 mm; P < .05). In situ force in the capsule during anterior loading was increased in the defect state at both 60°/60° (intact: 38.9 ± 14.4 N vs defect: 43.2 ± 15.9 N; P < .05) and 30°/30° (intact: 39.6 ± 13.8 N vs defect: 45.6 ± 9.3 N; P < .05). The medial bony contact forces were also increased in the defect state at 30°/30° (intact: 25.0 ± 13.8 N vs defect: 28.9 ± 13.2 N; P < .05) during anterior loading. We believe that the stabilizing function of the intact capsule was the primary contributor to the finding of only small increases of anterior translation, capsule forces, and bony contact forces observed with a 25% Hill-Sachs defect in response to an anterior load. These findings imply that a 25% Hill-Sachs defect in isolation may not be responsible for recurrent instability if the function of the capsule is restored to the intact state and that the presence of the Hill-Sachs defect may be a marker for significant concomitant injury to the anterior glenoid rim. However, the small changes in these parameters may have long-term implications for the development of osteoarthritis.

Innervation of the anterior byssal retractor muscle in Mytilus edulis L. II. Ultrastructure of the glio-interstitial cells.

PubMed

Gilloteaux, J

1975-08-27

Studies on the intrinsic innervation of the anterior byssal retractor muscle (ABRM) in Mytilus edulis L. were continued at the ultrastructural level. Electron micrographs show nerve processes ensheathed by glio-interstitial cells running between muscle fibers. The glio-interstitial cells may represent all the types of osmiophilic cells previously described by the light microscopic ZIO technique in the anterior byssal retractor muscle.

Anterior Urethral Valve: Uncommon Association with Renal Duplicity.

PubMed

Salem, Amina Ben; Mazhoud, Ines; Laamiri, Rachida; Salem, Randa; Laajili, Hayet; Sahnoun, Lassaad; Hafsa, Chiraz

2017-01-01

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15-30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

Review article: Surgical approaches for correction of post-tubercular kyphosis.

PubMed

Panchmatia, Jaykar R; Lenke, Lawrence G; Molloy, Sean; Cheung, Kenneth M C; Kebaish, Khaled M

2015-12-01

This study reviewed the literature regarding the pros and cons of various surgical approaches (anterior, anterolateral, combined, and posterior) for correction of post-tubercular kyphosis. The anterior and anterolateral approaches are effective in improving neurological deficit but not in correcting kyphosis. The combined anterior and posterior approach and the posterior approach combined with 3-column osteotomy achieve good neurological improvement and kyphosis correction. The latter is superior when expertise and facilities are available.

Supernumerary Teeth in the Maxillary Anterior Region: The Dilemma of Early Versus Late Surgical Intervention.

PubMed

Sarne, Ofer; Shapira, Yehoshua; Blumer, Sigalit; Finkelstein, Tamar; Schonberger, Shirley; Bechor, Naomi; Shpack, Nir

Supernumerary teeth are the most common developmental dental anomalies in the maxillary anterior region causing interference to the developing permanent incisors resulting in poor dental and facial esthetics. Two different opinions regarding the timing for surgical removal of the supernumerary teeth are presented. In this case report, three brothers with supernumerary teeth in the maxillary anterior region are presented, their surgical and orthodontic management and outcome are discussed.

Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve.

PubMed

Laranjo, Sérgio; Oliveira, Mário; Trigo, Conceição

2015-08-01

Left anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

Mutations at the PAX6 locus are found in heterogeneous anterior segment malformations including Peters' anomaly.

PubMed

Hanson, I M; Fletcher, J M; Jordan, T; Brown, A; Taylor, D; Adams, R J; Punnett, H H; van Heyningen, V

1994-02-01

Mutation or deletion of the PAX6 gene underlies many cases of aniridia. Three lines of evidence now converge to implicate PAX6 more widely in anterior segment malformations including Peters' anomaly. First, a child with Peters' anomaly is deleted for one copy of PAX6. Second, affected members of a family with dominantly inherited anterior segment malformations, including Peters' anomaly are heterozygous for an R26G mutation in the PAX6 paired box. Third, a proportion of Sey/+ Smalleye mice, heterozygous for a nonsense mutation in murine Pax-6, have an ocular phenotype resembling Peters' anomaly. We therefore propose that a variety of anterior segment anomalies may be associated with PAX6 mutations.

Indomethacin inhibits the effects of oestrogen in the anterior pituitary gland of the rat.

PubMed

Rosental, D G; Machiavelli, G A; Cherñavsky, A C; Speziale, N S; Burdman, J A

1989-06-01

Two inhibitors of prostaglandin synthesis, indomethacin and aspirin, blocked the increase of oestrogen-binding sites in the nuclear subcellular fraction, an increase which occurs after the administration of oestradiol. Consequently the biological effects of oestrogens in the anterior pituitary gland of the rat (prolactin synthesis, concentration of progesterone-binding sites and cell proliferation) are diminished. The anterior pituitary gland synthesized prostaglandin F2 alpha (PGF2 alpha), PGE2 and PGD2 from arachidonic acid. This synthesis was blocked when indomethacin was added to the culture media. Oestrogen increased the concentration of PGE2: an increase that was partially prevented by indomethacin. Prostaglandins may have an important role on the effects of oestrogen in the anterior pituitary gland of the rat.

Non-masticatory uses of anterior teeth of Sima de los Huesos individuals (Sierra de Atapuerca, Spain).

PubMed

Lozano, Marina; Bermúdez de Castro, José M; Carbonell, Eudald; Arsuaga, Juan Luis

2008-10-01

In this study we examine the labial and occlusal surfaces of incisors and canines of hominins recovered from the Sima de los Huesos (SH), middle Pleistocene site, in order to establish the possible extra-masticatory use of anterior teeth. We have compared the microwear of these fossils with microwear from the anterior teeth of Australian Aborigines, a population characterized by ethnographic evidence of the use of their teeth as a third hand. These two samples of teeth were microscopically analyzed using Scanning Electron Microscopy (SEM). Our results support the "cultural" origin of microwear observed on fossil teeth: we conclude that the SH hominins used their anterior teeth as a "third hand" for para- or extra-masticatory activities.

Anterior subcarinal node dissection on the left side using video thoracoscopy: an easier technique.

PubMed

Baste, Jean-Marc; Haddad, Laura; Melki, Jean; Peillon, Christophe

2015-04-01

Lobectomy for lung carcinoma is usually associated with complete node dissection, but it is often difficult to perform using video thoracoscopy, especially on the left side. In this case, our team uses an anterior technique for subcarinal lymphadenectomy. After left lobectomy, we lift the bronchial stump by its anterior face to open and dissect the subcarinal space. Exposure is difficult using the more usual technique of posterior subcarinal lymphadenectomy, and the different techniques (often requiring retractors) remain complex because some vessels might be injured. We recommend using anterior lymphadenectomy, which should facilitate video thoracoscopy for lymphadenectomy on the left side. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Two patients with TAFRO syndrome exhibiting strikingly similar anterior mediastinal lesions with predominantly fat attenuation on chest computed tomography.

PubMed

Ozawa, Yoko; Yamamoto, Hiroshi; Yasuo, Masanori; Takahashi, Hidekazu; Tateishi, Kazunari; Ushiki, Atsuhito; Kawakami, Satoshi; Fujinaga, Yasunari; Asaka, Shiho; Sano, Kenji; Takayama, Hiroshi; Imamura, Hiroshi; Hanaoka, Masayuki

2017-03-01

We herein report on two middle-aged men with TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis or renal failure, and organomegaly) syndrome, a unique clinicopathological variant of multicentric Castleman׳s disease recently proposed in Japan. Strikingly similar anterior mediastinal fat swellings with soft tissue density were observed in the patients on chest computed tomography. In TAFRO syndrome, bilateral pleural effusion and slight lymph node swelling are common in the thoracic region; however, anterior mediastinal lesions have not been previously observed. Although the mechanisms of anterior mediastinal lesions have not been defined, these lesions seem to have a close relationship with TAFRO syndrome. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Neurodynamic responses to the femoral slump test in patients with anterior knee pain syndrome.

PubMed

Lin, Pei-Ling; Shih, Yi-Fen; Chen, Wen-Yin; Ma, Hsiao-Li

2014-05-01

Matched-control, cross-sectional study. The purpose of this study was to compare the responses to the femoral slump test (FST), including the change in hip range of motion and level of discomfort, between subjects with and without anterior knee pain. Anterior knee pain syndrome is a common problem among adults. The FST is the neurodynamic test used to assess the mechanosensitivity of the femoral component of the nervous system. However, as of yet, there is no literature discussing the use of the FST in patients with anterior knee pain. Thirty patients with anterior knee pain and 30 control participants, matched by gender, age, and dominant leg, were recruited. The subjects received the FST, during which the hip extension angle and the location and intensity of pain/discomfort were recorded. Reproduction of symptoms that were alleviated by neck extension was interpreted as a positive test. Differences in hip extension angle and pain intensity between groups were examined using a 2-way, repeated-measures analysis of variance and a Kruskal-Wallis analysis. The level of significance was set at α = .05. Subjects with anterior knee pain had a smaller hip extension angle than that of controls (-3.6° ± 5.3° versus 0.6° ± 6.1°; mean difference, 4.2°; 95% confidence interval [CI]: 1.24°, 7.15°; P = .006). Eight patients with anterior knee pain showed a positive FST, and those with a positive FST had a smaller hip extension angle (-5.7° ± 4.5°) than that of controls (mean difference, 6.3°; 95% CI: 0.8°, 11.8°; P = .007). There was no difference in the hip extension angle between the positive and negative FST groups (mean difference, 2.9°; 95% CI: -8.5°, 2.0°) or between the negative FST and control groups (mean difference, 3.4°; 95% CI: -0.4°, 7.3°). Results of this study suggest that altered mechanosensitivity of the femoral nerve occurred in the patients with anterior knee pain who presented with a positive FST. The role of increased mechanosensitivity in the development and management of anterior knee pain should be investigated in the future.

Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity.

PubMed

Stephen, Joanna M; Halewood, Camilla; Kittl, Christoph; Bollen, Steve R; Williams, Andy; Amis, Andrew A

2016-02-01

Injury to the posteromedial meniscocapsular junction has been identified after anterior cruciate ligament (ACL) rupture; however, there is a lack of objective evidence investigating how this affects knee kinematics or whether increased laxity can be restored by repair. Such injury is often overlooked at surgery, with possible compromise to results. (1) Sectioning the posteromedial meniscocapsular junction in an ACL-deficient knee will result in increased anterior tibial translation and rotation. (2) Isolated ACL reconstruction in the presence of a posteromedial meniscocapsular junction lesion will not restore intact knee laxity. (3) Repair of the posteromedial capsule at the time of ACL reconstruction will reduce tibial translation and rotation to normal. (4) These changes will be clinically detectable. Controlled laboratory study. Nine cadaveric knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Measurements were recorded with the following loads: 90-N anterior-posterior tibial forces, 5-N·m internal-external tibial rotation torques, and combined 90-N anterior force and 5-N·m external rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following conditions: intact, ACL deficient, ACL deficient and posteromedial meniscocapsular junction sectioned, ACL deficient and posteromedial meniscocapsular junction repaired, ACL patellar tendon reconstruction with posteromedial meniscocapsular junction repair, and ACL reconstructed and capsular lesion re-created. Statistical analysis used repeated-measures analysis of variance and post hoc paired t tests with Bonferroni correction. Tibial anterior translation and external rotation were both significantly increased compared with the ACL-deficient knee after posterior meniscocapsular sectioning (P < .05). These parameters were restored after ACL reconstruction and meniscocapsular lesion repair (P > .05). Anterior and external rotational laxities were significantly increased after sectioning of the posteromedial meniscocapsular junction in an ACL-deficient knee. These were not restored after ACL reconstruction alone but were restored with ACL reconstruction combined with posterior meniscocapsular repair. Tibial anterior translation changes were clinically detectable by use of the Rolimeter. This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage. © 2015 The Author(s).

Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study: Laboratory investigation.

PubMed

Oberkircher, Ludwig; Born, Sebastian; Struewer, Johannes; Bliemel, Christopher; Buecking, Benjamin; Wack, Christina; Bergmann, Martin; Ruchholtz, Steffen; Krüger, Antonio

2014-10-01

Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation. Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3-T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed. In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p < 0.05, Kruskal-Wallis test). In this cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged in the clinical setting, anterior plate fixation in combination with bone grafting might not provide sufficient stabilization; additional posterior stabilization may be needed.

Whitening of endodontically untreated calcified anterior teeth.

PubMed

Pedorella, C A; Meyer, R D; Woollard, G W

2000-01-01

Definitive treatment for whitening endodontically untreated anterior teeth with dystrophic calcification is provided by removing the coronal sclerotic dentin and utilizing internal and external bleaching as necessary.

A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals with ACL Injury. Part II: Determinants of Dynamic Knee Stability

PubMed Central

Hurd, Wendy J.; Axe, Michael J.; Snyder-Mackler, Lynn

2010-01-01

Objectives To clarify the determinants of dynamic knee stability early after anterior cruciate ligament (ACL) injury. Materials and Methods 345 consecutive patients who were regular participants in IKDC level I/II sports before injury and had an acute isolated ACL injury from the practice of a single orthopaedic surgeon underwent a screening examination including clinical measures, knee laxity, quadriceps strength, hop testing, and patient self-reported knee function an average of 6 weeks after injury when impairments were resolved. Independent t-tests were performed to evaluate differences in quadriceps strength and anterior knee laxity between potential copers and noncopers. Hierarchical regression was performed to determine the influence of quadriceps strength, pre-injury activity level, and anterior knee laxity on hop test performance, as well as the influence of timed hop, cross-over hop, quadriceps strength, pre-injury activity level, and anterior knee laxity on self-assessed global function. Results Neither anterior knee laxity nor quadriceps strength differed between potential copers and non-copers. Quadriceps strength influenced hop test performance more significantly than pre-injury activity level or anterior knee laxity, but the variance accounted for by quadriceps strength was low (Range: 4-8%). Timed hop performance was the only variable that impacted self-assessed global function. Conclusions Traditional surgical decision making based on passive anterior knee laxity and pre-injury activity level is not supported by the results, as neither are good predictors of dynamic knee stability. Clinical tests that capture neuromuscular adaptations, including the timed hop test, may be useful in predicting function and guiding individualized patient management after ACL injury. PMID:17932399

Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results

PubMed Central

Zhu, Feng; Wang, Bin; Zhu, Zezhang; Yu, Yang; Sun, Xu; Ma, Weiwei

2010-01-01

The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical invasion as well as achieve similar clinical outcomes compared with classical anterior approach. PMID:21181213

Constancy and characteristics of the anterior cutaneous branch of the first intercostal nerve: correcting the descriptions in human anatomy texts.

PubMed

Miyawaki, Makoto

2006-12-01

Human anatomy texts state that the anterior cutaneous branch of the first intercostal nerve (Rca-Th1) does not exist or that, even if it does, it is poorly developed. However, an anterior cutaneous branch in the first intercostal space (Rca-1) was observed in 74.8% of cases examined (104/139 sides) and was not poorly developed at all. Some of the observed Rca-I were even larger than the anterior cutaneous branches in the second intercostal space (Rca-ll). The segment of origin of the Rca-I was analyzed in 37 sides and 66.2% (49/74 branches) were confirmed to be from Th1. As a result, in contrast with traditional beliefs, it was shown that Rca-Th1 exists. The Rca-I was classified into two types according to the course and distribution: (i) an anterior cutaneous branch that appeared at the anterior end of the first intercostal space (ICS), ran through the pectoralis major muscle and extended in the first ICS (Rca-1); and (ii) another branch that appeared at the same place but ran downward along the anterior surface of the second costal cartilage, deep to the pectoralis major muscle, to reach the inferior edge of the second costal cartilage or the second ICS, passed through the pectoralis major muscle and extended to the second rib or the second ICS (pseudo Rca-2). It was found that 77.8% (35/45 branches) of Rca-1 and 48.3% (14/29 branches) of pseudo Rca-2 were derived from Th1. Accordingly, the author suggests that the description in human anatomy texts should be revised to read, '... the Rca-Th1 exists quite constantly and some of appear at a position resembling Rca-Th2'.

The relationship between quadriceps muscle force, knee flexion, and anterior cruciate ligament strain in an in vitro simulated jump landing.

PubMed

Withrow, Thomas J; Huston, Laura J; Wojtys, Edward M; Ashton-Miller, James A

2006-02-01

An instrumented cadaveric knee construct was used to quantify the association between impact force, quadriceps force, knee flexion angle, and anterior cruciate ligament relative strain in simulated unipedal jump landings. Anterior cruciate ligament strain will correlate with impact force, quadriceps force, and knee flexion angle. Descriptive laboratory study. Eleven cadaveric knees (age, 70.8 [19.3] years; 5 male; 6 female) were mounted in a custom fixture with the tibia and femur secured to a triaxial load cell. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated using pretensioned steel cables (stiffness, 7 kN/cm), and the quadriceps tendon force was measured using a load cell. Mean strain on the anteromedial bundle of the anterior cruciate ligament was measured using a DVRT. With the knee in 25 degrees of flexion, the construct was vertically loaded by an impact force initially directed 4 cm posterior to the knee joint center. Tibiofemoral kinematics was measured using a 3D optoelectronic tracking system. The increase in anterior cruciate ligament relative strain was proportional to the increase in quadriceps force (r(2) = 0.74; P < .00001) and knee flexion angle (r(2) = 0.88; P < .00001) but was not correlated with the impact force (r(2) = 0.009; P = .08). The increase in knee flexion and quadriceps force during this simulated 1-footed landing strongly influenced the relative strain on the anteromedial bundle of the anterior cruciate ligament. These results suggest that even in the presence of knee flexor muscle forces, the increase in quadriceps force required to prevent the knee from flexing during landing can place the anterior cruciate ligament at risk for large strains.

Similar Superior Patient-Reported Outcome Measures for Anterior and Posterolateral Approaches After Total Hip Arthroplasty: Postoperative Patient-Reported Outcome Measure Improvement After 3 months in 12,774 Primary Total Hip Arthroplasties Using the Anterior, Anterolateral, Straight Lateral, or Posterolateral Approach.

PubMed

Peters, Rinne M; van Beers, Loes W A H; van Steenbergen, Liza N; Wolkenfelt, Julius; Ettema, Harmen B; Ten Have, Bas L E F; Rijk, Paul C; Stevens, Martin; Bulstra, Sjoerd K; Poolman, Rudolf W; Zijlstra, Wierd P

2018-06-01

Patient-reported outcome measures (PROMs) are used to evaluate the outcome of total hip arthroplasty (THA). We determined the effect of surgical approach on PROMs after primary THA. All primary THAs, with registered preoperative and 3 months postoperative PROMs were selected from the Dutch Arthroplasty Register. Based on surgical approach, 4 groups were discerned: (direct) anterior, anterolateral, direct lateral, and posterolateral approaches. The following PROMs were recorded: Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS); Oxford Hip Score; EQ-5D index score; EQ-5D thermometer; and Numeric Rating Scale measuring pain, both active and in rest. The difference between preoperative and postoperative scores was calculated (delta-PROM) and used as primary outcome measure. Multivariable linear regression analysis was performed for comparisons. Cohen's d was calculated as measure of effect size. All examined 4 approaches resulted in a significant increase of PROMs after primary THA in the Netherlands (n = 12,274). The anterior and posterolateral approaches were associated with significantly more improvement in HOOS-PS scores compared with the anterolateral and direct lateral approaches. Furthermore, the posterolateral and anterior approaches showed greater improvement on Numeric Rating Scale pain scores compared with the anterolateral approach. No relevant differences in delta-PROM were seen between the anterior and posterolateral surgical approaches. Anterior and posterolateral surgical approaches showed more improvement in self-reported physical functioning (HOOS-PS) compared with anterolateral and direct lateral approaches in patients receiving a primary THA. However, clinical differences were only small. Copyright © 2018 Elsevier Inc. All rights reserved.

Nitric Oxide Plays a Key Role in Ovariectomy-Induced Apoptosis in Anterior Pituitary: Interplay between Nitric Oxide Pathway and Estrogen.

PubMed

Ronchetti, Sonia A; Machiavelli, Leticia I; Quinteros, Fernanda A; Duvilanski, Beatriz H; Cabilla, Jimena P

2016-01-01

Changes in the estrogenic status produce deep changes in pituitary physiology, mainly because estrogens (E2) are one of the main regulators of pituitary cell population. Also, E2 negatively regulate pituitary neuronal nitric oxide synthase (nNOS) activity and expression and may thereby modulate the production of nitric oxide (NO), an important regulator of cell death and survival. Little is known about how ovary ablation affects anterior pituitary cell remodelling and molecular mechanisms that regulate this process have not yet been elucidated. In this work we used freshly dispersed anterior pituitaries as well as cell cultures from ovariectomized female rats in order to study whether E2 deficiency induces apoptosis in the anterior pituitary cells, the role of NO in this process and effects of E2 on the NO pathway. Our results showed that cell activity gradually decreases after ovariectomy (OVX) as a consequence of cell death, which is completely prevented by a pan-caspase inhibitor. Furthermore, there is an increase of fragmented nuclei and DNA cleavage thereby presenting the first direct evidence of the existence of apoptosis in the anterior pituitary gland after OVX. NO production and soluble guanylyl cyclase (sGC) expression in anterior pituitary cells increased concomitantly to the apoptosis. Inhibition of both, NO synthase (NOS) and sGC activities prevented the drop of cell viability after OVX, showing for the first time that increased NO levels and sGC activity observed post-OVX play a key role in the induction of apoptosis. Conversely, E2 and prolactin treatments decreased nNOS expression and activity in pituitary cells from OVX rats in a time- and E2 receptor-dependent manner, thus suggesting interplay between NO and E2 pathways in anterior pituitary.

Usefulness of the "grand-piano sign" for determining femoral rotational alignment in total knee arthroplasty.

PubMed

Ohmori, Takaaki; Kabata, Tamon; Kajino, Yoshitomo; Taga, Tadashi; Inoue, Daisuke; Yamamoto, Takashi; Takagi, Tomoharu; Yoshitani, Junya; Ueno, Takuro; Tsuchiya, Hiroyuki

2018-01-01

The "grand-piano sign" is a well-known indicator of proper rotational femoral alignment. We investigated changes in the shape of the femoral anterior cutting plane by changing the rotational alignment, anterior portion depth, and cutting plane flexion angle. We simulated various cutting planes after cutting the anterior portion of the femur next to the distal femoral osteotomy in 50 patients with varus knee and also a femoral anterior osteotomy with four degree (S group) and seven degree (T group) flexion angles regarding the mechanical axis. We defined the final cutting plane as the farthest position that we could reach without making a notch and the precutting plane as two millimeters anterior from the final cutting plane. The simulated resection plane was rotated to produce external and internal rotation angles of 0°, three degrees, and five degrees relative to the surgical transepicondylar axis (SEA). We investigated medial and lateral portions of the femoral anterior cutting plane length ratio (M/L). When we cut parallel to SEA, M/L was 0.67±0.09 and 0.62±0.12 in the T and S groups, respectively. M/L was approximately 0.8 and 0.5 with five degree internal and external rotations, respectively (P<0.01). On comparing final cutting and precutting planes, there were no significant differences in M/L without five degree external rotation in the T group and no significant difference in any case in the S group (P>0.01). The ideal M/L of the femoral anterior cutting plane was 0.62-0.67. M/L did not change with a precutting plane in almost all rotational patterns. Copyright © 2017. Published by Elsevier B.V.