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Gentiloni MML, Paci V, Cimaroli I, Agostinelli A, Giannoni M, Campanati A, Diotallevi F, Carotti M, Sessa F, Sordillo R, Macchini C, Fiorini F, Massaccesi L, Ciferri M, Gigli M, Marconi V, Perini L, Marani A, Giovagnoni A, Polonara G, Offidani AM, Benfaremo D, Proft F, Poddubbny D, Moroncini G. The ATTRACT study: screening for the early identification of axial psoriatic arthritis in a cohort of Italian psoriatic patients. Rheumatology (Oxford) 2023:kead566. [PMID: 37878802 DOI: 10.1093/rheumatology/kead566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE There is growing interest in the early identification of patients with axial psoriatic arthritis (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. METHODS The dermatologist-centered screening (DCS) questionnaire was administrated by Dermatologists to consecutive patients fulfilling the inclusion criteria (1. age ≥ 18 years and 2. clinical diagnosis of psoriasis made by a dermatologist) to identify patients eligible (affirmative answers 1-3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic, and imaging data were collected from all referred patients. RESULTS Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months, and 140 (53%) reporting back pain onset before the age of 45. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients.Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with Pso without PsA. CONCLUSION The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA.
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Affiliation(s)
- Michele Maria Luchetti Gentiloni
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Valentino Paci
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Ilaria Cimaroli
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Alice Agostinelli
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Melania Giannoni
- Dermatologic Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Anna Campanati
- Dermatologic Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Federico Diotallevi
- Dermatologic Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Marina Carotti
- Radiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Sessa
- Neuroradiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Raffaella Sordillo
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Cristina Macchini
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Federico Fiorini
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Leonardo Massaccesi
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Monia Ciferri
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Marco Gigli
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Valentina Marconi
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Lucia Perini
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Internal Medicine Residency Programme, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Andrea Marani
- Dermatologic Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Radiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gabriele Polonara
- Neuroradiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Anna Maria Offidani
- Dermatologic Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Devis Benfaremo
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin, Berlin, Germany
| | - Denis Poddubbny
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin, Berlin, Germany
| | - Gianluca Moroncini
- Medical Clinic, Marche Polytechnic University & Department of Internal Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
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Marek RD. A surrogate forelimb: Evolution, function and development of the avian cervical spine. J Morphol 2023; 284:e21638. [PMID: 37708511 DOI: 10.1002/jmor.21638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
The neck is a critical portion of the avian spine, one that works in tandem with the beak to act as a surrogate forelimb and allows birds to manipulate their surroundings despite the lack of a grasping capable hand. Birds display an incredible amount of diversity in neck morphology across multiple anatomical scales-from varying cervical counts down to intricate adaptations of individual vertebrae. Despite this morphofunctional disparity, little is known about the drivers of this enormous variation, nor how neck evolution has shaped avian macroevolution. To promote interest in this system, I review the development, function and evolution of the avian cervical spine. The musculoskeletal anatomy, basic kinematics and development of the avian neck are all documented, but focus primarily upon commercially available taxa. In addition, recent work has quantified the drivers of extant morphological variation across the avian neck, as well as patterns of integration between the neck and other skeletal elements. However, the evolutionary history of the avian cervical spine, and its contribution to the diversification and success of modern birds is currently unknown. Future work should aim to broaden our understanding of the cervical anatomy, development and kinematics to include a more diverse selection of extant birds, while also considering the macroevolutionary drivers and consequences of this important section of the avian spine.
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Affiliation(s)
- Ryan D Marek
- Department of Cell and Developmental Biology, Centre for Integrative Anatomy, University College London, London, UK
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Kim J, Mizher R, Cororaton A, Greditzer H, Sofka C, Ellis S, Deland J. Cervical Ligament Insufficiency in Progressive Collapsing Foot Deformity: It May Be More Important Than We Know. Foot Ankle Int 2023; 44:949-957. [PMID: 37737017 DOI: 10.1177/10711007231178825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Subluxation at the subtalar joint is one of the major radiographic features that characterize progressive collapsing foot deformity (PCFD). Although it is recognized that the cervical ligament plays an important function in maintaining the subtalar joint's stability, its role and involvement in PCFD is largely unknown. The purpose of this study was to assess the prevalence of cervical ligament insufficiency in patients with PCFD and to establish if the degree of its pathology changes with increasing axial plane deformity. METHODS This study retrospectively reviewed magnetic resonance imaging (MRI) of 78 PCFD patients and age- and gender-matched controls. The structures evaluated were the cervical, spring, and talocalcaneal interosseous ligaments. Structural derangement was graded on a 5-part scale (0-4), with grade 0 being normal and grade 4 indicating a tear of greater than 50% of the cross-sectional area. Plain radiographic parameters (talonavicular coverage angle [TNC], lateral talo-first metatarsal [Meary] angle, calcaneal pitch, and hindfoot moment arm) as well as axial plane orientation of the talus (TM-Tal) and calcaneus (TM-Calc) relative to the transmalleolar axis and talocalcaneal subluxation (Diff Calc-Tal) were correlated with the cervical ligament MRI grading system. RESULTS The overall distribution of the degree of cervical ligament involvement was significantly different between the PCFD and control groups (P < .001). MRI evidence of a tear in the cervical ligament was identified in 47 of 78 (60.3%) feet in the PCFD group, which was significantly higher than the control group (10.9%) and comparable to that of superomedial spring (43.6%) and talocalcaneal interosseous (44.9%) ligaments. Univariate ordinal logistic regression modeling demonstrated a predictive ability of TM-Calc (odds ratio [OR] 1.17, 95% CI 1.06-1.30, P = .004), Diff Calc-Tal (OR 1.15, 95% CI 1.06-1.26, P = .002), TNC (OR 1.08, 95% CI 1.03-1.13, P = .003), and Meary angle (OR 1.05, 95% CI 1.02-1.10, P = .006) in determining higher cervical ligament grade on MRI. CONCLUSION This study found that cervical ligament insufficiency is more often than not associated with PCFD, and that an increasing axial plane deformity appears to be associated with a greater degree of insufficiency. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
| | - Rami Mizher
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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Wong MJ, Rajarathinam M. Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review. Can J Pain 2023; 7:2193617. [PMID: 37214187 PMCID: PMC10193888 DOI: 10.1080/24740527.2023.2193617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
Background Axial facet joint interventions (e.g., medial branch block and radiofrequency ablation, facet joint intra-articular injection) are commonly performed for managing chronic spinal pain. Although traditionally performed with fluoroscopy or computed tomography (CT) guidance, ultrasound-guided techniques have also been developed for these interventions. Aims The aim of this study is to present contemporary ultrasound-guided techniques for facet joint interventions and synthesize data addressing their accuracy, safety, and efficacy. Methods The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of ultrasound-guided facet joint interventions with human subjects from November 1, 1992, to November 1, 2022. Additional sources were drawn from reference lists and citations of relevant studies. Results We found 48 studies assessing ultrasound-guided facet joint interventions. Ultrasound guidance for injection of the cervical facet joints and their innervating nerves had favorable accuracy (78%-100%), with lower procedural time compared to fluoroscopy or CT guidance and comparable pain relief. Accuracy with ultrasound-guided lumbar facet joint intra-articular injection (86%-100%) was more reliable than medial branch block (72%-97%); analgesia was comparable to fluoroscopy and CT guidance. In general, these procedures were more challenging for patients with obesity, and deeper structures were more difficult to accurately target (e.g., lower cervical levels, L5 dorsal ramus). Conclusions Ultrasound-guided facet joint interventions continue to evolve. Some technically challenging interventions may be impractical for widespread usage or require further technical refinement. The utility of ultrasound guidance with obesity and abnormal anatomy may be reduced.
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Affiliation(s)
- Michael J. Wong
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Abazid RM, Frost A, Mathew A, Tzemos N. A novel approach to produce axial echocardiographic images by three-dimensional transesophageal echocardiography: A step-by-step guide. Echocardiography 2023; 40:373-375. [PMID: 36843428 DOI: 10.1111/echo.15546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023] Open
Abstract
Three-Dimensional (3-D) echocardiography is becoming increasingly used to diagnose and describe the spatial location of valvular pathologies and atrial septal defects during transesophageal echocardiography (TEE). The role of 3D-TEE is not well established in diagnosing other congenital heart diseases like partial anomalous pulmonary venous drainage (PAPVD) and coronary anomalous. We propose a step by step approach to producing computed tomography-simulated axial images from 3-D TEE to simplify TEE interpretation and diagnosis of cardiac abnormalities.
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Affiliation(s)
- Rami M Abazid
- Division of Cardiology, Department of Medicine, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew Frost
- Division of Cardiology, Department of Medicine, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew Mathew
- Division of Cardiology, Department of Medicine, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Medicine, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
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Tsai MT, Chang HW. Contribution of Accessibility to Urban Resilience and Evacuation Planning Using Spatial Analysis. Int J Environ Res Public Health 2023; 20:2913. [PMID: 36833615 PMCID: PMC9956902 DOI: 10.3390/ijerph20042913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Cities evolve and change with economic development and population growth, and urban planning laws in Taiwan have regulations that should be comprehensively reviewed every six years. Most current government policies aim to add new disaster prevention shelters or rescue stations. An economical way to improve the disaster prevention capabilities of urban planning is through examining or reviewing spatial structures and disaster prevention plans from the perspective of citizens or residents. The UN Office of Disaster Risk Reduction (UNDRR) launched the Making Cities Resilient Campaign policy to enhance disaster-resistant and sustainable urban environments through integrated disaster mitigation, reduction, response, and evacuation plans. This study used space syntax to ascertain evacuation route features using geometric distance analysis. There was 31.61% efficiency in relation to accessible roads on a comprehensive map. We could clearly see that since the areas in the first quadrant were relatively close to accessible roads, and there was an area that was not connected to the existing evacuation channels. The increased number of channels was more accessible and extensive. Such suggestions are helpful for government departments to prepare for disaster management. The spatial characteristics of the physical environment are explained by the accessibility and efficiency of axial maps and visibility analyzed by space syntax. Our findings reveal that space syntax is an important application when examining evacuation maps.
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Affiliation(s)
| | - Hung-Wen Chang
- Department of Architecture, National Taiwan University of Science and Technology (NTUST), Taipei City 106335, Taiwan
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Sandeep Reddy B, Naik D, Kenkere D. Role of Multidetector Computed Tomography in the Evaluation of Maxillofacial Trauma. Cureus 2023; 15:e35008. [PMID: 36938234 PMCID: PMC10021354 DOI: 10.7759/cureus.35008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Maxillofacial fractures are among the commonest injuries occurring in trauma patients. Multislice computed tomography (CT) is a widely used radiological investigation that accurately reveals the number, location, and extent of the fractures as well as concomitant soft tissue injuries and has been found to be superior in the diagnosis of maxillofacial fractures owing to high sensitivity and specificity. This study was performed to assess the efficacy of axial, coronal, sagittal, and three-dimensional (3D) reformatted images in the detection of fractures in maxillofacial trauma. MATERIALS AND METHODS This was a cross-sectional descriptive study conducted on 49 adult patients with maxillofacial injuries undergoing multislice CT using a multidetector SiemensSOMATOM Emotion eco 16 slice CT scanner (Siemens AG, Munich, Germany). CT protocol consisted of non-contrast axial 16-slice helical series beam collimation ~ 3 mm, pitch ~ 0.8 - 1, tube current ~ 270 mAs, voltage ~ 130 kV, Total exposure time ~ 18 seconds, total radiation ~ 200 mGy. Along with the axial, coronal and sagittal images were reconstructed with 0.5 mm increment. 3D volume-rendering images were also obtained. 3D images were compared with axial images, coronal and sagittal plane images. RESULTS The maximum number of cases was in the age group of 21-30 years with the male: female ratio being 5.12:1. The most common cause of injury was road traffic accidents (RTA). Mandible fractures were found to be the most common (20 patients, 40.8%) followed by fractures of nasal bone (18 patients, 36.7%). The incidence of frontal bone fractures was found to be the least (six patients, 12.24%). Our study found that 3D images are superior to axial in assessing the extent and degree of displacement of maxillofacial fractures in general. The maxillary sinus was found to be the most commonly fractured sinus (19 patients, 38.7%). Sphenoid sinus fractures were the least common (seen in two patients, 4.08%). CT findings correlated with the operative findings in most types of fractures. CONCLUSION Multidetector CT with multiplanar and 3D reformation is highly accurate in the identification of fractures and assessing the extent and degree of displacement of fractures; hence, it is the imaging modality of choice in maxillofacial trauma. 3D images are much better for the detection of maxillofacial fractures compared to axial, coronal, or sagittal views, especially in maxilla and mandibular bone fractures. It is also found to be better at providing information on the patterns of the fracture lines and the displacement of the fracture fragments. Another added advantage of multidetector CT is that it is a non-invasive technique with good accuracy and a short scan time.
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Affiliation(s)
| | - Deepti Naik
- Radio-Diagnosis, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Deepika Kenkere
- Oral and Maxillofacial Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Huang Q, Zhang C, Bai H, Wang Q, Li Z, Lu Y, Ma T. Biomechanical evaluation of two modified intramedullary fixation system for treating unstable femoral neck fractures: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1116976. [PMID: 36896014 PMCID: PMC9989215 DOI: 10.3389/fbioe.2023.1116976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose: The existing implants for fixation of femoral neck fractures have poor biomechanical stability, so the failure rate is high. We designed two modified intramedullary implants for treating unstable femoral neck fractures (UFNFs). We tried to improve the biomechanical stability of fixation by shortening the moment and reducing stress concentration. Each modified intramedullary implant was compared with cannulated screws (CSs) through finite element analysis (FEA). Methods: Five different models were included: three cannulated screws (CSs, Model 1) in an inverted triangle configuration, the dynamic hip screw with an anti-rotation screw (DHS + AS, Model 2), the femoral neck system (FNS, Model 3), the modified intramedullary femoral neck system (IFNS, Model 4), and the modified intramedullary interlocking system (IIS, Model 5). Three-dimensional (3D) models of femur and implants were constructed by using 3D modelling software. Three load cases were simulated to assess the maximal displacement of models and fracture surface. The maximal stress at the bone and implants was also evaluated. Results: FEA data showed that Model 5 had the best performance in terms of maximum displacement while Model 1 had the worst performance for this index under axial load of 2100 N. With respect to Maximum stress, Model 4 had the best performance while Model 2 had the worst performance under axial load. The general trends under bending and torsion load were consistent with that under axial load. Our data demonstrated that the two modified intramedullary implants exhibited the best biomechanical stability, followed by FNS and DHS + AS, and then three cannulated screws in axial, bending, and torsion load cases. Conclusion: The two modified intramedullary designs showed the best biomechanical performance among the five implants included in this study. Therefore, this might provide some new options for trauma surgeons to deal with unstable femoral neck fractures.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - HuanAn Bai
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yao Lu
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Garcia-Montoya L, Emery P. Disease modification in ankylosing spondylitis with TNF inhibitors: spotlight on early phase clinical trials. Expert Opin Investig Drugs 2021; 30:1109-1124. [PMID: 34842481 DOI: 10.1080/13543784.2021.2010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic inflammatory disease whose main hallmark is involvement of the axial skeleton. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line treatment; however, their use is limited because of side effects. Tumor necrosis factor inhibitors (TNFi) are a safe and effective therapy, and they have been approved for the management of AS. AREAS COVERED This is a review of the efficacy of TNFi in disease modification in AS. It is focused on results from early-phase clinical trials; however, it also discusses the most relevant findings in order to optimize anti-TNF treatment. A literature search was done using PubMed, Medline, Embase, Google Scholar, and Cochrane library, looking for scientific publications from inception to August 2021. Further information was retrieved from ClinicalTrial.gov and Clinicaltrialsregister.eu. EXPERT OPINION TNFi have demonstrated short- and long-term improvements in all aspects of disease activity, as well as physical function in patients with AS. They have drastically revolutionized the management of the disease; and even though new drugs have become available in the market, TNFi has not been displaced for the treatment of AS, and still constitute the best alternative when NSAIDs are no-longer an option.
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Affiliation(s)
- Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Colucci F, Carvalho V, Gonzalez-Robles C, Bhatia KP, Mulroy E. From Collar to Coccyx: Truncal Movement Disorders: A Clinical Review. Mov Disord Clin Pract 2021; 8:1027-1033. [PMID: 34631937 DOI: 10.1002/mdc3.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background Movement disorders affecting the trunk remain a diagnostic challenge even for experienced clinicians. However, despite being common and debilitating, truncal movement disorders are rarely discussed and poorly reviewed in the medical literature. Objectives To review common movement disorders affecting the trunk and provide an approach for clinicians based on the truncal region involved (shoulder, chest, diaphragm, abdomen, pelvis, and axial disorders). For each disorder, clinical presentation, etiologic differential diagnosis, and "clinical clues" are discussed. Conclusion This review provides a clinically focused, practical approach to truncal movement disorders, which will be helpful for physicians in everyday practice.
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Affiliation(s)
- Fabiana Colucci
- Clinical and Biological Sciences Department, Neurology Unit San Luigi Gonzaga Hospital Turin Italy
| | - Vanessa Carvalho
- Department of Neurology Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos Matosinhos Portugal
| | - Cristina Gonzalez-Robles
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom
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Cortés-Bretón Brinkmann J, García-Gil I, Pedregal P, Peláez J, Prados-Frutos JC, Suárez MJ. Long-Term Clinical Behavior and Complications of Intentionally Tilted Dental Implants Compared with Straight Implants Supporting Fixed Restorations: A Systematic Review and Meta-Analysis. Biology (Basel) 2021; 10:biology10060509. [PMID: 34201306 PMCID: PMC8229234 DOI: 10.3390/biology10060509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Following tooth loosening due to periodontal disease, caries, trauma, or tumoral processes, bone resorption and remodeling of the alveolar ridge makes the insertion of implants difficult. A number of bone augmentation techniques are available to treat atrophic jaws. However, when posterior bone is lacking and extensive bone augmentation surgeries are rejected by the patient, placing distally tilted posterior implants may offer a valid therapeutic option for implant-supported restorations. This treatment modality places the implants in preexisting bone, improving bone anchorage and prosthetic support. Nevertheless, some studies suggest that for tilted implants, bending moments are greater at the level of the angled abutment. Abstract The aim of this study was to assess the long-term clinical behavior of straight implants in comparison with intentionally tilted dental implants (ITDI) supporting fixed restorations in partial or total edentulous arches, analyzing implant survival and success rates, complications, and marginal bone loss (MBL) after >5 years of function. An electronic search was conducted in five electronic databases (MEDLINE/Pubmed, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials) supplemented by a manual search. The electronic and manual search identified 1853 articles, of which 8 articles were selected for analysis. Out of a total of 3987 dental implants, 2036 were axial dental implants and 1951 tilted. Similar results were found in implant survival or overall implant success rates. Moreover, no statistically significant differences were found in MBL (p = 0.369; MD 0.116 mm (−0.137; 0.369) 95% CI) The prosthodontic/biological complications reported in the articles were very diverse and irregularly distributed. This systematic review suggests that there is no difference between tilted compared with straight dental implants in the medium-long term (>5 years). However, further research is needed to generate long-term data and confirm the present review’s findings.
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Affiliation(s)
- Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Ignacio García-Gil
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (I.G.-G.); (P.P.); (M.J.S.)
| | - Patricia Pedregal
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (I.G.-G.); (P.P.); (M.J.S.)
| | - Jesús Peláez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (I.G.-G.); (P.P.); (M.J.S.)
- Correspondence:
| | - Juan Carlos Prados-Frutos
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, 28922 Alcorcón, Spain;
- IDIBO GROUP (Group of High-Performance Research, Development and Innovation in Dental Biomaterials), Rey Juan Carlos University, 28922 Alcorcón, Spain
| | - María Jesús Suárez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (I.G.-G.); (P.P.); (M.J.S.)
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12
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Kannojiya V, Das AK, Das PK. Comparative assessment of different versions of axial and centrifugal LVADs: A review. Artif Organs 2021; 45:665-681. [PMID: 33434332 DOI: 10.1111/aor.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
Continuous-flow left ventricular assist devices (LVADs) have gained tremendous acceptance for the treatment of end-stage heart failure patients. Among different versions, axial flow and centrifugal flow LVADs have shown remarkable potential for clinical implants. It is also very crucial to know which device serves its purpose better to treat heart failure patients. A thorough comparison of axial and centrifugal LVADs, which may guide doctors in deciding before the implant, still lacks in the literature. In this work, an assessment of axial and centrifugal LVADs has been made to suggest a better device by comparing their engineering, clinical, and technological development of design aspects. Hydrodynamic and hemodynamic aspects for both types of pumps are discussed along with their biocompatibility, bearing types, and sizes. It has been observed numerically that centrifugal LVADs perform better over axial LVADs in every engineering aspect like higher hydraulic efficiency, better characteristics curve, lesser power intake, and also lesser blood damage. However, the clinical outcomes suggest that centrifugal LVADs experience higher events of infections, renal, and respiratory dysfunction. In contrast, axial LVADs encountered higher bleeding and cardiac arrhythmia. Moreover, recent technological developments suggested that magnetic type bearings along with biocompatible coating improve the life of LVADs.
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Affiliation(s)
- Vikas Kannojiya
- Mechanical and Industrial Engineering Department, IIT Roorkee, Roorkee, India
| | - Arup Kumar Das
- Mechanical and Industrial Engineering Department, IIT Roorkee, Roorkee, India
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13
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Provenzano DA, Heller JA, Hanes MC. Current Perspectives on Neurostimulation for the Management of Chronic Low Back Pain: A Narrative Review. J Pain Res 2021; 14:463-479. [PMID: 33628045 PMCID: PMC7899039 DOI: 10.2147/jpr.s249580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/16/2020] [Indexed: 01/29/2023] Open
Abstract
Neurostimulation techniques for the treatment of chronic low back pain (LBP) have been rapidly evolving; however, questions remain as to which modalities provide the most efficacious and durable treatment for intractable axial symptoms. Modalities of spinal cord stimulation, such as traditional low-frequency paresthesia based, high-density or high dose (HD), burst, 10-kHz high-frequency therapy, closed-loop, and differential target multiplexed, have been limitedly studied to determine their efficacy for the treatment of axial LBP. In addition, stimulation methods that target regions other than the spinal cord, such as medial branch nerve stimulation of the multifidus muscles and the dorsal root ganglion may also be viable treatment options. Here, current scientific evidence behind neurostimulation techniques have been reviewed with a focus on the management of chronic axial LBP.
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Affiliation(s)
- David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, PA, USA.,Western PA Surgery Center, Wexford, PA, USA
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14
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Feld J, Ye JY, Chandran V, Inman RD, Haroon N, Cook R, Gladman DD. Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis? Rheumatology (Oxford) 2020; 59:1340-1346. [PMID: 31593590 DOI: 10.1093/rheumatology/kez457] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare patients with ankylosing spondylitis with psoriasis (ASP) and without psoriasis (AS), to axial PsA (axPsA) patients. METHODS Two adult cohorts were recruited from the AS clinic: ASP and AS. These two cohorts were compared with two adult cohorts recruited from the PsA clinic: axPsA (radiographic sacroiliitis: ⩾bilateral grade 2 or unilateral grade 3 or 4); and Peripheral PsA. All patients were followed prospectively according to the same protocol. The demographic, clinical and radiographic variables were compared. Adjusted means were used to account for varying intervals between visits. A logistic regression was performed and adjusted for follow-up duration. RESULTS There were 477 axPsA patients, 826 peripheral PsA, 675 AS and 91 ASP patients included. AS patients were younger (P < 0.001), more male and HLA-B*27 positive (76%, 72% vs 64%, P ⩽ 0.001, 82%, 75%, vs 19%, P = 0.001). They had more back pain at presentation (90%, 92% vs 19%, P = 0.001), worse axial disease activity scores (bath ankylosing spondylitis disease activity index: 4.1, 3.9 vs 3.5 P = 0.017), worse back metrology (bath ankylosing spondylitis metrology index: 2.9, 2.2 vs 1.8, P < 0.001), worse physician global assessments (2.4, 2.2 vs 2.1, P < 0.001), were treated more with biologics (29%, 21% vs 7%, P = 0.001) and had a higher grade of sacroiliitis (90%, 84% vs 51%, P < 0.001). Similar differences were detected in the comparison of ASP to axPsA and in a regression model. CONCLUSION AS patients, with or without psoriasis, seem to be different demographically, genetically, clinically and radiographically from axPsA patients. axPsA seems to be a distinct entity.
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Affiliation(s)
- Joy Feld
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto
| | - Justine Yang Ye
- Krembil Research Institute, Toronto Western Hospital, University Health Network
| | - Vinod Chandran
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Robert D Inman
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Department of Immunology, Medical Sciences Building, University of Toronto, Toronto
| | - Nigil Haroon
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Dafna D Gladman
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto
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15
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Lisson CG, Lisson CS, Vogele D, Strauss B, Schuetze K, Cintean R, Beer M, Schmidt SA. Improvement of image quality applying iterative scatter correction for grid-less skeletal radiography in trauma room setting. Acta Radiol 2020; 61:768-775. [PMID: 31569948 DOI: 10.1177/0284185119878348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Iterative reconstruction is well established for CT. Plain radiography also takes advantage of iterative algorithms to reduce scatter radiation and improve image quality. First applications have been described for bedside chest X-ray. A recent experimental approach also provided proof of principle for skeletal imaging. PURPOSE To examine clinical applicability of iterative scatter correction for skeletal imaging in the trauma setting. MATERIAL AND METHODS In this retrospective single-center study, 209 grid-less radiographs were routinely acquired in the trauma room for 12 months, with imaging of the chest (n = 31), knee (n = 111), pelvis (n = 14), shoulder (n = 24), and other regions close to the trunk (n = 29). Radiographs were postprocessed with iterative scatter correction, doubling the number of images. The radiographs were then independently evaluated by three radiologists and three surgeons. A five-step rating scale and visual grading characteristics analysis were used. The area under the VGC curve (AUCVGC) quantified differences in image quality. RESULTS Images with iterative scatter correction were generally rated significantly better (AUCVGC = 0.59, P < 0.01). This included both radiologists (AUCVGC = 0.61, P < 0.01) and surgeons (AUCVGC = 0.56, P < 0.01). The image-improving effect was significant for all body regions; in detail: chest (AUCVGC = 0.64, P < 0.01), knee (AUCVGC = 0.61, P < 0.01), pelvis (AUCVGC = 0.60, P = 0.01), shoulder (AUCVGC = 0.59, P = 0.02), and others close to the trunk (AUCVGC = 0.59, P < 0.01). CONCLUSION Iterative scatter correction improves the image quality of grid-less skeletal radiography in the clinical setting for a wide range of body regions. Therefore, iterative scatter correction may be the future method of choice for free exposure imaging when an anti-scatter grid is omitted due to high risk of tube-detector misalignment.
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Affiliation(s)
- Christoph G Lisson
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Catharina S Lisson
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Beatrice Strauss
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Konrad Schuetze
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Raffael Cintean
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Stefan A Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
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16
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Molski KL, Tarasiuk P. Stress Concentration Factors for Butt-Welded Plates Subjected to Tensile, Bending and Shearing Loads. Materials (Basel) 2020; 13:ma13081798. [PMID: 32290372 PMCID: PMC7215753 DOI: 10.3390/ma13081798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
This paper deals with the analysis of stress concentration at the weld toe of a Double-V and a Single-V butt-welded joints subjected to tensile, bending and shearing loads. For each geometrical and loading case accurate close form stress concentration factor formula based on more than 3.3 thousand finite element method solutions were obtained. The percentage error of the formulas is lower than 2.5% for a wide range of values of geometrical parameters including weld toe radius, weld width, plate thickness and weld toe angle. The limiting case, in which the weld toe radius tends to zero is also considered. In the cases of shearing loads, a plane model based on thermal analogy was developed. The whole analysis was performed assuming that a circular arc represents the shape of the excess weld metal. Presented solutions may be used in computer aided fatigue assessment of structural elements.
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17
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Lin WS, Eckert SE. Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 16:78-105. [PMID: 30328193 DOI: 10.1111/clr.13294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. MATERIALS AND METHODS A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. RESULTS A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. CONCLUSIONS Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.
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Affiliation(s)
- Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Steven E Eckert
- Mayo Clinic School of Medicine, Rochester, Minnesota.,Director of Research and Clinical Development, ClearChoice Management Services, Greenwood Village, Colorado
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18
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LaPrade RF, Cram TR, Mitchell JJ, Geeslin AG, Lockard CA, Fitzcharles EK, Dornan GJ. Axial-Oblique Versus Standard Axial 3-T Magnetic Resonance Imaging for the Detection of Trochlear Cartilage Lesions: A Prospective Study. Orthop J Sports Med 2018; 6:2325967118801009. [PMID: 30327787 PMCID: PMC6178377 DOI: 10.1177/2325967118801009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Imaging of the femoral trochlea has been inherently difficult because of its
convex anatomy. Purpose/Hypothesis: The purpose of this study was to compare the diagnostic utility of a standard
axial magnetic resonance imaging (MRI) sequence with an axial-oblique MRI
sequence of the knee for the detection of trochlear articular cartilage
lesions on a high-field 3-T MRI scanner. We hypothesized that axial-oblique
MRI scans of the knee obtained along the true axis of the trochlea would
significantly improve the detection of high-grade cartilage lesions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent MRI and subsequent surgery for any indication were
prospectively enrolled into this study between June 2014 and February 2015.
The articular cartilage of the trochlea was evaluated independently by 3
raters on axial and axial-oblique MRI and compared with arthroscopic
findings (gold standard). The interrater and intrarater reliability of mild
(International Cartilage Repair Society [ICRS] grades 1 or 2) and severe
(ICRS grades 3 or 4) lesions on MRI were assessed as well as the
sensitivity, specificity, positive predictive value, and negative predictive
value. Results: A total of 99 knees in 96 patients were included in the study. Interrater and
intrarater agreement for the identification of severe lesions were moderate
to good on the proximal trochlea and fair to moderate on the distal
trochlea. No significant differences in sensitivity were found between axial
and axial-oblique scans for any grade of lesion (55% vs 51%, respectively;
P = .700) or for severe lesions (61% vs 52%,
respectively; P = .289). Similarly, specificity for
detecting severe lesions was not significantly different between axial and
axial-oblique scans (95% vs 87%, respectively; P = .219).
Last, no significant differences in sensitivity or specificity were found
between MRI sequences when separately evaluating proximal and distal
trochlear lesions (all P > .05). Conclusion: The axial-oblique sequence was unable to improve the sensitivity of MRI in
detecting articular cartilage lesions on the trochlea. Both conventional
axial and axial-oblique sequences, reviewed independently of the complete
MRI series, had low sensitivity in detecting trochlear articular cartilage
lesions. For this reason, clinicians should utilize all MRI planes to
evaluate the articular cartilage of the trochlea. Future studies should
focus on improving MRI techniques for detecting and characterizing cartilage
lesions of the trochlea.
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Affiliation(s)
- Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Tyler R Cram
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Mitchell
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Andrew G Geeslin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Eric K Fitzcharles
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Abstract
BACKGROUND Axial carpal dislocations and fracture-dislocations remain difficult to understand and to treat. The outcome is directly related to the injury pattern and long-term results are not good in most cases. METHODS 39-year-old male admitted to our emergency department after his left hand was caught between 2 rollers for 10 minutes. He was diagnosed of an open axial carpal dislocation type B (perihamate peripisiform) and type E (peritrapezium) of Garcia-Elias. An extensive debridement, reduction of the carpometacarpal dislocations and stabilization with Kirschner wires was performed requiring a full thickness skin graft 14 days after the trauma. RESULTS At 4-year follow-up, he had 70° of wrist extension, and 78° of wrist flexion, grip strength of 65% compared to the healthy side and x-ray showed mild signs of osteoarthritis. He was satisfied and returned to the same job. CONCLUSIONS Axial carpal dislocations continue to be difficult injuries to address but also to classify. Since the prognosis depends on the injury pattern and other associated lesions, we believe that adding a type G which include the association of different patterns to the classification of Garcia-Elias could be useful not in changing the treatment but probably indicating a worse prognosis.
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Affiliation(s)
- Isidro Jiménez
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain,Isidro Jiménez, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur s/n, Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
| | - Martine Dury
- SOS Main Strasbourg, Clinique des Diaconesses, Strasbourg, France
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20
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Felfeli P, Wenz H, Al-Zghloul M, Groden C, Förster A. Combination of standard axial and thin-section coronal diffusion-weighted imaging facilitates the diagnosis of brainstem infarction. Brain Behav 2017; 7:e00666. [PMID: 28413710 PMCID: PMC5390842 DOI: 10.1002/brb3.666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/25/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Although diffusion-weighted imaging (DWI) is a very sensitive technique for the detection of small ischemic lesions in the human brain, in particular in the brainstem it may fail to demonstrate acute ischemic infarction. In this study, we sought to evaluate the value of additional thin-section coronal DWI for the detection of brainstem infarction. METHODS In 155 consecutive patients (median age 69 [interquartile range, IQR 57-78] years, 95 [61.3%] males) with isolated brainstem infarction, MRI findings were analyzed, with emphasis on ischemic lesions on standard axial (5 mm) and thin-section coronal (3 mm) DWI. RESULTS On DWI, we identified ischemic lesions in the mesencephalon in 12 (7.7%), pons in 115 (74.2%), and medulla oblongata in 31 (20%) patients. In 3 (1.9%) cases-all of these with medulla oblongata infarction-the ischemic lesion was detected only on thin-section coronal DWI. Overall, in 35 (22.6%) patients the ischemic lesion was more easily identified on thin-section coronal DWI in comparison to standard axial DWI. In these, the ischemic lesions were significantly smaller (0.06 [IQR 0.05-0.11] cm3 vs. 0.25 [IQR 0.13-0.47] cm3; p < .001) in comparison to those patients whose ischemic lesion was more easily (6 [3.9%]) or at least similarly well identified (114 [73.5%]) on standard axial DWI. CONCLUSIONS Since thin-section coronal DWI may facilitate the diagnosis of brainstem infarction, we suggest its inclusion in standard stroke MRI protocols.
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Affiliation(s)
- Philippe Felfeli
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Holger Wenz
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Christoph Groden
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Alex Förster
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
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21
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Abstract
Background Scapholunate interosseous ligament (SLIL) injuries can often be difficult to detect using magnetic resonance imaging (MRI), especially with older 1.0 and 1.5 Tesla magnets. Wrist arthroscopy is the gold standard for diagnosis of SLIL injuries, but is an invasive procedure with associated risks. Purpose To assess whether SLIL injuries can be more accurately detected using axial MRI sequences instead of coronal sequences. Material and Methods An institutional review board approved retrospective analysis of arthroscopic wrist surgeries performed at our institution. Patients that had a preoperative MRI performed at our university center using a 1.5 Tesla scanner with a dedicated wrist coil were included in the study. Three fellowship-trained musculoskeletal radiologists reviewed the axial sequences and coronal sequences independently. The accuracy of the coronal and axial sequences was compared with the arthroscopic/surgical findings. Result Twenty-six patients met the inclusion criteria. The sensitivity for SLIL tears was 79% and 65% for the axial and coronal sequences, respectively. The specificity was 82% for the axial and 69% for the coronal sequences, respectively. The positive and negative predictive values for the axial sequences were 76% and 84% respectively, compared to 68% and 71% for the coronal sequences, a statistically significant difference. Conclusion SLIL tears are more readily detectable on axial MRI sequences than coronal. Clinically, patients with radial-sided wrist pain and suspicion for SLIL tears should have the axial sequences scrutinized carefully. An otherwise normal study with the axial sequence being degraded by motion or other MRI artifacts might need repeat imaging.
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Affiliation(s)
- Harry G Greditzer
- Department of Radiology & Imaging/Hospital for Special Surgery, New York, New York, USA
| | - Joshua Zeidenberg
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Check C Kam
- Department of Orthopaedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Robert R Gray
- Department of Orthopaedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Paul D Clifford
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Douglas N Mintz
- Department of Radiology & Imaging/Hospital for Special Surgery, New York, New York, USA
| | - Jean Jose
- Department of Radiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
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22
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Flynn G, Ramasse QM, Ryan KM. Solvent Vapor Growth of Axial Heterostructure Nanowires with Multiple Alternating Segments of Silicon and Germanium. Nano Lett 2016; 16:374-380. [PMID: 26672625 DOI: 10.1021/acs.nanolett.5b03950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Herein, we report the formation of multisegment Si-Ge axial heterostructure nanowires in a wet chemical synthetic approach. These nanowires are grown by the liquid injection of the respective silicon and germanium precursors into the vapor phase of an organic solvent in which a tin-coated stainless steel substrate is placed. The Si-Ge transition is obtained by sequential injection with the more difficult Ge-Si transition enabled by inclusion of a quench sequence in the reaction. This approach allows for alternating between pure Si and pure Ge segments along the entire nanowire length with good control of the respective segment dimensions. The multisegment heterostructure nanowires presented are Ge-Si, Si-Ge-Si, Ge-Si-Ge, Si-Ge-Si-Ge, and Si-Ge-Si-Ge-Si-Ge. The interfacial abruptness of the Ge to Si interface is also determined through the use of aberration corrected scanning transmission electron microscopy and electron energy loss spectroscopy.
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Affiliation(s)
- Grace Flynn
- Materials and Surface Science Institute and Department of Chemical and Environmental Sciences, University of Limerick , Limerick, Ireland
| | - Quentin M Ramasse
- SuperSTEM Laboratory , SciTech Daresbury Campus, Daresbury WA4 4AD, United Kingdom
| | - Kevin M Ryan
- Materials and Surface Science Institute and Department of Chemical and Environmental Sciences, University of Limerick , Limerick, Ireland
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Simon CB, Riley JL, Fillingim RB, Bishop MD, George SZ. Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain. J Pain 2015; 16:1268-1279. [PMID: 26342650 DOI: 10.1016/j.jpain.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/05/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however response to TENS in older adults compared with younger adults is untested. In a dose-response study stratified by age, 60 participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high-frequency high-intensity TENS over a 2- to 3-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold) and central pain excitability (phasic heat temporal summation and heat aftersensations) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain reports across sessions. Independent of age, individuals experienced episodic increase in the pressure pain detection threshold and reduction in aftersensation after TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the 4 sessions. However, older adults received higher TENS amplitude across all sessions to achieve TENS responses similar to those in younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief to that of younger individuals after high-frequency, high-intensity TENS when higher dose parameters are used. PERSPECTIVE This study examined age group differences in experimental and axial CLBP response to TENS, delivered under the current recommended parameters of strong, but tolerable amplitude. Older adults had comparable TENS response although at higher TENS amplitude than younger adults, which may have important mechanistic and clinical implications.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Mark D Bishop
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
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24
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Beliez L, Barrière G, Bertrand SS, Cazalets JR. Origin of thoracic spinal network activity during locomotor-like activity in the neonatal rat. J Neurosci 2015; 35:6117-30. [PMID: 25878284 DOI: 10.1523/JNEUROSCI.4145-14.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Effective quadrupedal locomotor behaviors require the coordination of many muscles in the limbs, back, neck, and tail. Because of the spinal motoneuronal somatotopic organization, motor coordination implies interactions among distant spinal networks. Here, we investigated some of the interactions between the lumbar locomotor networks that control limb movements and the thoracic networks that control the axial muscles involved in trunk movement. For this purpose, we used an in vitro isolated newborn rat spinal cord (from T2 to sacrococcygeal) preparation. Using extracellular ventral root recordings, we showed that, while the thoracic cord possesses an intrinsic rhythmogenic capacity, the lumbar circuits, if they are rhythmically active, will entrain the rhythmicity of the thoracic circuitry. However, if the lumbar circuits are rhythmically active, these latter circuits will entrain the rhythmicity of the thoracic circuitry. Blocking the synaptic transmission in some thoracic areas revealed that the lumbar locomotor network could trigger locomotor bursting in distant thoracic segments through short and long propriospinal pathways. Patch-clamp recordings revealed that 72% of the thoracic motoneurons (locomotor-driven motoneurons) expressed membrane potential oscillations and spiking activity coordinated with the locomotor activity expressed by the lumbar cord. A biphasic excitatory (glutamatergic)/inhibitory (glycinergic) synaptic drive was recorded in thoracic locomotor-driven motoneurons. Finally, we found evidence that part of this locomotor drive involved a monosynaptic component coming directly from the lumbar locomotor network. We conclude that the lumbar locomotor network plays a central role in the generation of locomotor outputs in the thoracic cord by acting at both the premotoneuronal and motoneuronal levels.
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25
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Kim HS, Bindiganavile SS, Han I. Oncologic outcome after local recurrence of chondrosarcoma: Analysis of prognostic factors. J Surg Oncol 2015; 111:957-61. [PMID: 26040553 DOI: 10.1002/jso.23925] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 04/04/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Literature on outcome after local recurrence (LR) in chondrosarcoma is scarce and better appreciation of prognostic factors is needed. OBJECTIVES (1) To evaluate post-LR oncologic outcomes of disease-specific survival and subsequent LR and (2) to identify prognostic factors for post-LR oncologic outcomes. PATIENTS AND METHODS Review of 28 patients with locally recurrent chondrosarcoma from the original cohort of 150 patients, who were treated surgically with or without adjuvants between 1982 and 2011, was performed. Mean age was 46 years (range, 21-73) which included 20 males and 8 females with mean follow up of 8.4 ± 7.5 years (range, 1.2-31.0). RESULTS Post-LR survival at 5 years was 58.6 ± 10.3%. Age greater than 50 years (P = 0.011) and LR occurring within 1 year of primary surgery (P = 0.011) independently predicted poor survival. Seven patients suffered subsequent LR, which was significantly affected by surgical margin for LR (P = 0.038). CONCLUSION Long-term survival of locally recurrent chondrosarcoma is achievable in a substantial number of patients. Older age at onset of LR and shorter interval from primary surgery to LR identifies high risk patients for poor post-LR survival while, wide surgical margins at LR surgery reduces the risk of subsequent LR.
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Affiliation(s)
- Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | | | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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26
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Czyz CN, Bacon TS, Stacey AW, Cahill EN, Costin BR, Karanfilov BI, Cahill KV. Nasolacrimal system aeration on computed tomographic imaging: effects of patient positioning and scan orientation. Clin Ophthalmol 2015; 9:469-73. [PMID: 25792799 PMCID: PMC4362979 DOI: 10.2147/opth.s80752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the impact of patient positioning and scan orientation on the appearance of air in the nasolacrimal drainage system on computed tomography (CT) imaging, and the repeatability of the observations. Methods This was a retrospective analysis of CT images for 92 patients. Results Air was found to be present more fully in the upright-position group as compared with the supine-position group. Comparing axial and coronal scan orientation, no difference in aeration was found, except for the nasolacrimal duct in the upright-position group. Conclusion Patient position should be accounted for in diagnostic conclusions and treatment decisions based on CT.
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Affiliation(s)
- Craig N Czyz
- Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth, Columbus, OH, USA
| | - Thomas S Bacon
- Department of Medical Education, Mount Carmel Health Systems, Columbus, OH, USA
| | - Andrew W Stacey
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
| | - Eva N Cahill
- Department of Biology, Wittenberg University, Springfield, OH, USA
| | - Bryan R Costin
- Department of Ophthalmology, William H Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Kenneth V Cahill
- Department of Ophthalmology, William H Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Melgar MA, Tobler WD, Ernst RJ, Raley TJ, Anand N, Miller LE, Nasca RJ. Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation. Int J Spine Surg 2014; 8:14444-1010. [PMID: 25694920 PMCID: PMC4325488 DOI: 10.14444/1010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months). Results There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change. Conclusions/Clinical Relevance Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change.
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Affiliation(s)
| | - William D Tobler
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | | | | | - Neel Anand
- Spine Trauma, Minimally Invasive Spine Surgery Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA
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Patil RS, Kale TP, Kotrashetti SM, Baliga SD, Prabhu N, Issrani R. Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study. Acta Odontol Scand 2014; 72:984-8. [PMID: 25227590 DOI: 10.3109/00016357.2014.933252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.
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Affiliation(s)
- Rashmi S Patil
- Karnataka Cancer Therapy and Research Institute , Hubli, Karanataka , India
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29
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Webster EL, Hudson PE, Channon SB. Comparative functional anatomy of the epaxial musculature of dogs (Canis familiaris) bred for sprinting vs. fighting. J Anat 2014; 225:317-27. [PMID: 24917310 DOI: 10.1111/joa.12208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/27/2022] Open
Abstract
The axial musculoskeletal system of quadrupedal mammals is not currently well understood despite its functional importance in terms of facilitating postural stability and locomotion. Here we examined the detailed architecture of the muscles of the vertebral column of two breeds of dog, the Staffordshire bull terrier (SBT) and the racing greyhound, which have been selectively bred for physical combat and high speed sprint performance, respectively. Dissections of the epaxial musculature of nine racing greyhounds and six SBTs were carried out; muscle mass, length, and fascicle lengths were measured and used to calculate muscle physiological cross-sectional area (PCSA), and to estimate maximum muscle potential for force, work and power production. The longissimus dorsi muscle was found to have a high propensity for force production in both breeds of dog; however, when considered in combination with the iliocostalis lumborum muscle it showed enhanced potential for production of power and facilitating spinal extension during galloping gaits. This was particularly the case in the greyhound, where the m. longissimus dorsi and the m. iliocostalis lumborum were estimated to have the potential to augment hindlimb muscle power by ca. 12%. Breed differences were found within various other muscles of the axial musculoskeletal system, particularly in the cranial cervical muscles and also the deep muscles of the thorax which insert on the ribs. These may also highlight key functional adaptations between the two breeds of dog, which have been selectively bred for particular purposes. Additionally, in both breeds of dog, we illustrate specialisation of muscle function by spinal region, with differences in both mass and PCSA found between muscles at varying levels of the axial musculoskeletal system, and between muscle functional groups.
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Affiliation(s)
- Emma L Webster
- Department of Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
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Louwerens JKG, Groot D, van Duijvenbode DC, Spruit M. Alternative Surgical Strategy for AxiaLIF Pseudarthrosis: A Series of Three Case Reports. Evid Based Spine Care J 2014; 4:143-8. [PMID: 24436713 PMCID: PMC3836895 DOI: 10.1055/s-0033-1357357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
Study Design Retrospective case series. Objective The objective of this study is to describe an alternative technique to attain interbody lumbar fusion in the event of pseudarthrosis after axial lumbar interbody fusion (AxiaLIF) and to assess its safety. Methods Three patients who suffered from pseudarthrosis after AxiaLIF underwent revision surgery with a DEVEX cage (DePuy Synthes, Raynham, MA, United States) through an anterior approach. We report technical details as well as clinical and radiological results at 12 months follow-up. Results Preoperative symptoms resolved in all cases. There were no perioperative complications. One patient had a deep venous thrombosis at postoperative day 9. A decrease in visual analog scale score for pain was observed, from 8.67 preoperatively to 2 postoperatively at final follow-up. Radiographic workup after 12 months showed no sign of implant failure or loosening, and fusion was obtained in all cases. Conclusion Anterior fusion with a DEVEX cage in front of a TranS1 screw (TranS1 screw, Inc., Wilmington, North Carolina, United States) for AxiaLIF pseudarthrosis is safe and effective.
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Affiliation(s)
- Jan K G Louwerens
- Centre for Orthopaedic Research, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Diederik Groot
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Woerden, The Netherlands
| | | | - Maarten Spruit
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Wiesner L, Schröder S, Gralla S, Goeck D, Kramer M, Ondreka N. [Intraocular osteosarcoma in a dog]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2014; 42:187-193. [PMID: 24920146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/09/2013] [Indexed: 06/03/2023]
Abstract
The present case describes the diagnostic and therapeutic procedure of a dog with an intraocular osteosarcoma. According to the results of the diagnostic imaging studies, the tentative diagnosis of an intraocular neoplasm with perforation of the globe and orbital invasion of the tumour was made and an orbital exenteration was performed. The histopathological diagnosis of the extracted organ implied an intraocular, extraskeletal osteosarcoma. Seventy-seven days later the patient displayed an acute paraparesis. Clinical and diagnostic reevaluation using magnetic resonance imaging (MRI) was performed and the dog was euthanized at the owner's request. By means of MRI and necropsy, an additional axial osteosarcoma of the 6th lumbar vertebra and a malignant melanoma of the right tonsil were diagnosed.
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Affiliation(s)
- L Wiesner
- Luisa-Katharina Wiesner, Klinikum Veterinärmedizin, Klinik für Kleintiere, Chirurgie, der Justus-Liebig-Universität Gießen, Frankfurter Straße 108, 35392 Gießen, E-Mail:
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