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Sample records for sacrificing medial pivot

  1. A long term clinical outcome of the Medial Pivot Knee Arthroplasty System.

    Science.gov (United States)

    Macheras, George A; Galanakos, Spyridon P; Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P; Papadakis, Stamatios A

    2017-03-01

    The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°-135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. The obtained results demonstrate excellent long-term clinical outcome for this knee design. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  2. Biomass of Sacrificed Spruce/Aspen (SNF)

    Data.gov (United States)

    National Aeronautics and Space Administration — Dimension analysis (diameter at breast high, tree height, depth of crown), estimated leaf area, and total aboveground biomass for sacrificed spruce and aspens in...

  3. Biomass of Sacrificed Spruce/Aspen (SNF)

    Data.gov (United States)

    National Aeronautics and Space Administration — ABSTRACT: Dimension analysis (diameter at breast high, tree height, depth of crown), estimated leaf area, and total aboveground biomass for sacrificed spruce and...

  4. Comprender: propuesta de pivotes

    Directory of Open Access Journals (Sweden)

    Santiago Alonso

    2011-06-01

    Full Text Available How do we understand? A pivot proposalThe basic question is what it is needed to understand. The proposal is that understanding requires pivots, a useful word to integrate findings in different areas. In that sense, a pivot can be understood as a mental model. It can also be the body, an idea based on embodied cognition. But more fundamentally, our biology and brain are the central pivots for understanding. Therefore, this essay can be seen as a brief travel through three different subjects: Mental Models, Embodied Cognition and Cognitive Neuroscience, all of which are necessary to understand how a person understands.

  5. Effects of Pivoting Neuromuscular Training on Pivoting Control and Proprioception

    Science.gov (United States)

    Lee, Song Joo; Ren, Yupeng; Chang, Alison H.; Geiger, François; Zhang, Li-Qun

    2014-01-01

    Purpose Pivoting neuromuscular control and proprioceptive acuity may play an important role in ACL injuries. The goal of this study was to investigate whether pivoting neuromuscular training on an offaxis elliptical trainer (POINT) could improve pivoting neuromuscular control, proprioceptive acuity, and functional performance. Methods Among 41 subjects, 21 subjects participated in 18 sessions of POINT (3 sessions/week for 6 weeks), and 20 subjects served as controls who did their regular workout. Both groups received pre-, mid-, and post-intervention evaluations. Propensity score analysis with multivariable regression adjustment was used to investigate the effect of training on pivoting neuromuscular control (pivoting instability, leg pivoting stiffness, maximum internal and external pivoting angles), proprioceptive acuity, and functional performance in both groups. Results Compared to the control group, the training group significantly improved pivoting neuromuscular control as reduced pivoting instability, reduced maximum internal and external pivoting angles, increased leg pivoting stiffness, and decreased entropy of time to peak EMG in the gluteus maximus and lateral gastrocnemius under pivoting perturbations. Furthermore, the training group enhanced weight-bearing proprioceptive acuity and improved the single leg hop distance. Conclusion Improvement of pivoting neuromuscular control in functional weight-bearing activities and task performances following POINT may help develop lower limb injury prevention and rehabilitation methods to reduce ACL and other musculoskeletal injuries associated with pivoting sports. PMID:24389517

  6. Effects of pivoting neuromuscular training on pivoting control and proprioception.

    Science.gov (United States)

    Lee, Song Joo; Ren, Yupeng; Chang, Alison H; Geiger, François; Zhang, Li-Qun

    2014-07-01

    Pivoting neuromuscular control and proprioceptive acuity may play an important role in anterior cruciate ligament injuries. The goal of this study was to investigate whether pivoting off-axis intensity adjustable neuromuscular control training (POINT) could improve pivoting neuromuscular control, proprioceptive acuity, and functional performance. Among 41 subjects, 21 subjects participated in 18 sessions of POINT (three sessions per week for 6 wk), and 20 subjects served as controls who did their regular workout. Both groups received pre-, mid-, and postintervention evaluations. Propensity score analysis with multivariable regression adjustment was used to investigate the effect of training on pivoting neuromuscular control (pivoting instability, leg pivoting stiffness, maximum internal, and external pivoting angles), proprioceptive acuity, and functional performance in both groups. Compared with the control group, the training group significantly improved pivoting neuromuscular control as reduced pivoting instability, reduced maximum internal and external pivoting angles, increased leg pivoting stiffness, and decreased entropy of time to peak EMG in the gluteus maximus and lateral gastrocnemius under pivoting perturbations. Furthermore, the training group enhanced weight-bearing proprioceptive acuity and improved the single leg hop distance. Improvement of pivoting neuromuscular control in functional weight-bearing activities and task performances after POINT may help develop lower limb injury prevention and rehabilitation methods to reduce anterior cruciate ligament and other musculoskeletal injuries associated with pivoting sports.

  7. The main sacrifice: Sacrificing own children in Slavic folk literature

    Directory of Open Access Journals (Sweden)

    Đapović Lasta S.

    2004-01-01

    Full Text Available This paper discusses the work of M. Dragomanov "Slavs fables about sacrificing own children." These fables are divided into three groups whereas the second group is discussed here. This particular group includes fables on sacrificing one's own child (a son out of pity for the poor, a few tales from the Ukraine, Bulgaria, and two Serbian folk songs: Deacon Stefan and two angels, and True ordeal of the two God's angels. The analysis shows that all fables encourage merciful behavior. Bad behavior toward the poor, on the other hand, is always punished, and good, desirable behavior even if it includes sacrificing one's own child in order to cure the sick is always rewarded, whereas the sacrificed child becomes resurrected. Serbian folk songs also contain the motif of one's own child sacrifice in order to cure blind or mute people, and here the child gets resurrected too. However, these songs differ greatly from the fables. Namely, they encourage in the name of mercy, the breakdown of certain norms of socially desirable behaviors; like for example, work restrictions on Sundays-and this encouraged breakdown represents the main point of the songs. A request for sacrificing one's own child could have, in addition to altruism, other hidden meanings, for instance, a possible punishment due to the breakdown of religious norms. The songs have multiple layers and meanings. In a nutshell all documents assert the highest ethical principles of Christianity. Nonetheless, human sacrifice, which seems in opposition with Christian values, creates confusion and gives at the same time, a pagan note to these texts. However the author argues that all cited fables contain the connection: sacrifice-salvation-resurrection, which could point out to Christ's own sacrifice.

  8. Sacrificing the buccal branch of the facial nerve during parotidectomy.

    Science.gov (United States)

    Dhiwakar, Muthuswamy; Khan, Zubair A

    2016-12-01

    The need for and consequence of sacrificing the buccal branch of the facial nerve during parotidectomy is unknown. We sought to determine the indication, frequency, and functional outcome of buccal branch sacrifice. We conducted a prospective study of all cases of parotidectomy at a tertiary referral center. Of 100 consecutive cases of parotidectomy, the buccal branch was sacrificed in 23 cases. This subgroup was more likely to have anterior or deep lesions (p < .001), retrograde facial nerve dissection (p = .037), and immediate postoperative upper and lower facial weakness (p = .051 and .002, respectively). However, if the temporozygomatic and cervicomandibular branches were anatomically preserved, full facial (including buccal) function was restored. Deep or anterior lesions may warrant sacrifice of the buccal branch for adequate access and excision. However, this does not result in long-term impairment of facial function. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1821-1825, 2016. © 2016 Wiley Periodicals, Inc.

  9. Analysis of Pivot Sampling in Dual-Pivot Quicksort

    DEFF Research Database (Denmark)

    Nebel, Markus E.; Wild, Sebastian; Martinez, Conrado

    2016-01-01

    The new dual-pivot Quicksort by Vladimir Yaroslavskiy—used in Oracle’s Java runtime library since version 7—features intriguing asymmetries. They make a basic variant of this algorithm use less comparisons than classic single-pivot Quicksort. In this paper, we extend the analysis to the case wher...

  10. On sacrificing and self-preservation: One interpretation

    Directory of Open Access Journals (Sweden)

    Jovanović Đokica R.

    2014-01-01

    Full Text Available One of the initial points of departure is actually an idea by Branko Lazarević, an almost forgotten writer and critic, who stated that 'sacrifice and the only pure self-denial', adding that we are witness to two types of sacrifice: 'Bearing a cross signifies to a victim that one still remains on the other (non-spiritual, author's note side'. Sacrificing therefore means that one has entered this (spiritual, author's note side. In this paper the author is discussing the phenomenon of the so-called transparent, visible sacrifice, i.e. those sacrifices that are on 'this side', which, as such, is the only one detectable in sociological investigations. The basic premise of the paper claims that the basis of the phenomenon of sacrifice there is a need for co-participation, submissiveness towerds authority (be it military, religious, political… which is a condition for coexistence in a community. Survival is possible only as an extension of physical existence or as a participating part of a commemorative culture. The paper also analyses the assumption that the culture of sacrifice, among other things, constitutes itself under a set of possible punitive measures (physical or moral. Among others, some ideas by Russian authors stating that the institution of a sacrifice develops in a state of fear caused by ritual murder of a state's subjects, smerds, before the dead body of their supreme leader. The Russian writers naturally do not rule out a practice of ritual killing of subjects in different and older cultures other than that of Proto-Slavic ones.

  11. Injerto libre braquial medial Free medial arm graft

    Directory of Open Access Journals (Sweden)

    P. Martos Díaz

    2007-12-01

    Full Text Available Introducción. Entre las reconstrucciones de defectos titulares de cabeza y cuello, el injerto libre microvascularizado braquial medial no ha adquirido mucha popularidad debido a las variaciones anatómicas que se reflejan en la vascularización de éste. Nuestro objetivo es realizar una descripción de la anatomía y técnica quirúrgica, así como una revisión de la literatura describiendo las ventajas y desventajas de este tipo de injerto. Material y método. Presentamos el caso de una paciente con carcinoma epidermoide de mucosa yugal izquierda con afectación ganglionar ipsilateral. Se procedió a su resección con márgenes más disección cervical funcional. La reconstrucción del defecto se llevó a cabo mediante un injerto libre microvascularizado braquial medial de brazo izquierdo. Discusión. Pensamos que el injerto libre braquial medial de brazo se trata de una opción más segura a la hora de la reconstrucción de defectos cervicofaciales, aportando una serie de ventajas entre las que destacan: no sacrificio de una arteria terminal, cierre primario de la zona donante, mínimo defecto estético, y poseer una piel fina, elástica y sin vello.Introduction. Free medial microvascularized arm grafts have not become very popular for the reconstruction of head and neck defects due to anatomic variations in their vascularization. Our objective was to describe the anatomy and surgical technique and to review the literature on the advantages and disadvantages of free medial arm grafts. Material and methods. We report the case of a patient with squamous cell carcinoma of the left jugal mucosa with same-side lymph node involvement. The tumor was resected with margins and a functional cervical dissection was performed. The defect was reconstructed using a free medial microvascularized graft from the left arm. Discussion. We believe that free medial arm grafts are a safer option for the reconstruction of cervicofacial defects and that they offer

  12. [Coordination in oncology, pivot nurses].

    Science.gov (United States)

    Feld, Dominique

    2016-06-01

    The function of the pivot nurse was created when the Cancer Plans were first introduced to improve patient management and has constantly developed since then. It is an essential role for the coordination of care and the different players involved along the patient's care pathway. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Medial tibial stress syndrome

    National Research Council Canada - National Science Library

    Kortebein, P M; Kaufman, K R; Basford, J R; Stuart, M J

    2000-01-01

    Medial tibial stress syndrome is discussed with consideration of history and terminology for shin soreness, the most confusing of the multiple terms for those with diffuse exertional medial tibia pain...

  14. HPC s Pivot to Data

    Energy Technology Data Exchange (ETDEWEB)

    Parete-Koon, Suzanne [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Caldwell, Blake A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Canon, Richard Shane [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). National Energy Research Scientific Computing Center (NERSC); Dart, Eli [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Sciences Network (ESnet); Hick, Jason [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). National Energy Research Scientific Computing Center (NERSC); Hill, Jason J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Layton, Chris [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Pelfrey, Daniel S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Shipman, Galen M [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Skinner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). National Energy Research Scientific Computing Center (NERSC); Nam, Hai Ah [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Wells, Jack C. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility (OLCF); Zurawski, Jason [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Sciences Network (ESnet)

    2014-05-03

    Computer centers such as NERSC and OLCF have traditionally focused on delivering computational capability that enables breakthrough innovation in a wide range of science domains. Accessing that computational power has required services and tools to move the data from input and output to computation and storage. A ''pivot to data'' is occurring in HPC. Data transfer tools and services that were previously peripheral are becoming integral to scientific workflows. Emerging requirements from high-bandwidth detectors, high-throughput screening techniques, highly concur- rent simulations, increased focus on uncertainty quantification, and an emerging open-data policy posture toward published research are among the data-drivers shaping the networks, file systems, databases, and overall compute and data environment. In this paper we explain the pivot to data in HPC through user requirements and the changing resources provided by HPC with particular focus on data movement. For WAN data transfers we present the results of a study of network performance between centers.

  15. DMPD: Pivotal role of PGE2 and IL-10 in the cross-regulation of dendritic cell-derivedinflammatory mediators. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 16978535 Pivotal role of PGE2 and IL-10 in the cross-regulation of dendritic cell-derivedinflammatory media...l) (.csml) Show Pivotal role of PGE2 and IL-10 in the cross-regulation of dendritic cell-derivedinflammatory media...egulation of dendritic cell-derivedinflammatory mediators. Authors Harizi H, Gualde N. Publication Cell Mol

  16. How Good Is Multi-Pivot Quicksort?

    DEFF Research Database (Denmark)

    Aumüller, Martin; Dietzfelbinger, Martin; Klaue, Pascal

    2016-01-01

    Multi-Pivot Quicksort refers to variants of classical quicksort where in the partitioning step k pivots are used to split the input into k + 1 segments. For many years, multi-pivot quicksort was regarded as impractical, but in 2009 a two-pivot approach by Yaroslavskiy, Bentley, and Bloch was chosen...... of the partitioning cost is caused by rearranging elements. A rigorous analysis of an algorithm for rearranging elements in the partitioning step is carried out, observing mainly how often array cells are accessed during partitioning. The algorithm behaves best if three to five pivots are used. Experiments show...

  17. How Good Is Multi-Pivot Quicksort?

    DEFF Research Database (Denmark)

    Aumüller, Martin; Dietzfelbinger, Martin; Klaue, Pascal

    2016-01-01

    of the partitioning cost is caused by rearranging elements. A rigorous analysis of an algorithm for rearranging elements in the partitioning step is carried out, observing mainly how often array cells are accessed during partitioning. The algorithm behaves best if three to five pivots are used. Experiments show...... that this translates into good cache behavior and is closest to predicting observed running times of multi-pivot quicksort algorithms. Finally, it is studied how choosing pivots from a sample affects sorting cost. The study is theoretical in the sense that although the findings motivate design recommendations...... as the standard sorting algorithm in Sun’s Java 7. In 2014 at ALENEX, Kushagra et al. introduced an even faster algorithm that uses three pivots. This article studies what possible advantages multi-pivot quicksort might offer in general. The contributions are as follows: Natural comparison-optimal algorithms...

  18. Mediality/Intermediality

    OpenAIRE

    Erne, Lukas Christian; Fischer, Andreas; Jucker, Andreas H.; Heusser, Martin

    2008-01-01

    The essays explore a wide diversity of medial phenomena ranging from Shakespearean drama to contemporary literature, and from the motif of the Arthurian Round Table to the treatment of a metafictional novel in cartoon form. The core issues discussed include theory and methodology, the practical value of mediality for literary studies, the relationship between the written text and visual representation, and the role of performance and performativity. Collectively, the essays constitute a compr...

  19. Extending Teach and Repeat to Pivoting Wheelchairs

    Directory of Open Access Journals (Sweden)

    Guillermo Del Castillo

    2003-02-01

    Full Text Available The paper extends the teach-and-repeat paradigm that has been successful for the control of holonomic robots to nonholonomic wheelchairs which may undergo pivoting action over the course of their taught movement. Due to the nonholonomic nature of the vehicle kinematics, estimation is required -- in the example given herein, based upon video detection of wall-mounted cues -- both in the teaching and the tracking events. In order to accommodate motion that approaches pivoting action as well as motion that approaches straight-line action, the estimation equations of the Extended Kalman Filter and the control equations are formulated using two different definitions of a nontemporal independent variable. The paper motivates the need for pivoting action in real-life settings by reporting extensively on the abilities and limitations of estimation-based teach-and-repeat action where pivoting and near-pivoting action is disallowed. Following formulation of the equations in the near-pivot mode, the paper reports upon experiments where taught trajectories which entail a seamless mix of near-straight and near-pivot action are tracked.

  20. Operational Implications of Pivots of Maneuver,

    Science.gov (United States)

    1991-09-05

    Year, Month, Day) 15. PAGE COUNT Vlonograph I FROM TO -q/0q/q1 16. SUPPLEMENTARY NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if...maneuver ABSTRACT (Continue on reverse if necessary and identify by block number) 1his monograph examines the concpt of pivots of milaneuver from the...achieve decisive victory against the enem. The focus of logistcal and lomnt operations was on the pivots of ,,n,e,𔄂-4 . established by the operationa

  1. Arthroscopic partial medial meniscectomy

    Directory of Open Access Journals (Sweden)

    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  2. Torn medial collateral ligament (image)

    Science.gov (United States)

    ... MCL), is an injury to the medial collateral ligament. This ligament extends from the upper-inside surface of the ... the bottom-inside surface of the femur. The ligament prevents the knee joint from medial instability, that ...

  3. A New Pivot Algorithm for Star Identification

    Directory of Open Access Journals (Sweden)

    Jakyoung Nah

    2014-09-01

    Full Text Available In this study, a star identification algorithm which utilizes pivot patterns instead of apparent magnitude information was developed. The new star identification algorithm consists of two steps of recognition process. In the first step, the brightest star in a sensor image is identified using the orientation of brightness between two stars as recognition information. In the second step, cell indexes are used as new recognition information to identify dimmer stars, which are derived from the brightest star already identified. If we use the cell index information, we can search over limited portion of the star catalogue database, which enables the faster identification of dimmer stars. The new pivot algorithm does not require calibrations on the apparent magnitude of a star but it shows robust characteristics on the errors of apparent magnitude compared to conventional pivot algorithms which require the apparent magnitude information.

  4. Pivotal Response Intervention I: Overview of Approach.

    Science.gov (United States)

    Koegel, Lynn Kern; Koegel, Robert L.; Harrower, Joshua K.; Carter, Cynthia Marie

    1999-01-01

    This article presents an overview of several pivotal response interventions. Areas discussed include responsivity to multiple cues, motivation to initiate and respond appropriately to social and environmental stimuli, and self-regulation of behaviors. The trend to streamline intervention by targeting behaviors that have a widespread effect on…

  5. De un sendero sacrificial surcado de goce // from a sacrificed path plow through of pleasure

    Directory of Open Access Journals (Sweden)

    Mario Orozco Guzmán

    2011-06-01

    Full Text Available El presente trabajo discierne un semblante maldito del sacrificio. En nombre del amor se ha idealizado el sacrificio como paradigma de su audacia y heroísmo, mientras la cultura se ha encargado de enaltecer la proeza sacrificial como puesta en acto del amor. El destinatario de esta inmolación suprema inscribe la producción del goce divino en calidad de objeto “a”, tal como lo revelan sacrificios paradigmáticos presentes en la historia y la literatura. // The current work discerns a cursed countenance from the sacrifice. The sacrifice has been idealized in love's name, as paradigm of its courage and heroism, meanwhile the culture has taken charge of dignifying the sacrificed feat as event in the love act. The addressee of this supreme immolation registers the production of the divine enjoyment as “a” object, just as it is revealed by paradigmatic sacrifices present on history and literature.

  6. Medial canthus retiform hemangioendothelioma

    Directory of Open Access Journals (Sweden)

    Yasser H Al-Faky

    2014-01-01

    Full Text Available Retiform hemangioendothelioma (RH is a distinct entity in the spectrum of vascular tumors with a high local recurrence rate. It is considered a low-grade, well-differentiated cutaneous angiosarcoma with low metastatic potential. We report here for the first time a case of medial canthus recurrent RH. It may be helpful in our practice to include RH as a differential diagnosis of eyelid lesions. It is noteworthy that the progressive course and recurrence tendency of RH might be misdiagnosed as angiosarcoma or basal cell carcinoma (BCC, if not expected and carefully evaluated by the pathologist.

  7. Design Considerations for Artificial Pancreas Pivotal Studies.

    Science.gov (United States)

    Russell, Steven J; Beck, Roy W

    2016-07-01

    The development of artificial pancreas systems has evolved to the point that pivotal studies designed to assess efficacy and safety are in progress or soon to be initiated. These pivotal studies are intended to provide the necessary data to gain clearance from the U.S. Food and Drug Administration, coverage by payers, and adoption by patients and clinicians. Although there will not be one design that is appropriate for every system, there are certain aspects of protocol design that will be considerations in all pivotal studies designed to assess efficacy and safety. One key aspect of study design is the intervention to be used by the control group. A case can be made that the control group should use the currently available best technology, which is sensor-augmented pump therapy. However, an equally, if not more, compelling case can be made that the control intervention should be usual care. In this Perspective, we elaborate on this issue and provide a pragmatic approach to the design of clinical trials of artificial pancreas systems. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  8. Transcutaneous medial canthal tendon incision to the medial orbit.

    Science.gov (United States)

    Timoney, Peter J; Sokol, Jason A; Hauck, Matthew J; Lee, H B Harold; Nunery, William R

    2012-01-01

    The surgical approach to the medial orbit allows superior exposure of the medial orbital wall and nasal bones, extending to the orbital apex, with excellent cosmetic results. This is a retrospective database study of all patients (N = 98) undergoing a transcutaneous medial canthal tendon incision in practice during 2009. This 1.5- to 2.0-cm incision is made just anterior to, in the same plane as, and shaving the anterior ramus of the medial canthal tendon. After exposing the origin of the anterior ramus of the medial canthal tendon, the periorbita along with the attached medial canthal tendon is elevated, exposing the entire medial orbital wall from the orbital strut to the trochlea. Anterior dissection allows access to the nasal bones to the dorsum of the nasal bridge. The parameters studied in this report were the complication rates (including scarring requiring revision, telecanthus, diplopia related to the technique, and injury to the optic nerve or other orbital structures) and photographic evidence of the final cosmetic result of this approach. During 2009, 173 surgical procedures were performed through the transcutaneous medial canthal tendon incision. The procedures comprised 89 fracture repairs of the nasal or ethmoid complex, 2 naso-orbito-ethmoid fracture repairs, 4 cases of isolated nasal fracture repair, 37 medial wall decompressions for ophthalmic Graves disease, 13 cases of subperiosteal abscess drainage, and 28 dacyrocystorhinostomies using a slightly modified incisional position. The inferior oblique was not cut or released in any of these cases. There were no observed cases of medial canthal webbing, injury to orbital structures, telecanthus, optic neuropathy, or iatrogenically induced diplopia related to the technique. By definition, the authors' follow-up time is limited to less than 2 years in each case; however, all complications, which the authors have considered for this report, would have been readily observable in this postoperative period

  9. Atraumatic medial collateral ligament oedema in medial compartment knee osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Bergin, D.; Keogh, C.; O' Connell, M.; Zoga, A. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Rowe, D.; Shah, B. [Boston Univ., MA (United States). Medical Center; Fitzpatrick, P. [Department of Public Health and Epidemiology, University College Dublin (Ireland); Eustace, S. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); X-Ray Department, Cappagh National Orthopedic Hospital, Dublin (Ireland)

    2002-01-01

    Objective: To describe and determine the prevalence of atraumatic medial collateral oedema identified in patients with medial compartment osteoarthritis. Design and patients: Sixty patients, 30 patients with medial compartment knee osteoarthritis (Kellgren and Lawrence grade 2 to 4) and 30 age-matched patients with atraumatic knee pain without osteoarthritis, referred for MR imaging over a 2 year period were included in the study. In each case, severity of osteoarthritis was recorded on radiographs and correlated with the presence or absence of medial collateral ligament oedema at MR imaging. Results: Medial collateral oedema was identified in 27 of the 30 patients with osteoarthritis, of whom 14 had grade 1 oedema and 13 had grade 2 oedema compared with the presence of medial collateral ligament oedema (grade 1) in only two of the 30 control patients without osteoarthritis (P<<0.0001). Conclusion: Medial collateral oedema is common in patients with osteoarthritis in the absence of trauma. When identified, medial collateral ligament oedema should be considered to be a feature of osteoarthritis and should not be incorrectly attributed to an acute traumatic injury. (orig.)

  10. Informing cancer patient based on his type of personality:The self-sacrificing patient.

    Science.gov (United States)

    Kallergis, George

    2015-01-01

    Imparting the bad news has become a hard task for the doctor, and is usually perceived as unpleasant by the patient to whom the bad news is revealed. It is vital that the physician's approach be tailored to the cancer patient's personality. Gathering by the informing process protocols already suggested the hardest step for the doctors to take is empathic understanding which, presupposes tailoring to the individual's needs. The aim of this article was to describe the self-sacrificing type of personality thoroughly, so that any physician can make a diagnosis and tailor the information strategy to their needs. As method of research was used the qualitative method through groups with doctors and nurses, while research within groups lasted for 5 years. Assessing the denial mechanism is hard for a person that regards disease as punishment and propitiation. The physician must mobilize his countertransference, the sense he gets from the discussions with the patient and their overall communication. If he finds that the patient has self-control, then the approach of imparting the news resembles that of the controlling-orderly personality. If he ascertains that the patient has a lasting embarrassment, he should be more careful and impart the news gradually, his approach resembling that of the dependent person.

  11. Pivoting neuromuscular control and proprioception in females and males.

    Science.gov (United States)

    Lee, Song Joo; Ren, Yupeng; Kang, Sang Hoon; Geiger, François; Zhang, Li-Qun

    2015-04-01

    Noncontact ACL injuries occur most commonly in pivoting sports and are much more frequent in females than in males. However, information on sex differences in proprioceptive acuity under weight-bearing and leg neuromuscular control in pivoting is scarce. The objective of this study was to investigate sex differences in pivoting neuromuscular control during strenuous stepping tasks and proprioceptive acuity under weight-bearing. 21 male and 22 female subjects were recruited to evaluate pivoting proprioceptive acuity under weight-bearing, and pivoting neuromuscular control (in terms of leg pivoting instability, stiffness, maximum internal and external pivoting angles, and entropy of time-to-peak EMG in lower limb muscles) during strenuous stepping tasks performed on a novel offaxis elliptical trainer. Compared to males, females had significantly lower proprioceptive acuity under weight-bearing in both internal and external pivoting directions, higher pivoting instability, larger maximum internal pivoting angle, lower leg pivoting stiffness, and higher entropy of time-to-peak EMG in the gastrocnemius muscles during strenuous stepping tasks with internal and external pivoting perturbations. Results of this study may help us better understand factors contributing to ACL injuries in females and males, develop training strategies to improve pivoting neuromuscular control and proprioceptive acuity, and potentially reduce ACL and lower-limb musculoskeletal injuries.

  12. Sacrifício rei, estado ruandês e genocídio

    Directory of Open Access Journals (Sweden)

    Christopher C. Taylor

    Full Text Available Em contraste com as análises do genocídio ruandês de 1994, que privilegiam o político, este artigo sustenta que o poder e a política durante o tempo que precedeu o genocídio foram afetadas por noções ruandesas específicas de cosmologia e ontologia. Para entender esse componente "imaginário" da violência, precisamos examinar atentamente as crenças e práticas relacionadas com a instituição da realeza sagrada em Ruanda. Embora essas crenças e práticas foram oficialmente encerradas em 1931, quando o último rei de Ruanda sagrado foi deposto e substituído por seu filho educado por missionários, a sua matriz cosmológica manteve-se em tempos recentes. Isto pode ser visto na literatura popular de rua Ruandesa, que circulou amplamente nos dias que antecederam o genocídio. Nessa literatura, o então presidente Juvenal Habyarimana era comparado explicitamente a um rei ruandês. Mais importante ainda para os objetivos deste artigo, foi a comparação mais difusa, implícita, e simbólica entre Habyarimana e um rei sagrado. Em particular, alguns dos elementos-chave neste simbolismo iluminam (e mostram a importância da persistência da imagem de como um rei (ou presidente deveria se comportar. Como havia muitos jornalistas ruandeses reacionários (e racistas que tinham começado a duvidar da capacidade do presidente Habyarimana de ser um "bom rei", seu "sacrifício"'subseqüente estava, em um sentido simbólico, fortemente predestinado.

  13. Medial collateral ligament recession for chronic medial knee laxity.

    Science.gov (United States)

    Backes, Jeffrey R; Wiltfong, Roger E; Steensen, Robert N

    2013-06-01

    The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament. We present a simple technique for MCL recession that can be used for isolated MCL laxity as well as in chronic ACL/MCL knee injuries. This technique allows for secure fixation with bone-to-bone healing, avoids donor-site morbidity, maintains relative MCL isometry, and can be performed through a modest incision. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Excel PivotTables and PivotCharts Your Visual Blueprint for Creating Dynamic Spreadsheets

    CERN Document Server

    McFedries, Paul

    2010-01-01

    Master two of the most powerful features of Excel. Even if you use Excel all the time, you may not be up to speed on two of Excel's most useful features. PivotTable and PivotChart turn long lists of unreadable data into dynamic, easy-to-read tables and charts that highlight the information you need most; you can tweak results with a click or easily fuse data from several sources into one document. Now you can learn how to tap these powerful Excel tools with this practical guide. Using a series of step-by-step tutorials and easy-to-follow screenshots, this book shows you in a visual way how to

  15. Adaptive and Dynamic Pivot Selection for Similarity Search

    OpenAIRE

    Salvetti, Mariano; Deco, Claudia; Reyes, Nora; Bender, Cristina

    2011-01-01

    In this paper, a new indexing and similarity search method based on dynamic selection of pivots is presented. It uses Sparse Spatial Selection (SSS) for the initial selection of pivots. Two new selection policies of pivots are added, in order to the index suits itself to searches when it adapts to the metric space. The proposed structure automatically adjusts to the region where most of searches are made. In this way, the amount of distance computations during searches is reduced. The adjustm...

  16. Thigh Muscle Activity, Knee Motion, and Impact Force During Side-Step Pivoting in Agility-Trained Female Basketball Players

    Science.gov (United States)

    Wilderman, Danielle R; Ross, Scott E; Padua, Darin A

    2009-01-01

    Context: Improving neuromuscular control of hamstrings muscles might have implications for decreasing anterior cruciate ligament injuries in females. Objective: To examine the effects of a 6-week agility training program on quadriceps and hamstrings muscle activation, knee flexion angles, and peak vertical ground reaction force. Design: Prospective, randomized clinical research trial. Setting: Sports medicine research laboratory. Patients or Other Participants: Thirty female intramural basketball players with no history of knee injury (age  =  21.07 ± 2.82 years, height  =  171.27 ± 4.66 cm, mass  =  66.36 ± 7.41 kg). Intervention(s): Participants were assigned to an agility training group or a control group that did not participate in agility training. Participants in the agility training group trained 4 times per week for 6 weeks. Main Outcome Measure(s): We used surface electromyography to assess muscle activation for the rectus femoris, vastus medialis oblique, medial hamstrings, and lateral hamstrings for 50 milliseconds before initial ground contact and while the foot was in contact with the ground during a side-step pivot maneuver. Knee flexion angles (at initial ground contact, maximum knee flexion, knee flexion displacement) and peak vertical ground reaction force also were assessed during this maneuver. Results: Participants in the training group increased medial hamstrings activation during ground contact after the 6-week agility training program. Both groups decreased their vastus medialis oblique muscle activation during ground contact. Knee flexion angles and peak vertical ground reaction force did not change for either group. Conclusions: Agility training improved medial hamstrings activity in female intramural basketball players during a side-step pivot maneuver. Agility training that improves hamstrings activity might have implications for reducing anterior cruciate ligament sprain injury associated with side-step pivots. PMID

  17. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Resorlu Mustafa

    2017-11-01

    Full Text Available This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa in osteoarthritis, chondromalacia patella and medial meniscal tears.

  18. Multimedia Pivot Tables for Multimedia Analytics on Image Collections

    NARCIS (Netherlands)

    Worring, M.; Koelma, D.; Zahálka, J.

    2016-01-01

    We propose a multimedia analytics solution for getting insight into image collections by extending the powerful analytic capabilities of pivot tables, found in the ubiquitous spreadsheets, to multimedia. We formalize the concept of multimedia pivot tables and give design rules and methods for the

  19. WASP (Write a Scientific Paper) using Excel - 2: Pivot tables.

    Science.gov (United States)

    Grech, Victor

    2018-01-12

    Data analysis at the descriptive stage and the eventual presentation of results requires the tabulation and summarisation of data. This exercise should always precede inferential statistics. Pivot tables and pivot charts are one of Excel's most powerful and underutilised features, with tabulation functions that immensely facilitate descriptive statistics. Pivot tables permit users to dynamically summarise and cross-tabulate data, create tables in several dimensions, offer a range of summary statistics and can be modified interactively with instant outputs. Large and detailed datasets are thereby easily manipulated making pivot tables arguably the best way to explore, summarise and present data from many different angles. This second paper in the WASP series in Early Human Development provides pointers for pivot table manipulation in Excel™. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Evaluating a Pivot-Based Approach for Bilingual Lexicon Extraction

    Directory of Open Access Journals (Sweden)

    Jae-Hoon Kim

    2015-01-01

    Full Text Available A pivot-based approach for bilingual lexicon extraction is based on the similarity of context vectors represented by words in a pivot language like English. In this paper, in order to show validity and usability of the pivot-based approach, we evaluate the approach in company with two different methods for estimating context vectors: one estimates them from two parallel corpora based on word association between source words (resp., target words and pivot words and the other estimates them from two parallel corpora based on word alignment tools for statistical machine translation. Empirical results on two language pairs (e.g., Korean-Spanish and Korean-French have shown that the pivot-based approach is very promising for resource-poor languages and this approach observes its validity and usability. Furthermore, for words with low frequency, our method is also well performed.

  1. Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity

    Directory of Open Access Journals (Sweden)

    Hua Sun

    2017-01-01

    Conclusions: Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.

  2. Medial tibial “spackling” to lessen chronic medial tibial soft tissue irritation

    Directory of Open Access Journals (Sweden)

    J. Ryan Martin, MD

    2016-09-01

    Full Text Available We describe a unique, utilitarian reconstructive treatment option known as tibial “spackling” for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative treatment, our experience with utilizing bone cement to reconstruct the medial tibial bone defect and create a smooth medial tibial surface has been successful in eliminating chronic medial soft tissue irritation.

  3. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee.

    Science.gov (United States)

    Jacobson, Kurt E; Chi, Frederic S

    2006-06-01

    Injuries to the medial side of the knee are not always isolated injuries of the superficial medial collateral ligament. Medial-sided injuries can also involve the deep medial collateral ligament, the posteromedial corner, or the medial meniscus. Magnetic resonance imaging is a useful adjunct to the physical examination; however, the extent of medial-sided injuries is frequently underappreciated on these images. An understanding of the anatomy and biomechanics of the medial side of the knee and a thorough physical examination aids the physician in determining the full extent of injury and helping the physician to treat each unique injury pattern.

  4. Distribution of Force in the Medial Collateral Ligament Complex During Simulated Clinical Tests of Knee Stability.

    Science.gov (United States)

    Schafer, Kevin A; Tucker, Scott; Griffith, Timothy; Sheikh, Saad; Wickiewicz, Thomas L; Nawabi, Danyal H; Imhauser, Carl W; Pearle, Andrew D

    2016-05-01

    Pivot-shift injury commonly results in combined anterior cruciate ligament (ACL)/medial collateral ligament (MCL) injury, yet the contribution of the components of the MCL complex to restraining multiplanar rotatory loads forming critical subcomponents of the pivot shift is not well understood. To quantify the role of the MCL complex in restraining multiplanar rotatory loads. Controlled laboratory study. A robotic manipulator was used to apply combined valgus and internal rotation torques in a simplified model of the pivot-shift examination in 12 cadaveric knees (49 ± 11 years). Tibiofemoral kinematics were recorded with the ACL intact. Loads borne by the superficial MCL (sMCL), posterior oblique ligament (POL), deep MCL (dMCL), and ACL were determined via the principle of superposition. The POL bore about 50% of the load carried by the ACL in response to the combined torques at 5° and 15° of flexion. The POL bore load during the internal rotation component of the combined torques, while the sMCL carried load during the valgus and internal rotation phases of the simulated pivot. Load in the dMCL was always knee stability in the ACL-competent knee. Both the sMCL and POL work together with the ACL to resist combined moments, which form key components of the pivot-shift examination. © 2016 The Author(s).

  5. Microtubules search for chromosomes by pivoting around the spindle pole

    Science.gov (United States)

    Tolic-Norrelykke, Iva

    2014-03-01

    During cell division, proper segregation of genetic material between the two daughter cells requires that the spindle microtubules attach to the chromosomes via kinetochores, protein complexes on the chromosome. The central question, how microtubules find kinetochores, is still under debate. We observed in fission yeast that kinetochores are captured by microtubules pivoting around the spindle pole body, instead of growing towards the kinetochores. By introducing a theoretical model, we show that the observed angular movement of microtubules is sufficient to explain the process of kinetochore capture. Our theory predicts that the speed of the capture process depends mainly on how fast microtubules pivot. We confirmed this prediction experimentally by speeding up and slowing down microtubule pivoting. Thus, microtubules explore space by pivoting, as they search for intracellular targets such as kinetochores.

  6. Pivotal response treatment for autism spectrum disorder: current perspectives

    National Research Council Canada - National Science Library

    Lei J; Ventola P

    2017-01-01

    ...: Pivotal response treatment (PRT) is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD...

  7. Pivot and cluster strategy: a preventive measure against diagnostic errors

    National Research Council Canada - National Science Library

    Shimizu, Taro; Tokuda, Yasuharu

    2012-01-01

    .... In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS), encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1...

  8. Gyroscope pivot bearing dimension and surface defect detection

    National Research Council Canada - National Science Library

    Ge, Wenqian; Zhao, Huijie; Li, Xudong

    2011-01-01

    ... illumination system is proposed. After detecting the micro-defects of a gyroscope pivot bearing with a high curvature glabrous surface and analyzing the characteristics of the surface detection and reflection model, a complex...

  9. Multimedia Pivot Tables for Multimedia Analytics on Image Collections

    OpenAIRE

    Worring, M; Koelma, D.; Zahálka, J.

    2016-01-01

    We propose a multimedia analytics solution for getting insight into image collections by extending the powerful analytic capabilities of pivot tables, found in the ubiquitous spreadsheets, to multimedia. We formalize the concept of multimedia pivot tables and give design rules and methods for the multimodal summarization, structuring, and browsing of the collection based on these tables, all optimized to support an analyst in getting structural and conclusive insights. Our proposed solution p...

  10. Transfrontoethmoidal approach to medial intraconal lesions.

    Science.gov (United States)

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

    2009-12-01

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

  11. Transformation from Film to Nanorod via a Sacrifical Layer: Pulsed Laser Deposition of ZnO for Enhancing Photodetector Performance.

    Science.gov (United States)

    Ou, Sin-Liang; Yu, Fei-Peng; Wuu, Dong-Sing

    2017-10-27

    A novel fabrication method for single crystalline ZnO nanorods by pulsed laser deposition (PLD) using a chemical-bath-deposited ZnS seed layer is proposed. For the substrate temperature (Ts) lower than 700 °C, the PLD-ZnO showed a polycrystalline phase and film-type morphology, resulting from the ZnS seed layer with a cubic phase. However, the ZnS film became a sacrifical layer and single crystalline ZnO(002) nanorods can be achieved at Ts of 900 °C, where ZnS was decomposed to zinc metals and sulfur fumes. The transformation from ZnO film to nanorod microstructure was demonstrated with the change of ZnS layer into Zn grains. Enhanced performance of the metal-semiconductor-metal photodetectors were fabricated with ZnO/ZnS samples grown at Ts of 500, 700, and 900 °C. The responsivities (@1 V and 370 nm) of these three devices were 1.71, 6.35, and 98.67 A/W, while their UV-to-visible discrimination ratios were 7.2, 16.5, and 439.1, respectively. Obviously, a higher light-capturing efficiency was obtained in the 900 °C-grown ZnO/ZnS device owing to its one-dimensional nanostructure with high crystal quality. The results indicate PLD combined with a sacrifical nanostructure is a promising method for obtaining high-quality ZnO nanorods, which paves the way for the fabrication of high performance ZnO-based devices.

  12. Pivot Nursing: An Alternative to Traditional ED Triage.

    Science.gov (United States)

    Christensen, Maria; Rosenberg, Mark; Mahon, Eileen; Pineda, Sharon; Rojas, Eva; Soque, Victoria; Johansen, Mary L

    2016-09-01

    A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time. After education, the pivot process was implemented using 4 determinants established by a multidisciplinary team. The pivot process was slowly implemented for 6 hours over a 1-week period to work out processing issues. Arrival time, door-to-physician time, and departure time from the emergency department were elements used to calculate the patient's turnaround time. Length of ED stay was collected monthly beginning in the fourth quarter of 2011. Comparisons were made after Pivot implementation in the fourth quarter of 2012. Despite the increasing volume, the mean door-to-physician time decreased from 71 to 40 minutes, a 43.7% reduction. The overall turnaround time decreased from 220 to 181 minutes, representing approximately a 17.7% reduction. The percentage of patients who left without being seen decreased from 2.5% to 1.0%. The pivot process improved patient flow in the emergency department, reducing time spent by the patient in the department. The pivot process is a viable alternative to traditional triage. Nurses are able to accurately pivot patients with a reduced amount of information. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  13. Acute Medial Plantar Fascia Tear.

    Science.gov (United States)

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

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

  14. Medial Patella Subluxation: Diagnosis and Treatment

    OpenAIRE

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and pa...

  15. Medial Impingement of the Ankle in Athletes

    OpenAIRE

    Manoli, Arthur

    2010-01-01

    Context: Medial impingement syndrome of the ankle is common in the athletic population. A marginal osteophyte on the leading edge of the medial talar facet and a corresponding “kissing” osteophyte on the tibia, in front of the medial malleolus, may abut and cause pain and limited dorsiflexion. Background: Palpation of the talar osteophyte and standard imaging—especially, the oblique view of the foot—are useful in making the diagnosis. Surgical removal of the osteophyte may be necessary. Concl...

  16. PowerPivot for advanced reporting and dashboards

    CERN Document Server

    Bosco, Robert

    2013-01-01

    A step-by-step tutorial with focused examples that builds progressively from basic to advanced topics and helps you create business intelligence reports and dashboards quickly and efficiently using the PowerPivot add-in.This book is ideal for data analysts, reporting and MIS professionals, business analysts, managers, dashboard makers, business intelligence professionals, self-service business intelligence personnel, and students. It is assumed that you have basic data analysis skills and intermediate level Excel skills. Familiarity with Pivot Tables as well as basic knowledge of VBA scripting

  17. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury.

    Science.gov (United States)

    Kini, Sunil-Gurpur; du Pre, Karel; Bruce, Warwick

    2015-01-01

    Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

  18. Medial subtalar dislocation: Case report

    Directory of Open Access Journals (Sweden)

    Manojlović Radovan

    2010-01-01

    Full Text Available Introduction. Subtalar dislocation (SI is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. Case Outline. A case of medial subtalar dislocation as a result of basketball injury, so-called 'basketball foot', is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. Conclusion. Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

  19. Book Review Pivotal Love Relationships By Richard Alapack (2007 ...

    African Journals Online (AJOL)

    Love's Pivotal Relationships: The Chum, First Love, Outlaw and the Intimate Partner. Milton Keynes, UK/Bloomington, Indiana: AuthorHouse Press. Paperback (218 pages). ISBN: 978-1-434-31904-3. Hardcover (232 pages). ISBN: 978-1-434-32452-8. Indo-Pacific Journal of Phenomenology, Volume 8, Edition 1 May 2008 ...

  20. 175 Years of Linear Programming-Pivots in Column Space

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 4; Issue 1. 175 Years of Linear Programming - Pivots in Column Space. Vijay Chandru M R Rao. Series Article Volume 4 Issue 1 January 1999 pp 8-22. Fulltext. Click here to view fulltext PDF. Permanent link:

  1. Leadership and nurse retention: the pivotal role of nurse managers.

    Science.gov (United States)

    Anthony, Mary K; Standing, Theresa S; Glick, JoAnn; Duffy, Martha; Paschall, Fran; Sauer, Mary R; Sweeney, Denise Kosty; Modic, Mary Beth; Dumpe, Michelle L

    2005-03-01

    As the link between executives and bedside nurses, nurse managers assume roles that bridge both organizational and professional goals. Nurse retention is one of the many responsibilities that characterize the nurse manager's work. To better understand the pivotal role of nurse managers, the authors describe the views of 32 nurse managers regarding their roles and the characteristics they need to promote retention.

  2. Inisight in Image Collections by Multimedia Pivot Tables

    NARCIS (Netherlands)

    Worring, M.; Koelma, D.

    2015-01-01

    We propose a multimedia analytics solution for getting insight in image collections by extending the powerful method of pivot tables, found in the ubiquitous spreadsheets, to multimedia. Our proposed solution is designed by considering the characteristics of multimedia data as well as insight and

  3. Medial Patella Subluxation: Diagnosis and Treatment

    Science.gov (United States)

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

  4. Medial Patella Subluxation: Diagnosis and Treatment.

    Science.gov (United States)

    McCarthy, Mark A; Bollier, Mathew J

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity.

  5. Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment

    Science.gov (United States)

    Ventola, Pamela E.; Yang, Daniel; Abdullahi, Sebiha M.; Paisley, Courtney A.; Braconnier, Megan L.; Sukhodolsky, Denis G.

    2016-01-01

    Children with ASD show high frequency of restricted and repetitive behaviors (RRBs); however, higher-order RRBs, such as restricted interests, have remained largely resistant to treatment. This study evaluated change in severity of RRBs following a 16-week open trial of Pivotal Response Treatment (PRT). Participants included 15 children with ASD ages 4 to 7 years. RRBs, as measured by the Repetitive Behavioral Scales- Revised (RBS-R) and Aberrant Behaviors Checklist (ABC), decreased significantly after treatment. These reductions remained significant after controlling for change in social communication skills. PRT shows promise in reducing RRBs; although PRT explicitly addresses pivotal social communication skills, there is a secondary and less direct effect on RRBs. PMID:27230762

  6. Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

    Science.gov (United States)

    Barber, F Alan; Getelman, Mark H; Berry, Kathy L

    2017-04-01

    To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  7. Braking characteristics during cutting and pivoting in female soccer players.

    Science.gov (United States)

    Jones, Paul A; Herrington, Lee; Graham-Smith, Philip

    2016-10-01

    Most biomechanical studies into changing direction focus on final contact (FC), whilst limited research has examined penultimate contact (PEN). The aim of this study was to explore the kinematic and kinetic differences between PEN and FC of cutting and pivoting in 22 female soccer players (mean±SD; age: 21±3.1years, height: 1.68±0.07m, mass: 58.9±7.3kg). Furthermore, the study investigated whether horizontal force-time characteristics during PEN were related to peak knee abduction moments during FC. Three dimensional motion analyses of cutting and pivoting on the right leg were performed using Qualysis 'Proreflex' infrared cameras (240Hz). Ground reaction forces (GRF) were collected from two AMTI force platforms (1200Hz) to examine PEN and FC. Both manoeuvres involved significantly (Pangles, peak horizontal GRF, but lower average horizontal GRF during PEN compared to FC. Average horizontal GRF during PEN (R=-0.569, R(2)=32%, P=0.006) and average horizontal GRF ratio (R=0.466, R(2)=22%, P=0.029) were significantly related to peak knee abduction moments during the FC of cutting and pivoting, respectively. The results indicate PEN during pre-planned changing direction helps reduce loading on the turning leg where there is greater risk of injuries to knee ligaments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. T3-T4 laryngeal cancer in The Netherlands Cancer Institute: 10-year results of the consistent application of an organ preserving/-sacrificing protocol

    NARCIS (Netherlands)

    Timmermans, A.J.; de Gooijer, C.J.; Hamming-Vrieze, O.; Hilgers, F.J.M.; van den Brekel, M.W.M.

    2015-01-01

    Background Both organ-preserving concurrent (chemo)radiotherapy ((C)RT) and organ-sacrificing surgery (total laryngectomy) are used for treatment of advanced laryngeal cancer. The purpose of this study was to present the assessment of our treatment protocol for T3 (C)RT and T4 disease (total

  9. T3-T4 laryngeal cancer in The Netherlands Cancer Institute; 10-year results of the consistent application of an organ-preserving/-sacrificing protocol

    NARCIS (Netherlands)

    Timmermans, Adriana J.; de Gooijer, Cornedine J.; Hamming-Vrieze, Olga; Hilgers, Frans J. M.; van den Brekel, Michiel W. M.

    2015-01-01

    Both organ-preserving concurrent (chemo)radiotherapy ((C)RT) and organ-sacrificing surgery (total laryngectomy) are used for treatment of advanced laryngeal cancer. The purpose of this study was to present the assessment of our treatment protocol for T3 (C)RT and T4 disease (total

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

    Science.gov (United States)

    Fournier, Pierre-Etienne

    2003-06-01

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

  11. CT density analysis of the medial cuneiform.

    Science.gov (United States)

    Panchbhavi, Vinod K; Boutris, Nickolas; Patel, Karan; Molina, Domingo; Andersen, Clark R

    2013-11-01

    A cannulated lag screw inserted through the medial cuneiform into the base of the second metatarsal is often utilized to reduce the diastasis and aid healing of Lisfranc injuries. Also procedures such as a midfoot or a Lapidus arthrodesis require adequate implant-bone purchase in the medial cuneiform. The medial cuneiform contains cancellous bone of varying density. Knowledge of density variation may be helpful for implant usage and manufacturing of area specific implants. In 60 randomly selected patients, mean computed tomography (CT) intensity in Hounsfield units was measured at 12 sampled locations within the medial cuneiform and served as a proxy for bone density. The patients' age, gender, and race were recorded. An analysis of variance (ANOVA) assessed the effect of age, gender, race, and sample site on bone density. Statistical testing assumed 95% level of confidence. ANOVA showed age, gender, and sample site had significant effects (P race had no significant effect (P = .28). The distal-dorsal-lateral (DDL) site was significantly denser than all other sites (P < .001) except the middle-dorsal-lateral (MDL) (P = .53). The proximal-plantar-lateral (PPL) site was significantly less dense than all other sites (P < .001) except the middle-plantar-lateral/medial and the proximal-plantar-medial sites (P < .14). A general trend of density increasing in the distal and dorsal directions was evident, and within the dorsal sites there was a trend of increasing density in the lateral direction. This is the first study to date to measure density of the medial cuneiform using living subjects. The sample size of 60 patients was also the largest of any study measuring density of this bone. We conclude that the densest area of the medial cuneiform is the most anterior, dorsal, and lateral portion. The findings of this study may indicate the most optimal area for implant purchase in the medial cuneiform when reducing the diastasis between the base of the second metatarsal and

  12. Medial tibial stress syndrome: Case report

    OpenAIRE

    Jovičić Milica; Jovičić Vladimir; Hrković Marija; Lazović Milica

    2014-01-01

    Introduction. Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential ...

  13. UMAPRM: Uniformly sampling the medial axis

    KAUST Repository

    Yeh, Hsin-Yi Cindy

    2014-05-01

    © 2014 IEEE. Maintaining clearance, or distance from obstacles, is a vital component of successful motion planning algorithms. Maintaining high clearance often creates safer paths for robots. Contemporary sampling-based planning algorithms That utilize The medial axis, or The set of all points equidistant To Two or more obstacles, produce higher clearance paths. However, They are biased heavily Toward certain portions of The medial axis, sometimes ignoring parts critical To planning, e.g., specific Types of narrow passages. We introduce Uniform Medial Axis Probabilistic RoadMap (UMAPRM), a novel planning variant That generates samples uniformly on The medial axis of The free portion of Cspace. We Theoretically analyze The distribution generated by UMAPRM and show its uniformity. Our results show That UMAPRM\\'s distribution of samples along The medial axis is not only uniform but also preferable To other medial axis samplers in certain planning problems. We demonstrate That UMAPRM has negligible computational overhead over other sampling Techniques and can solve problems The others could not, e.g., a bug Trap. Finally, we demonstrate UMAPRM successfully generates higher clearance paths in The examples.

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

    Science.gov (United States)

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

    2009-10-01

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

  15. HISTOLOGICAL STUDIES OF THE EFFECTS OF MONOSODIUM GLUTAMATE ON THE MEDIAL GENICULATE BODY OF ADULT WISTAR RATS

    Directory of Open Access Journals (Sweden)

    A.O.Eweka

    2007-01-01

    Full Text Available Histological effects of Monosodium glutamate (MSG commonly used as food additive on the medial geniculate body (MGB of adult wistar rats were carefully studied. The rats of both sexes (n=24, average weight of 185g were randomly assigned into two treatments (n=16 and control (n=8 groups.The rats in the treatment groups received 3g and 6g of MSG thoroughly mixed with their feeds for fourteen days, while the control rats received equal amounts of feeds without MSG added. The rats were fed with grower's mash purchased from Edo Feeds and Flour Mill Ltd, Ewu, Edo State and were given water liberally. The rats were sacrificed on day fifteen of the experiment. The medial geniculate body was carefully dissected out and quickly fixed in 10% formal saline for routine histological study after H&E method.The histological findings after H&E methods indicated that the treated sections of the medial geniculate body showed some cellular degenerative changes, autophagic vacuoles with some vacuolations appearing in the stroma, and some degree of neuronal hypertrophy when compared to the control sections. These findings indicate that MSG consumption may have a deleterious effect on the neurons of the medial geniculate body (MGB. MSG may probably have adverse effects on the auditory sensibilities by its deleterious effects on the nerve cells of the MGB of adult wistar rats. It is recommended that further studies aimed at corroborating these observations be carried out.

  16. MEDIAL BRACHIAL CUTANEOUS NERVE CONDUCTION VELOCITY: A DIAGNOSTIC METHOD FOR MEDIAL CORD LESIONS

    Directory of Open Access Journals (Sweden)

    B TAVANA

    2000-06-01

    Full Text Available Introduction. Regarding to the absence of doccumented studies concerning medial brachial coetaneous nerve conduction, the present study was conducted to evaluate this parameter as a diagnostic method for injuries to medial cord and lower trunk of brachial plexus. Methods. The sensory nerve action potential of median, ulnar and medial antebrachial cutaneous nerves were recorded to show these roots (Cs-TV are intact. Then, the medial brachial cutaneous nerve was stimulated on the line that connects axilla to medial epicondyle (parallel with mid axillary line at the junction site of coracobrachialis muscle to humerus recording was done 2 cm above the medial epicondyle (10 cm under stimulating site. Results. In all cases the wave was biphasic with primary negative phase. The latency was 2±0.3 ms-1 (range 1.4-2.6 ms-1 and the amplitude of SNAP was 30±10 mv (range 10-50 mV. The nerve conduction velocity was 61±4 ms-1 (range 53-69 ms-1. Discussion. With regard to the intensity and site of stimulation and recording area, this wave is not due to compound nerve action potential of median or ulnar nerve. This study may be useful in evaluation of T1 root and in differential diagnosis of medial cord and lower trunk lesions with ulnar and medial part of median nerve injuries.

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

    Science.gov (United States)

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

    2010-05-01

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

  18. Gyroscope pivot bearing dimension and surface defect detection.

    Science.gov (United States)

    Ge, Wenqian; Zhao, Huijie; Li, Xudong

    2011-01-01

    Because of the perceived lack of systematic analysis in illumination system design processes and a lack of criteria for design methods in vision detection a method for the design of a task-oriented illumination system is proposed. After detecting the micro-defects of a gyroscope pivot bearing with a high curvature glabrous surface and analyzing the characteristics of the surface detection and reflection model, a complex illumination system with coaxial and ring lights is proposed. The illumination system is then optimized based on the analysis of illuminance uniformity of target regions by simulation and grey scale uniformity and articulation that are calculated from grey imagery. Currently, in order to apply the Pulse Coupled Neural Network (PCNN) method, structural parameters must be tested and adjusted repeatedly. Therefore, this paper proposes the use of a particle swarm optimization (PSO) algorithm, in which the maximum between cluster variance rules is used as fitness function with a linearily reduced inertia factor. This algorithm is used to adaptively set PCNN connection coefficients and dynamic threshold, which avoids algorithmic precocity and local oscillations. The proposed method is used for pivot bearing defect image processing. The segmentation results of the maximum entropy and minimum error method and the one described in this paper are compared using buffer region matching, and the experimental results show that the method of this paper is effective.

  19. Gyroscope Pivot Bearing Dimension and Surface Defect Detection

    Directory of Open Access Journals (Sweden)

    Xudong Li

    2011-03-01

    Full Text Available Because of the perceived lack of systematic analysis in illumination system design processes and a lack of criteria for design methods in vision detection a method for the design of a task-oriented illumination system is proposed. After detecting the micro-defects of a gyroscope pivot bearing with a high curvature glabrous surface and analyzing the characteristics of the surface detection and reflection model, a complex illumination system with coaxial and ring lights is proposed. The illumination system is then optimized based on the analysis of illuminance uniformity of target regions by simulation and grey scale uniformity and articulation that are calculated from grey imagery. Currently, in order to apply the Pulse Coupled Neural Network (PCNN method, structural parameters must be tested and adjusted repeatedly. Therefore, this paper proposes the use of a particle swarm optimization (PSO algorithm, in which the maximum between cluster variance rules is used as fitness function with a linearily reduced inertia factor. This algorithm is used to adaptively set PCNN connection coefficients and dynamic threshold, which avoids algorithmic precocity and local oscillations. The proposed method is used for pivot bearing defect image processing. The segmentation results of the maximum entropy and minimum error method and the one described in this paper are compared using buffer region matching, and the experimental results show that the method of this paper is effective.

  20. Wave Energy, Lever Operated Pivoting Float LOPF Study

    DEFF Research Database (Denmark)

    Margheritini, Lucia

    for maximum energy output in regular as well as irregular waves. During storms the buoy pivots and streamlines itself to minimize loads on the mooring line. A conservative estimate shows that a full scale system for North Sea conditions has a float size width of 15 m that will, with 60% generator efficiency......The fully instrumented Resen Waves Lever Operated Pivoting Float LOPF wave energy buoy model has gone through the first stage of testing in regular waves in scale 1:25 of the North Sea wave conditions, in the 3D deep wave basin at the Hydraulic and Coastal Engineering Laboratory of Aalborg...... University in Denmark. The model size was 60cm W x 90cm L x 21cm H. The 60 cm width pointed towards the wave front. The LOPF buoy is characterized by a simple mechanical design with few moving parts and direct electrical output and it is taut moored to the sea bed, so all forces are referenced to the seabed...

  1. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear

    Energy Technology Data Exchange (ETDEWEB)

    Engelsohn, Eliyahu [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Umans, Hilary [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Jacobi Medical Center, Department of Orthopedic Surgery, Ardsley, NY (United States); DiFelice, Gregory S. [Jacobi Medical Center, Department of Orthopedic Surgery, Ardsley, NY (United States)

    2007-01-15

    We report two cases of marginal fractures of the medial tibial plateau associated with medial meniscal root tears. Both patients sustained knee dislocations, with complete tears of the posterior horn medial meniscal root. One sustained a ''reverse Segond fracture''; the other sustained an ''anteromedial impingement fracture'' of the tibial plateau. The meniscal root tears were arthroscopically confirmed and repaired. In the first patient, the integrity of the meniscal root repair was confirmed at a 6-month follow-up arthroscopy for lysis of adhesions. In the second patient, follow-up MRI at 10 months demonstrated a healed meniscal root. The association of medial meniscal root tear with marginal fractures of the medial tibial plateau has not been previously reported. (orig.)

  2. Tension band fixation of medial malleolus fractures.

    Science.gov (United States)

    Ostrum, R F; Litsky, A S

    1992-01-01

    A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. There were no nonunions or movements of wires postoperatively and only two patients had subjective complaints with reference to the wires that required hardware removal. There was one 2-mm malreduction and one patient with a wound slough and subsequent osteomyelitis. One fragment had 2 mm of displacement after fixation but went on to union. A biomechanical study was undertaken to compare fixation of the medial malleolus with K wires alone, K wires plus a tension band, and two cancellous screws. The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.

  3. Medial impingement of the ankle in athletes.

    Science.gov (United States)

    Manoli, Arthur

    2010-11-01

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

  4. PowerPivot for Business Intelligence Using Excel and SharePoint

    CERN Document Server

    Ralston, Barry

    2011-01-01

    PowerPivot comprises a set of technologies for easy access to data mining and business intelligence analysis from Microsoft Excel and SharePoint. Power users and developers alike can create sophisticated, online analytic processing (OLAP) solutions using PowerPivot for Excel, and then share those solutions with other users via PowerPivot for SharePoint. Data can be pulled in from any of the leading database platforms, as well as from spreadsheets and flat files. PowerPivot for Business Intelligence Using Excel and SharePoint is your key to mastering PowerPivot. The book takes a scenario-based

  5. Subexponential lower bounds for randomized pivoting rules for the simplex algorithm

    DEFF Research Database (Denmark)

    Friedmann, Oliver; Hansen, Thomas Dueholm; Zwick, Uri

    2011-01-01

    The simplex algorithm is among the most widely used algorithms for solving linear programs in practice. With essentially all deterministic pivoting rules it is known, however, to require an exponential number of steps to solve some linear programs. No non-polynomial lower bounds were known, prior...... to this work, for randomized pivoting rules. We provide the first subexponential (i.e., of the form 2Ω(nα), for some α>0) lower bounds for the two most natural, and most studied, randomized pivoting rules suggested to date. The first randomized pivoting rule considered is Random-Edge, which among all improving...... pivoting steps (or edges) from the current basic feasible solution (or vertex) chooses one uniformly at random. The second randomized pivoting rule considered is Random-Facet, a more complicated randomized pivoting rule suggested by Kalai and by Matousek, Sharir and Welzl. Our lower bound for the Random...

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

    Science.gov (United States)

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

    2017-12-01

    This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

  7. Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis.

    Science.gov (United States)

    Yang, Pan; Zhang, Ying; Liu, Jian; Xiao, Jin; Ma, Li Min; Zhu, Chang Rong

    2015-01-01

    This finite element analysis aimed to examine the effect of medial cortical support and medial screw support on loads at the implant-bone interface of locking plate fixation of proximal humeral fractures with a medial gap. An intact humerus from a healthy volunteer was used as the basis for a 3-dimensional (3D) computer-aided design (CAD) model. The 3D CAD model of the locking plate system was based on information in the manufacturer's catalogue. The proximal part of the humerus was osteotomized to create standard three-part fractures, which were then divided into a -MSC group (which lacked medial cortical support, and in which fractures with a 5-mm medial bone gap simulated this lack) and +MCS group (which had medial cortical support, and in which fractures with medial cortical-to-cortical contact simulated this). Both fracture groups were respectively fixed with either +MSS (in which medial screw support was simulated by the addition of two calcar screws to the locking plate system), or with -MSS (in which the lack of medial screw support was simulated by absence of the two additional calcar screws to the locking plate system). All the modeling was conducted to represent 90° arm abduction. On the screw-bone interface, medial screw support and medial cortical support decreased maximum shear stress by 17% and 23% respectively. On the locking plate, medial screw support and medial cortical support decreased maximum von Mises stress by 11% and 22% respectively. However, a combination of these two appeared to decrease maximum shear stress by 56% for the screw-bone interface, and maximum von Mises stress by 54% for the locking plate. Placement of calcar screws combined with good medial cortical contact in varus in locking plate fixation of proximal humeral fractures with a medial gap may provide optimal stability for the fixation.

  8. Dentin regeneration in vitro: the pivotal role of supportive cells.

    Science.gov (United States)

    About, I

    2011-07-01

    The elaboration of dentin-pulp engineering strategies requires the investigation of not only progenitor cell potentials but also their interactions with other non-progenitor "supportive" cells. Under severe caries lesions, progenitor cells may be activated by growth factors released after the acidic dissolution of carious dentin. However, dentin regeneration has also been observed after traumatic injuries without any significant dentin dissolution. This raises questions about the origin of signals involved in progenitor cell activation, migration, and differentiation. Study models such as the entire tooth culture and co-cultures of pulp and endothelial cells highlighted the role of interactions between the different pulp cell types and the pivotal role they play in dentin regeneration. Injured pulp fibroblasts secrete growth factors involved in progenitor cell activation and differentiation as well as neoangiogenesis which may pave the pathways for progenitor cell migration. This appears to be the first paper to focus on this very important field in dental pulp biology.

  9. Margin-Based Pivot Selection for Similarity Search Indexes

    Science.gov (United States)

    Kurasawa, Hisashi; Fukagawa, Daiji; Takasu, Atsuhiro; Adachi, Jun

    When developing an index for a similarity search in metric spaces, how to divide the space for effective search pruning is a fundamental issue. We present Maximal Metric Margin Partitioning (MMMP), a partitioning scheme for similarity search indexes. MMMP divides the data based on its distribution pattern, especially for the boundaries of clusters. A partitioning boundary created by MMMP is likely to be located in a sparse area between clusters. Moreover, the partitioning boundary is at maximum distances from the two cluster edges. We also present an indexing scheme, named the MMMP-Index, which uses MMMP and pivot filtering. The MMMP-Index can prune many objects that are not relevant to a query, and it reduces the query execution cost. Our experimental results show that MMMP effectively indexes clustered data and reduces the search cost. For clustered data in a vector space, the MMMP-Index reduces the computational cost to less than two thirds that of comparable schemes.

  10. Pivot and cluster strategy: a preventive measure against diagnostic errors.

    Science.gov (United States)

    Shimizu, Taro; Tokuda, Yasuharu

    2012-01-01

    Diagnostic errors constitute a substantial portion of preventable medical errors. The accumulation of evidence shows that most errors result from one or more cognitive biases and a variety of debiasing strategies have been introduced. In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS), encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1) and analytical process (System 2) in one strategy. With PCS, physicians can recall a set of most likely differential diagnoses (System 2) of an initial diagnosis made by the physicians' intuitive process (System 1), thereby enabling physicians to double check their diagnosis with two consecutive diagnostic processes. PCS is expected to reduce cognitive errors and enhance their diagnostic accuracy and validity, thereby realizing better patient outcomes and cost- and time-effective health care management.

  11. Perturb and Observe Control for an Embedded Point Pivoted Absorber

    Directory of Open Access Journals (Sweden)

    Gianluca Brando

    2016-11-01

    Full Text Available Marine energy sources represent an attractive and inexhaustible reservoir able to contribute to the fulfillment of the world energy demand in accordance with climate/energy regulatory frameworks. Wave energy converter (WEC integration into the main grid requires both the maximization of the harvested energy and the proper management of the generation variability. The present paper focuses on both these mentioned issues. More specifically, it presents an embedded point pivoted absorber (PPA and its related control strategy aimed at maximizing the harvested energy. Experimental and numerical investigations have been carried out in a wave/towing tank facility in order to derive the design characteristics of the full-scale model and demonstrate the validity and effectiveness of the proposed control strategy.

  12. Wave energy, lever operated pivoting float LOPF study

    Energy Technology Data Exchange (ETDEWEB)

    Margheritini, L.

    2012-11-01

    The fully instrumented Resen Waves Lever Operated Pivoting Float LOPF wave energy buoy model has gone through the first stage of testing in regular waves in scale 1:25 of the North Sea wave conditions, in the 3D deep wave basin at the Hydraulic and Coastal Engineering Laboratory of Aalborg University in Denmark. The model size was 60cm W x 90cm L x 21cm H. The 60 cm width pointed towards the wave front. The LOPF buoy is characterized by a simple mechanical design with few moving parts and direct electrical output and it is taut moored to the sea bed, so all forces are referenced to the seabed for maximum energy output in regular as well as irregular waves. During storms the buoy pivots and streamlines itself to minimize loads on the mooring line. A conservative estimate shows that a full scale system for North Sea conditions has a float size width of 15 m that will, with 60% generator efficiency, produce 610 MWh/y (609.497 kWh/y) with an average power output of 69.6 kW, which requires a generator capacity of 700 kW. It is expected the generator efficiency can be increased to 90% in the future. More specific calculations (from EnergiNet) show that with one generator of 695 kW the expected power production is 585 MWh/y; with a generator of 250 kW and 100 kW, the expected power production is 481 MWh/y and 182 MWh/y respectively. In addition there are several areas for future improvements for increased power production. (Author)

  13. Medial structure generation for registration of anatomical structures

    DEFF Research Database (Denmark)

    Vera, Sergio; Gil, Debora; Kjer, Hans Martin

    2017-01-01

    Medial structures (skeletons and medial manifolds) have shown capacity to describe shape in a compact way. In the field of medical imaging, they have been employed to enrich the description of organ anatomy, to improve segmentation, or to describe the organ position in relation to surrounding...... structures. Methods for generation of medial structures, however, are prone to the generation of medial artifacts (spurious branches) that traditionally need to be pruned before the medial structure can be used for further computations. The act of pruning can affect main sections of the medial surface...

  14. Medial Prefrontal Cortex Updates Its Status.

    Science.gov (United States)

    Cikara, Mina; Gershman, Samuel J

    2016-12-07

    How does the brain infer social status? A new study by Kumaran et al. (2016) identifies a region of the medial prefrontal cortex that, in concert with the amygdala and hippocampus, subserves updating of probabilistic beliefs about the status of individuals in a social hierarchy. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Medial branch neurotomy in low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Masala, Salvatore; Mammucari, Matteo; Simonetti, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); Nano, Giovanni [Interventional Radiology and Radiotherapy University ' ' Tor Vergata' ' , Department of Diagnostic and Molecular Imaging, Rome (Italy); University ' ' Tor Vergata' ' , Department of Radiology, Rome (Italy); Marcia, Stefano [S. Giovanni di Dio Hospital, Department of Diagnostic and Molecular Imaging, Cagliari (Italy)

    2012-07-15

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

  16. Neuromuscular Exercise Post Partial Medial Meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Hinman, Rana S; Wrigley, Tim V

    2015-01-01

    : In patients 3-12 months following a medial arthroscopic partial meniscectomy, a neuromuscular exercise program did not alter the peak knee adduction moment, a key predictor of osteoarthritis structural disease progression. Australia and New Zealand Clinical Trials Registry (#ACTRN12612000542897)....

  17. Rheo: Japanese Sound Art Interrogating Digital Mediality

    DEFF Research Database (Denmark)

    Vandsø, Anette

    2014-01-01

    THe article asks in what way the Japanese sound artist Ryoichi Kurokawa's audiovisual installation Rheo 5 Horisonz (2010) is 'digital'. Using Professor Lars Elleströms concept of 'mediality, the main claim in this article is that Rheo no only uses digital tehcnology, but also interrogates digital...

  18. Medial ankle pain after lateral ligament rupture

    NARCIS (Netherlands)

    van Dijk, C. N.; Bossuyt, P. M.; Marti, R. K.

    1996-01-01

    After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the

  19. Medial tibial stress syndrome: case report.

    Science.gov (United States)

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

    2014-01-01

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

  20. Medial frontal cortex and response conflict: Evidence from human intracranial EEG and medial frontal cortex lesion

    NARCIS (Netherlands)

    Cohen, M.X.; Ridderinkhof, K.R.; Haupt, S.; Elger, C.E.; Fell, J.

    2008-01-01

    The medial frontal cortex (MFC) has been implicated in the monitoring and selection of actions in the face of competing alternatives, but much remains unknown about its functional properties, including electrophysiological oscillations, during response conflict tasks. Here, we recorded intracranial

  1. Crime with Loss of Context : How the Translation Changed the Implied Reader of Åsa Larsson’s The Savage Altar: Innocence Will Be Sacrificed

    OpenAIRE

    Lindve, Katarina

    2008-01-01

    The implied reader of a novel is the person that the author writes for. In the case of Åsa Larsson’s Swedish detective novel Solstorm, the implied reader is familiar with Swedish politics, history, and geography but also with biblical references and Swedish customs. When the novel is translated into English, The Savage Altar: Innocence will be Sacrificed, there is a new implied reader, the translator’s implied reader. When culture-specific material is either omitted or misunderstood, or a cul...

  2. LMFBR large valve development. Comparison study of advantages and disadvantages of foreign design of offset pivot butterfly valves with AMCO's offset pivot ball valve

    Energy Technology Data Exchange (ETDEWEB)

    DeWall, L.

    1975-02-01

    The purpose of this effort was to compare the advantages and disadvantages of foreign designs of offset pivot butterfly valves presented during a specialists meeting on Operating Experience and Design Criteria of Sodium Valves with the characteristics of the present AMCO offset pivot ball valve design concept. In addition, the comparison was directed to indicating if work on a butterfly concept should be initiated by AMCO. This work could be in parallel with or in lieu of, the present AMCO effort on an offset pivot ball valve for isolation valve purposes.

  3. Biomechanical study of the effect of platelet rich plasma on the treatment of medial collateral ligament lesion in rabbits.

    Science.gov (United States)

    Costa, Eduardo Louzada da; Teixeira, Luiz Eduardo Moreira; Pádua, Bruno Jannotti; Araújo, Ivana Duval de; Vasconcellos, Leonardo de Souza; Dias, Luide Scalioni Borges

    2017-10-01

    To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.

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

    DEFF Research Database (Denmark)

    Bandholm, Thomas Quaade; Boysen, Lisbeth; Haugaard, Stine

    2008-01-01

    . Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis. Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean +/- 1 SD, 7.7 +/- 3.1 mm) and medial longitudinal-arch deformation (5.9 +/- 3.2 degrees) during......The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal......-arch deformation during quiet standing and gait. Thirty subjects aged 20 to 32 years were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography...

  5. Mechanical design of deformation compensated flexural pivots structured for linear nanopositioning stages

    Science.gov (United States)

    Shu, Deming; Kearney, Steven P.; Preissner, Curt A.

    2015-02-17

    A method and deformation compensated flexural pivots structured for precision linear nanopositioning stages are provided. A deformation-compensated flexural linear guiding mechanism includes a basic parallel mechanism including a U-shaped member and a pair of parallel bars linked to respective pairs of I-link bars and each of the I-bars coupled by a respective pair of flexural pivots. The basic parallel mechanism includes substantially evenly distributed flexural pivots minimizing center shift dynamic errors.

  6. Pivot and cluster strategy: a preventive measure against diagnostic errors

    Directory of Open Access Journals (Sweden)

    Shimizu T

    2012-11-01

    Full Text Available Taro Shimizu,1 Yasuharu Tokuda21Rollins School of Public Health, Emory University, Atlanta, GA, USA; 2Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, JapanAbstract: Diagnostic errors constitute a substantial portion of preventable medical errors. The accumulation of evidence shows that most errors result from one or more cognitive biases and a variety of debiasing strategies have been introduced. In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS, encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1 and analytical process (System 2 in one strategy. With PCS, physicians can recall a set of most likely differential diagnoses (System 2 of an initial diagnosis made by the physicians’ intuitive process (System 1, thereby enabling physicians to double check their diagnosis with two consecutive diagnostic processes. PCS is expected to reduce cognitive errors and enhance their diagnostic accuracy and validity, thereby realizing better patient outcomes and cost- and time-effective health care management.Keywords: diagnosis, diagnostic errors, debiasing

  7. [SECOT consensus on medial femorotibial osteoarthritis].

    Science.gov (United States)

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

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

  8. Forefoot flexibility and medial tibial stress syndrome.

    Science.gov (United States)

    Kudo, Shintarou; Hatanaka, Yasuhiko

    2015-12-01

    To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, prisk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.

  9. Thoracoscopic Medial-Basal Segment Segmentectomy.

    Science.gov (United States)

    Shimizu, Kimihiro; Nagashima, Toshiteru; Yajima, Toshiki; Ohtaki, Yoichi; Obayashi, Kai; Nakazawa, Seshiru; Kosaka, Takayuki; Mogi, Akira; Kuwano, Hiroyuki

    2017-11-01

    The technical details and anatomic features of medial-basal segment (S(7)) segmentectomy have not been reported. We report here thoracoscopic S(7) segmentectomy and S(7)a subsegmentectomy and explain the anatomic knowledge necessary to perform S(7) segmentectomy, especially the importance of recognizing bronchus (B(7)) branching patterns before surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Osteoligamentous injuries of the medial ankle joint

    OpenAIRE

    L?tscher, P.; Lang, T. H.; Zwicky, L; Hintermann, B.; Knupp, M

    2015-01-01

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

  11. Sacrifical sites, types and function

    Directory of Open Access Journals (Sweden)

    Örnulv Vorren

    1987-01-01

    Full Text Available Much has been written and said about Saami mythology and pre-Christian religion. There is, however, considerably less documentation of concrete cultural elements in scholarly descriptions. These investigations are considered important not only because they aim to provide documentation that can be used for studies of Saami mythology and pre-Christian religion. They also provide material that can throw light on the function of the holy places in a social context through analysis of their origin, their connections with certain families and persons, their associations with the siidas, their location within the areas where the Saamis from these siidas gained their livelihood, etc. The materials collected about the sacrificial sites also play an important role in studying the course of events leading up to the differentiation of Saami hunting and gathering culture. A question that has frequently arisen in the course of this work is with what powers or deities the different sacrificial sites were associated. This is naturally connected with their origin and their form. This, in turn, is reflected in the traditions and legends recounted concerning them. It is also reflected in their location in the physical environment and in the kinds of offerings that have been found. In the materials so far collected it is possible to distinguish between about eight different types of sacrificial site and holy mountain or fell according to their form and location: holy fells, rock formations, stone boulders, holes, cracks in fells, springs, lakes, ring-shaped sacrificial sites. Missionaries were urged to destroy the offering sites.

  12. NO to sacrificing future staff!

    CERN Multimedia

    Staff Association

    2011-01-01

    During our public meetings last week, we reviewed several subjects. However, the most urgent one today is the 2nd package of measures for our Pension Fund. In our previous issue, we devoted a long article to the Management’s plan for staff recruited from January 2012. A disaster! As we announced at our meetings, the Staff Association will organize a referendum at the beginning of April. For the message to be heard it is vital that as many staff as possible take part. By voting you will express your support to your staff representatives to stand in the way of these unacceptable measures. It is a matter of urgency that the staff makes their voice heard. Time is short, the decisions will be made in June. The future of our Organization is as stake. This is our future colleagues we are talking about. We must prevent this sacrifice. They must be welcomed in such a manner that there is no uneasiness between us. They must be made to feel welcome in their new family, CERN, our CERN. That they should pay an ...

  13. Persistently active neurons in human medial frontal and medial temporal lobe support working memory

    Science.gov (United States)

    Kamiński, J; Sullivan, S; Chung, JM; Ross, IB; Mamelak, AN; Rutishauser, U

    2017-01-01

    Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and the medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors, and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance. PMID:28218914

  14. The rectangular flexion gap is associated with an increased knee flexion angle in a cruciate-sacrificing rotating platform mobile-bearing total knee arthroplasty.

    Science.gov (United States)

    Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu; Yoshino, Kensuke

    2017-03-01

    The knee flexion angle after a total knee arthroplasty is an important indicator of clinical outcome. However, there is little appropriate information about the correlation between the ligament balancing and knee flexion angle after total knee arthroplasty. The purpose of this study was to investigate the effect of the ligamentous balance in extension and flexion on knee flexion angle one year after posterior cruciate ligament sacrificing rotating platform total knee arthroplasty. Eighty-five total knee arthroplasties in 71 patients were investigated in this study. The postoperative knee flexion angle and the percentage of improvement in the balanced group in which the difference between varus and valgus was less than 2° and the unbalanced group in extension and the rectangular group in which the asymmetry of the flexion gap was within 2° and the trapezoidal group in flexion were compared. The factors affecting postoperative knee flexion angle were also investigated in a forced entry multiple regression analysis. The mean flexion angle improved significantly from 116.2° to 122.5° in the rectangular group. By contrast, in the trapezoidal group, no significant improvement was seen (from 115.5° to 117.4°). The statistically significant difference was found between the rectangular and trapezoidal group in flexion in terms of the improvement of the knee flexion angle while there was no difference between the balanced and unbalanced group in extension. The multiple regression analysis showed that the asymmetry of the flexion gap was a predictor of the postoperative knee flexion angle. Asymmetric flexion gap affected negatively the postoperative knee flexion angle after posterior cruciate ligament sacrificing rotating platform total knee arthroplasty. A gap balancing technique is recommended for this type of implant. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  15. Microsurgical treatment of medial sphenoid ridge meningioma

    Directory of Open Access Journals (Sweden)

    Wei-qi HE

    2011-02-01

    Full Text Available Objective To explore the microsurgical technique of medial sphenoid ridge meningioma resectional therapy.Methods The clinical data were retrospectively analyzed of 29 patients(13 males and 16 females;aged 18-68 years with average of 42 years;duration of disease was 5 months to 8 years,averaged 28 months with medial sphenoidal ridge meningioma and admitted from Jan.2005 to Jan.2010.The anatomical relationship of the tumor to surrounding structures was assessed intraoperatively,the tumor was then completely resected through cutting off the tumor supplying vessels,shrinking the tumor volume and separating the tumors from adjacent vessels and nerves.All the patients were followed up for 4 months to 4 years.Results Of the 29 cases,20 got total tumor removal,7 got subtotal and 2 got partial tumor removal.Of the 20 patients with obviously preoperative visual impairment,12 were obviously relieved,6 showed no improvement and 2 got symptoms aggravation.Hemiplegia occurred in 2 cases and oculomoter nerve palsy in 6 cases.There was no death after surgery.A 6 months to 4 years follow-up showed that no recurrence was found in 27 patients with tumor resection level of Simpson I and II,2 patients with tumor resection level of Simpson III received postoperative radiotherapy or gamma knife surgery,and 1 recurred and received reoperation.Conclusions Fine intraoperative assessment of the anatomical relationship of the tumor to surrounding structures,separating and excising tumor according to the assessed result is the key of medial sphenoid ridge meningioma resection,and the tumor resection is favorable to visual rehabilitation and tumor control.

  16. Medial tibial stress syndrome: conservative treatment options

    OpenAIRE

    Galbraith, R. Michael; Lavallee, Mark E.

    2009-01-01

    Medial tibial stress syndrome (MTSS), commonly known as ?shin splints,? is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330?339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35?50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845?849, 2004). Although often not serious, it can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS ...

  17. Improvement in Offaxis Neuromuscular Control Under Slippery Conditions Following Six-Week Pivoting Leg Neuromuscular Training.

    Science.gov (United States)

    Lee, Song Joo; Ren, Yupeng; Press, Joel M; Lee, Jungwha; Zhang, Li-Qun

    2017-11-01

    Knee injuries are usually associated with offaxis loadings in the transverse and frontal planes. Thus, improvement of lower limb offaxis neuromuscular control is important in knee injury prevention and post-injury rehabilitation. The goal of this paper was to investigate the effects of six-week pivoting offaxis intensity adjustable neuromuscular control training (POINT) using a custom-made offaxis elliptical trainer on lower limb offaxis neuromuscular control performance in trained and untrained functional tasks under slippery conditions. Twenty-six subjects participated in 18 sessions of POINT (three sessions per week for six weeks) and 25 subjects served as controls who did a regular workout. Offaxis neuromuscular control performance measures in terms of pivoting instability, sliding instability, and time-to-peak offaxis EMG entropy were evaluated on both groups under slippery conditions including a trained free pivoting task and untrained free sliding task and free pivoting and sliding task. Compared with the control group, the training group significantly decreased pivoting instability and the time-to-peak offaxis EMG entropy in lower limb muscles, indicating improvement in offaxis neuromuscular control performance. Furthermore, the training group showed reduced pivoting instability and sliding instability during the untrained free pivoting and sliding task. This paper may help us develop more focused and effective offaxis training programs to reduce knee injuries associated with offaxis loadings.

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

    Science.gov (United States)

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

    1982-01-01

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

  19. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus.

    Science.gov (United States)

    Jonathan, Gan Zhi-Wei; Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

    2016-01-01

    We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis.

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

    Science.gov (United States)

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

    2017-03-13

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

  1. Ligament balancing in total knee arthroplasty—Medial stabilizing technique

    Directory of Open Access Journals (Sweden)

    Shuichi Matsuda

    2015-10-01

    Full Text Available Ligament balancing is one of the most important surgical techniques for successful total knee arthroplasty. It has traditionally been recommended that medial and lateral as well as flexion and extension gaps are equal. This article reviews the relevant literature and discusses the clinical importance of the aforementioned gaps. Current evidence indicates that achieving medial stability throughout the range of motion should be a high priority in ligament balancing in total knee arthroplasty. Finally, the medial stabilising surgical technique, which aims to achieve good medial stability in posterior cruciate-retaining total knee arthroplasty, is introduced.

  2. T3-T4 laryngeal cancer in The Netherlands Cancer Institute; 10-year results of the consistent application of an organ-preserving/-sacrificing protocol.

    Science.gov (United States)

    Timmermans, Adriana J; de Gooijer, Cornedine J; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M

    2015-10-01

    Both organ-preserving concurrent (chemo)radiotherapy ((C)RT) and organ-sacrificing surgery (total laryngectomy) are used for treatment of advanced laryngeal cancer. The purpose of this study was to present the assessment of our treatment protocol for T3 (C)RT and T4 disease (total laryngectomy + postoperative RT). We conducted a retrospective cohort study in 182 consecutive patients (1999-2008). The primary outcome was overall survival (OS) in relation to stage and treatment. One hundred two patients received RT (82.4% T3), 20 patients CRT (60.0% T3), and 60 patients total laryngectomy + RT (91.7% T4). Five-year OS: T3 52%, T4 48%, for RT 50%, for CRT 43%, and for total laryngectomy + RT 52%. Five-year laryngectomy-free interval was 72% after RT, and 83% after CRT. There were no differences in survival according to T classification or treatment modality. Because the majority of T3 laryngeal cancers were treated with (C)RT and the majority of T4 with total laryngectomy + RT, this gives food for thought on whether the present protocol for T3 laryngeal cancer is optimal. © 2014 Wiley Periodicals, Inc.

  3. Toughening of poly(lactic acid without sacrificing stiffness and strength by melt-blending with polyamide 11 and selective localization of halloysite nanotubes

    Directory of Open Access Journals (Sweden)

    B. J. Rashmi

    2015-08-01

    Full Text Available This paper aims at improving the mechanical behavior of biobased brittle amorphous polylactide (PLA by extrusion melt-blending with biobased semi-crystalline polyamide 11 (PA11 and addition of halloysite nanotubes (HNT. The morphological analysis of the PLA/PA11/HNT blends shows a strong interface between the two polymeric phases due to hydrogen bonding, and the migration of HNTs towards PA11 phase inducing their selective localization in one of the polymeric phases of the blend. A ‘salami-like’ structure is formed revealing a HNTs-rich tubular-like (fibrillar PA11 phase. Moreover, HNTs localized in the dispersed phase act as nucleating agents for PA11. Compared to neat PLA, this leads to a remarkable improvement in tensile and impact properties (elongation at break is multiplied by a factor 43, impact strength by 2, whereas tensile strength and stiffness are almost unchanged. The toughening mechanism is discussed based on the combined effect of resistance to crack propagation and nanotubes load bearing capacity due to the existence of the fibrillar structure. Thus, blending brittle PLA with PA11 and HNT nanotubes results in tailor-made PLA-based compounds with enhanced ductility without sacrificing stiffness and strength.

  4. A study of shallow water’s effect on a ship’s pivot point

    Directory of Open Access Journals (Sweden)

    Jorge Enrique Carreño

    2012-09-01

    Full Text Available Information regarding a turning ship’s pivot point has been collected, taking practical notes and ship maneuvering manuals into account as well as experimental data and simulated results, together revealing consistent behaviour when varying water depth or some ship’s particulars. Results from studies already carried out using the Colombian Navy’s River Support Patrol Vessel (RSPV are included here to estimate the pivot point and contrast results with theory and available observations. Linear manoeuvrability theory was tested and the results revealed poor agreement with kinematic equations. As to the depth variation effect, full-scale experiments confirmed that the pivot point’s position, when in shallow water, always varied in the same way, thereby agreeing with available pivot point information.

  5. The effect of gap width on viscous stresses within the leakage across a bileaflet valve pivot

    DEFF Research Database (Denmark)

    Travis, Brandon R; Andersen, Morten E; Fründ, Ernst Torben

    2008-01-01

    BACKGROUND AND AIM OF THE STUDY: Stresses of leakage flow may contribute to the increased tendency for thromboembolic complications in patients with mechanical valves. In bileaflet valves, leakage occurs primarily in the pivots, and the width of the pivot gap influences viscous stress magnitudes....... The present study was conducted to investigate the effects of gap width on viscous stresses within the pivots of a bileaflet mitral valve during the leakage phase. METHODS: A computational model of a bileaflet valve was created and inserted between models of the left atrium and ventricle. Three simulations...... reported within the pivots in previous studies. Velocities measured experimentally were even larger than those estimated computationally. CONCLUSION: These experiments suggest that viscous stresses in leakage flow across a bileaflet mitral valve increase with gap width, and may contribute more to blood...

  6. Medial tibial stress syndrome: conservative treatment options.

    Science.gov (United States)

    Galbraith, R Michael; Lavallee, Mark E

    2009-10-07

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

  7. Biomorphological analysis of pivot-root grass plants of Voronezh region

    Directory of Open Access Journals (Sweden)

    Elena M. Oleynikova

    2013-04-01

    Full Text Available The researches of several years allow distinguishing the ample group of pivot-root grass plants, growing on the territory of Voronezh region. The original classification of theis biomorphological group is offered. The short characteristic of main types of the structural organization models of polycarpic and monocarpic pivot-root species is quoted in virtue of study their morphogenesis and biological peculiarities.

  8. A sustainable model for training teachers to use pivotal response training.

    Science.gov (United States)

    Suhrheinrich, Jessica

    2015-08-01

    The increase in the rate of autism diagnoses has created a growing demand for teachers who are trained to use effective interventions. The train-the-trainer model, which involves training supervisors to train others, may be ideal for providing cost-effective training and ongoing support to teachers. Although research supports interventions, such as pivotal response training, as evidence-based, dissemination to school environments has been problematic. This study assessed the benefits of using the train-the-trainer model to disseminate pivotal response training to school settings. A multiple-baseline design was conducted across three training groups, each consisting of one school staff member (trainer), three special education teachers, and six students. Trainers conducted the teacher-training workshop with high adherence to training protocol and met mastery criteria in their ability to implement pivotal response training, assess implementation of pivotal response training, and provide feedback to teachers. Six of the nine teachers mastered all components of pivotal response training. The remaining three teachers implemented 89% of the pivotal response training components correctly. The majority of trainers and teachers maintained their abilities at follow-up. These results support the use of the train-the-trainer model as an effective method of disseminating evidence-based practices in school settings. © The Author(s) 2014.

  9. Ligament tension in the ACL-deficient knee: assessment of medial and lateral gaps.

    Science.gov (United States)

    Mayman, David; Plaskos, Christopher; Kendoff, Daniel; Wernecke, G; Pearle, Andrew D; Laskin, Richard

    2009-06-01

    Obtaining symmetric and balanced gaps under equilateral loads is a common goal in posterior cruciate ligament (PCL)-retaining and -sacrificing TKAs. Owing to limitations in existing surgical tensors, however, tensing knee ligaments with standardized and symmetric loads has been possible only with the patella subluxated or everted. We therefore determined the influences of (1) patellar eversion versus complete reduction, (2) PCL resection, and (3) load magnitude on gap symmetry and balance in the anterior cruciate ligament (ACL)-deficient knee. We used a novel computer-controlled tensioner to measure gaps in 10 cadavers with an applied force of 50 N, 75 N, and 100 N per side. Gap data were acquired at 0 masculine, 30 masculine, 60 masculine, 90 masculine, and 120 masculine flexion with the patella reduced and everted and with the PCL intact and resected. Everting the patella tightened the medial and lateral flexion gaps between 90 masculine and 120 masculine by 0.7 mm to 2.7 mm. PCL resection increased gaps from 30 degrees to 120 degrees by 1 mm to 3 mm. Increasing the force from 50 N to 100 N increased the mean gap by 0.5 mm. Everting the patella and resecting the PCL influenced gap balance and symmetry. Surgeons should be aware of how these conditions affect gaps during assessment and balancing.

  10. Traumatic 6th Nerve Palsy Managed with Medial Rectus Recession ...

    African Journals Online (AJOL)

    Conjunctival periotomy was done. Medial rectus was identified and separated from surrounding tissues. 6 mm medial rectus recession was done using hangback sutures, and Hummelsheim procedure was done in which superior and inferior rectus tendons were vertically spilt into temporal two‑thirds and nasal one‑third.

  11. Medial Malleolar Fractures: An Anatomic Survey Determining the ...

    African Journals Online (AJOL)

    A transverse cut was performed in the distal third of the tibia, roughly 1 and a half times the distal tibial plafond width from the ankle joint. A coronal cut was then performed using the center of the medial malleolus. Three observers measured the distance between the medial malleolus tip and beginning of the medullary canal ...

  12. Computing refined skeletal features from medial point clouds

    NARCIS (Netherlands)

    Kustra, Jacek; Jalba, Andrei; Telea, Alexandru

    2016-01-01

    Medial representations have been widely used for many shape analysis and processing tasks. Large and complex 3D shapes are, in this context, a challenging case. Recently, several methods have been proposed that extract point-based medial surfaces with high accuracy and computational scalability.

  13. Comparison of Medial and Posterior Surgical Approaches in ...

    African Journals Online (AJOL)

    When evaluated patients according to Flynn's criteria, for medial group, 31 cases (93.9%) had good–perfect result regarding ROM loss, whereas for posterior group 33 cases (97%) had good–perfect result. Regarding carrying angle change and posterior group were slightly better than medial group (perfect result observed ...

  14. Traumatic 6th Nerve Palsy Managed with Medial Rectus Recession ...

    African Journals Online (AJOL)

    left eye. Diagnosis of left eye traumatic 6th nerve palsy with medial rectus contracture was made. Left medial rectus recession with hangback sutures and Hummelsheim procedure were performed. Postoperatively, the patient's vision in the left eye had improved to 20/80 the esotropia had reduced to 15 prism diopters (delta).

  15. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...... migration can be used as a predictor of implant loosening....

  16. SPECT bone scintigraphy of medial collateral ligament/meniscus injury

    Energy Technology Data Exchange (ETDEWEB)

    Micallef, L.; Larcos, G. [Westmead Medical Imaging, Westmead, NSW (Australia)

    1998-06-01

    Full text: Acute or chronic knee pain is common amongst athletic persons. MRI is generally regarded as the best test, but is not widely available and may lack specificity in meniscal tears and cruciate injury. Bone scan with SPECT is an appealing alternative since it is relatively cheap and easily obtained. Further, a number of investigators have published data indicating sensitivity and specificity exceeding 85%. The purpose of the study is to determine typical scintigraphic findings in medial collateral ligament or medial meniscus injury. We present a small group of patients with acute knee trauma in whom arthroscopy and/or clinical follow-up indicated medial collateral ligament injury. Bone scans were undertaken after 900-1000 MBq of {sup 99m}Tc-MDP with immediate blood pool, delayed planar images and SPECT acquired on a Picker Prism 2000. SPECT was obtained with high resolution collimators and 20 sec/stop for 180 deg each. SPECT images showed focal radiopharmaceutical accumulation in the medial proximal tibial shaft and medial femoral condyle, corresponding to the superficial layer of the medial collateral ligament (best seen on coronal images). Disruption of the deep layer and/or medial meniscus can be suspected with abnormal uptake in part or all of the meniscus (best seen on transverse images). We conclude that acute/chronic medial collateral ligament injury can be detected on bone scintigraphy with abnormal uptake at the predicted anatomic site of attachment

  17. Non-noble metal Bi deposition by utilizing Bi{sub 2}WO{sub 6} as the self-sacrificing template for enhancing visible light photocatalytic activity

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Shixin [Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083 (China); Zhang, Yihe, E-mail: zyh@cugb.edu.cn [Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083 (China); Li, Min [Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083 (China); Du, Xin [Research Center for Bioengineering and Sensing Technology, Department of Chemistry& Biological Engineering, University of Science & Technology Beijing, Beijing 100083 (China); Huang, Hongwei, E-mail: hhw@cugb.edu.cn [Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing 100083 (China)

    2017-01-01

    Highlights: • Bi metal deposited Bi{sub 2}WO{sub 6} photocatalyst is synthesized via an in-situ reduction. • The light absorption of Bi{sub 2}WO{sub 6} is enhanced by Bi metal. • Charge separation efficiency of Bi{sub 2}WO{sub 6} is increased by Bi metal. • Bi-Bi{sub 2}WO{sub 6} shows highly promoted photocatalytic activity for phenol degradation. - Abstract: Bi metal deposited on Bi{sub 2}WO{sub 6} composite photocatalysts have been successfully synthesized via a simple in-situ reduction method at room temperature with using Bi{sub 2}WO{sub 6} as self-sacrificing template and NaBH{sub 4} as reducing agent. The reduction extent can be easily modulated by controlling the concentration of NaBH{sub 4} solution. X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Fourier-transform infrared (FTIR) spectra, N{sub 2} adsorption-desorption isotherms, scanning electron microscopy (SEM), transmission electron microscopy (TEM), high resolution TEM (HRTEM), diffuse reflection spectroscopy (DRS) and photoelectrochemical measurements were carried out to analyze the phase, morphology, optical property and photoelectrochemical property of the as-prepared samples. The photocatalytic activity is surveyed by degradation of phenol under visible light (λ > 420 nm), which showed that the BWO-0.2 photocatalyst exhibited the highest efficiency, which was over 3 times as high as pure Bi{sub 2}WO{sub 6}. The enhanced photocatalytic activity should be attributed to strengthened photoabsorption and charge separation efficiency derived from the surface plasmon resonance (SPR) of Bi metal.

  18. Toughening of poly(lactic acid) without sacrificing stiffness and strength by melt-blending with polyamide 11 and selective localization of halloysite nanotubes

    Science.gov (United States)

    Rashmi, Baralu Jagannatha; Prashantha, Kalappa; Lacrampe, Marie-France; Krawczak, Patricia

    2016-03-01

    This paper aims at improving the mechanical behavior of biobased brittle amorphous polylactide (PLA) by extrusion melt-blending with biobased semi-crystalline polyamide 11 (PA 11) and addition of natural halloysite nanotubes (HNT). The structure and properties of PLA/PA11/HNT blends were studied in terms of morphological, thermal and mechanical properties. The morphological analysis of the PLA/PA11/HNT blends shows a strong interface between the two polymeric phases due to hydrogen bonding, and the migration of HNTs towards PA 11 phase inducing their selective localization in one of the polymeric phases of the blend. A "salami-like" structure is formed revealing a HNTs-rich tubular-like (fibrillar) PA11 phase. Moreover, HNTs localized in the dispersed phase acts as nucleating agents for PA11. Blending PLA (80 wt.%) and PA11 (20 wt.%) increases PLA ductility (elongation at break, ɛr, is multiplied by more than 20), however at the slight expense of strength and stiffness. Further addition of HNTs (2 wt.%) further increases ductility (ɛr reaches 155 %, i.e. it is multiplied by more than 40) whereas tensile strength and modulus of PLA are unchanged and impact strength is more than doubled. The toughening mechanism is discussed based on the combined effect of resistance to crack propagation and nanotubes load bearing capacity due to the existence of the fibrillar structure. Thus, blending brittle PLA with PA11 and HNT nanotubes results in tailor-made PLA-based compounds with enhanced ductility without sacrificing stiffness and strength.

  19. Medial meniscus grafting restores normal tibiofemoral contact pressures.

    Science.gov (United States)

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

    2017-12-02

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

  20. Stress optimization of leaf-spring crossed flexure pivots for an active Gurney flap mechanism

    Science.gov (United States)

    Freire Gómez, Jon; Booker, Julian D.; Mellor, Phil H.

    2015-04-01

    The EU's Green Rotorcraft programme is pursuing the development of a functional and airworthy Active Gurney Flap (AGF) for a full-scale helicopter rotor blade. Interest in the development of this `smart adaptive rotor blade' technology lies in its potential to provide a number of aerodynamic benefits, which would in turn translate into a reduction in fuel consumption and noise levels. The AGF mechanism selected employs leaf-spring crossed flexure pivots. These provide important advantages over bearings as they are not susceptible to seizing and do not require maintenance (i.e. lubrication or cleaning). A baseline design of this mechanism was successfully tested both in a fatigue rig and in a 2D wind tunnel environment at flight-representative deployment schedules. For full validation, a flight test would also be required. However, the severity of the in-flight loading conditions would likely compromise the mechanical integrity of the pivots' leaf-springs in their current form. This paper investigates the scope for stress reduction through three-dimensional shape optimization of the leaf-springs of a generic crossed flexure pivot. To this end, a procedure combining a linear strain energy formulation, a parametric leaf-spring profile definition and a series of optimization algorithms is employed. The resulting optimized leaf-springs are proven to be not only independent of the angular rotation at which the pivot operates, but also linearly scalable to leaf-springs of any length, minimum thickness and width. Validated using non-linear finite element analysis, the results show very significant stress reductions relative to pivots with constant cross section leaf-springs, of up to as much as 30% for the specific pivot configuration employed in the AGF mechanism. It is concluded that shape optimization offers great potential for reducing stress in crossed flexure pivots and, consequently, for extending their fatigue life and/or rotational range.

  1. Editorial 4/2013: Medialer Habitus

    Directory of Open Access Journals (Sweden)

    Allesandro Barberi

    2013-12-01

    Full Text Available Die breite soziale Verwendung und Nutzung von Medien in unserer Wissens- und Informationsgesellschaft hat seit der dritten industriellen Revolution auch zu tiefgreifenden Änderungen in den Verhaltensweisen und Erfahrungsräumen der Menschen geführt. Angelehnt an die Bildungssoziologie Pierre Bourdieus, der mit dem Begriff des (individuellen und kollektiven Habitus derartige gesellschaftliche Transformationen praxeologisch und d. h. immer auch handlungstheoretisch zu fassen suchte, diskutieren MedienpädagogInnen seit geraumer Zeit den Wandel von Mediennutzung und Medienkompetenz rund um den Begriff des "Medialen Habitus". Denn Zeitungen, Filme, Bilder, Fernsehen oder Fotografie spielen eine eminente Rolle in der Konstitution von gesellschaftlicher Wahrnehmung und erfordern auch spezifische Praxisformen. Dabei überkreuzen sich die traditionellen Bestände der Sozial- und Medienwissenschaften schon auf begrifflicher Ebene und werfen so eine ganze Reihe relevanter medienpädagogischer Fragen in Theorie und Praxis auf, denen die Ausgabe 4/2013 der MEDIENIMPULSE mit dem Schwerpunkt "Medialer Habitus" gewidmet ist. Dabei standen der Redaktion und den AutorInnen u. a. folgende Fragen vor Augen: Wie haben sich die Verhaltensweisen und d. h. Habitusformen der Menschen durch Medien unterschiedlichster Art (vor allem in der Schule geändert und ändern sich noch? Welche Auswirkungen haben diese Änderungen auf die konkrete Unterrichtspraxis von Lernenden und Lehrenden? Welche Rolle spielt also der "mediale Habitus" in den sozialen Feldern des Unterrichts? Wie lassen sich Medienkompetenz und Mediennutzung anhand des Konzepts des "medialen Habitus" erläutern bzw. neuartig diskutieren? Inwiefern ist der individuelle und kollektive Habitus selbst als Medium von gesellschaftlichen Voraussetzungen zu fassen? Und: Wie wirken sich soziale Unterschiede und Ungleichheiten auf die Konstitution des "medialen Habitus" aus? Derartige Fragen stellten die Herausgeber

  2. Optogenetic dissection of medial prefrontal cortex circuitry

    Directory of Open Access Journals (Sweden)

    Danai eRiga

    2014-12-01

    Full Text Available The medial prefrontal cortex (mPFC is critically involved in numerous cognitive functions, including attention, inhibitory control, habit formation, working memory and long-term memory. Moreover, through its dense interconnectivity with subcortical regions (e.g. thalamus, striatum, amygdala and hippocampus, the mPFC is thought to exert top-down executive control over the processing of aversive and appetitive stimuli. Because the mPFC has been implicated in the processing of a wide range of cognitive and emotional stimuli, it is thought to function as a central hub in the brain circuitry mediating symptoms of psychiatric disorders. New optogenetics technology enables anatomical and functional dissection of mPFC circuitry with unprecedented spatial and temporal resolution. This provides important novel insights in the contribution of specific neuronal subpopulations and their connectivity to mPFC function in health and disease states. In this review, we present the current knowledge obtained with optogenetic methods concerning mPFC function and dysfunction and integrate this with findings from traditional intervention approaches used to investigate the mPFC circuitry in animal models of cognitive processing and psychiatric disorders.

  3. Astral microtubule pivoting promotes their search for cortical anchor sites during mitosis in budding yeast.

    Directory of Open Access Journals (Sweden)

    Stephan Baumgärtner

    Full Text Available Positioning of the mitotic spindle is crucial for proper cell division. In the budding yeast Saccharomyces cerevisiae, two mechanisms contribute to spindle positioning. In the Kar9 pathway, astral microtubules emanating from the daughter-bound spindle pole body interact via the linker protein Kar9 with the myosin Myo2, which moves the microtubule along the actin cables towards the neck. In the dynein pathway, astral microtubules off-load dynein onto the cortical anchor protein Num1, which is followed by dynein pulling on the spindle. Yet, the mechanism by which microtubules target cortical anchor sites is unknown. Here we quantify the pivoting motion of astral microtubules around the spindle pole bodies, which occurs during spindle translocation towards the neck and through the neck. We show that this pivoting is largely driven by the Kar9 pathway. The microtubules emanating from the daughter-bound spindle pole body pivot faster than those at the mother-bound spindle pole body. The Kar9 pathway reduces the time needed for an astral microtubule inside the daughter cell to start pulling on the spindle. Thus, we propose a new role for microtubule pivoting: By pivoting around the spindle pole body, microtubules explore the space laterally, which helps them search for cortical anchor sites in the context of spindle positioning in budding yeast.

  4. Pathology of Serially Sacrificed Female B6C3F1 Mice Continuously Exposed to Very Low-Dose-Rate Gamma Rays.

    Science.gov (United States)

    Tanaka, I B; Komura, J; Tanaka, S

    2017-03-01

    We have previously reported on life span shortening as well as increased incidence rates in several neoplasms in B6C3F1 mice that were continuously exposed to 21 mGy/day of gamma rays for 400 days. To clarify whether the life shortening was due to early appearance of neoplasms (shortened latency) or increased promotion/progression, 8-week-old female specific-pathogen-free B6C3F1 mice were gamma-ray irradiated at a low dose rate of 20 mGy/day for 400 days. At 100 days postirradiation, 60-90 mice were sacrificed, and thereafter every 100 days alongside the age-matched nonirradiated controls, for 700 days. Additional groups were allowed to live out their natural life span. Pathological examination was performed on all mice to identify lesions, non-neoplastic and neoplastic, as well as to determine the cause of death. Body weights were significantly increased in irradiated mice from sacrifice days 200-500. Incidence rates for spontaneously occurring non-neoplastic lesions, such as adrenal subcapsular cell hyperplasia, fatty degeneration of the liver, atrophy and tubulostromal hyperplasia of the ovaries, were significantly increased in irradiated mice. Significantly increased incidence rates with no shortening of latency periods were observed in irradiated mice for malignant lymphomas, hepatocellular adenomas/carcinomas, bronchioloalveolar adenomas, harderian gland adenoma/adenocarcinoma. Shortened latencies with significantly increased incidence rates were observed for adrenal subcapsular cell adenomas and ovarian neoplasms (tubulostromal adenoma, granulosa cell tumors) in irradiated mice. Life span shortening in mice exposed to 20 mGy/day was mostly due to malignant lymphomas. Multiple primary neoplasms were significantly increased in mice exposed to 20 mGy/day from sacrifice days 400-700 and in the life span group. Our results confirm that continuous low-dose-rate gamma-ray irradiation of female B6C3F1 mice causes both cancer induction (shortened latency) and

  5. Rhomboid flap: An option to medial canthal reconstruction

    Directory of Open Access Journals (Sweden)

    Rafael Corredor-Osorio

    2017-07-01

    Full Text Available Medial canthal defects after wide local excision of basal cell carcinoma can range from small to medium size which can be reconstructed by using full thickness skin-grafts or defect local flaps. This report describes the case of 51-year-old woman with a medial canthal tumor. The large defect after of excision was successfully reconstructed with local rhomboid flap. The result cosmetic was highly satisfactory. Local rhomboid flap reconstruction is a safe, rapid and practical technique for skin defects in the canthal medial region after tumor excisions.

  6. Performance Analysis of Gas Foil Bearing with Different Foil Pivot Configuration

    Directory of Open Access Journals (Sweden)

    Milind Babasaheb Patil

    2013-01-01

    Full Text Available A numerical model is developed in order to find out the performance characteristics of gas foil bearings. The static performance analysis of gas foil bearings has been carried out using an elastic foundation model of the foil. The steady state results have been compared with the experimental and theoretical results available in the literature. The characteristics of the bearing have been investigated with change in foil pivot position. It has been shown that the load carrying capacity is different for different foil pivot positions. Besides effect of bearing parameters like eccentricity ratio, length to diameter ratio, compliance coefficient, and bearing number on the load carrying capacity with different foil pivot positions have been studied.

  7. Identifying and locating land irrigated by center-pivot irrigation systems using satellite imagery

    Science.gov (United States)

    Hoffman, R. O.

    1980-01-01

    A methodology for using Landsat imagery for the identification and location of land irrigated by center-pivot irrigation systems is presented. The procedure involves the use of sets of Landsat band 5 imagery taken separated in time by about three weeks during the irrigation season, a zoom transfer scope and mylar base maps to record the locations of center pivots. Further computer processing of the data has been used to obtain plots of center-pivot irrigation systems and tables indicating the distribution and growth of systems by county for the state of Nebraska, and has been found to be in 95% agreement with current high-altitude IR photography. The information obtainable can be used for models of ground-water aquifers or resource planning.

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

    Science.gov (United States)

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

    2014-04-01

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

  9. Current developments concerning medial tibial stress syndrome.

    Science.gov (United States)

    Craig, Debbie I

    2009-12-01

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

  10. Medial tibial stress syndrome: a critical review.

    Science.gov (United States)

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

    2009-01-01

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

  11. Excel Data Analysis your visual blueprint for creating and analyzing data, charts and PivotTables

    CERN Document Server

    Etheridge, Denise

    2010-01-01

    Advanced techniques for Excel power users. Crunch and analyze Excel data the way the professionals do with this clean, uncluttered, visual guide to advanced Excel techniques. Using numerous screenshots and easy-to-follow numbered steps, this book clearly shows you how to perform professional-level modeling, charting, data access, data slicing, and other functions. You'll find super techniques for getting the most out of Excel's statistical and financial functions, Excel PivotTables and PivotCharts, Excel Solver and BackSolver, and more.: Provides a clear look at power-using Excel, the world's

  12. Developing a Simple Unique Head-Discharge Equation for Pivot Weirs with Different Side Contractions

    Directory of Open Access Journals (Sweden)

    neda Sheikh Rezazadeh Nikou

    2016-10-01

    Full Text Available Introduction: Pivot weirs (sharp crested inclined weirs, Fig. 1-a is frequently used for discharge measurement, controlling water surface and flow diversion. Some typical features of pivot weirs are: (a overshot design for better water level control, (b Their application as head gates, turnout or check structure which requiring low head loss and high accuracy, (c ease of removing sediment deposit behind the weir, and (d ability to manage and monitor on-site or operating remotely when connected to a supervisory control and data acquisition (SCADA network. Kindsvater and Carter (8 derived a weir discharge equation based on energy and continuity equations. Hulsing (4 determined head-discharge relationship of inclined suppressed sharp crested weir with the slope of 3:3, 2:3 and 1:3 toward downstream and compared them with the equivalent normal sharp crested weir. In the USBR report on pivot weirs (regarding The Boulder Canyon Project,1948 the head discharge data of the suppressed pivot weir were presented in a channel with 5.5m length, 2.9m depth and 0.61m width. Some field experiments were also carried out in the IID (Imperial Irrigation District on a trapezoidal cross-section (0.61 m bottom width channel with pivot weir of 1.7m length, and two different widths of 1.63m. The flow rate (350-880 lit/s was held constant and different angles (15-50° calibrated instead of holding the angle constant and varying the flow rate. Some other laboratory tests were performed with Wahlin and Replogle (1994 on two pivot weirs with 1.2 m and 1.14 m width for the 0.61 m and 0.46 m length of blade and contraction factor of 0.925. RUBICON Company established an extensive operation on the application and automation of pivot weirs in irrigation channels in Australia (Www.rubicon.com. All previous studies concentrated on modifying the normal rectangular weir head-discharge equation so that it can be used for the pivot weirs. In this study, it is trying to derive a

  13. Las habilidades del pivote en la alta competición de balonmano

    Directory of Open Access Journals (Sweden)

    Gabriel Daza Sobrino

    2012-03-01

    Full Text Available En el presente estudio se identifican las habilidades de los pivotes considerados competentes de la liga ASOBAL a lo largo de la temporada 2006-07. Definimos pivote como el jugador que desarrolla sus habilidades en la fase de ataque y que, por su situación, es determinante para la intervención y el condicionamiento de las acciones de los compañeros (Román, 1993. La investigación analiza la figura del pivote desde la perspectiva del deportista competente, compilando las características aptitudinales y el análisis de las acciones de juego en la alta competición. Se presentan las habilidades del pivote desde la estructura funcional del desarrollo del juego. Bajo este enfoque, se clasifican y se definen las dimensiones para la observación de la actividad del jugador. En la competición de balonmano las situaciones no son idénticas a las entrenadas y por lo tanto, el deportista tiene que seleccionar la alternativa más próxima entre todas las que conoce. Pocas veces realiza una habilidad realmente nueva que no soporte, al menos parcialmente, en los aprendizajes anteriores (Riera, 1997. Para conocer estas habilidades se utilizan dos técnicas de recopilación de datos: la entrevista a entrenadores expertos y la observación de la competición de los pivotes. Del análisis de los partidos se destaca que los pivotes observados resuelven las situaciones de juego mediante un número reducido de encadenamiento de habilidades. La actividad del pivote se conforma a partir de la combinación de siete habilidades básicas: ganar la posición, bloquear, fintar, lanzar, desmarcarse, contener al adversario impar y mantenerse alejado de la acción de creación. Entre estas, se destacan las habilidades que implican la utilización del cuerpo para la opción de alguna ventaja sobre el adversario. Asimismo, las habilidades del pivote se articulan mediante cuatro intenciones fundamentales: controlar el juego, pedir el balón, finalizar y ayudar.

  14. Medial Clamp Tine Positioning Affects Ankle Syndesmosis Malreduction.

    Science.gov (United States)

    Cosgrove, Christopher T; Putnam, Sara M; Cherney, Steven M; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M; Gardner, Michael J

    2017-08-01

    To determine whether the position of the medial clamp tine during syndesmotic reduction affected reduction accuracy. Prospective cohort. Urban Level 1 trauma center. Seventy-two patients with operatively treated syndesmotic injuries. Patients underwent operative fixation of their ankle syndesmotic injuries using reduction forceps. The position of the medial clamp tine was then recorded with intraoperative fluoroscopy. Malreduction rates were then assessed with bilateral ankle computerized tomography. Fibular position within the incisura was measured with respect to the uninjured side to determine whether a malreduction had occurred. Malreductions were then analyzed for associations with injury pattern, patient demographics, and the location of the medial clamp tine. A statistically significant association was found between medial clamp position and sagittal plane syndesmosis malreduction. In reference to anterior fibular translation, there was a 0% malreduction rate in the 18 patients where the clamp tine was placed in the anterior third, a 19.4% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.006). In reference to posterior fibular translation, there was a 11.1% malreduction when clamp placement was in the anterior third, a 16.1% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.062). There were no significant associations between medial clamp position and coronal plane malreductions (overcompression or undercompression) (P = 1). When using reduction forceps for syndesmotic reduction, the position of the medial clamp tine can be highly variable. The angle created with off-axis syndesmotic clamping is likely a major culprit in iatrogenic malreduction. Sagittal plane malreduction appears to be highly sensitive to clamp obliquity, which is directly related to the medial clamp tine placement. Based on these data, we recommend placing the medial clamp tine in the anterior third

  15. Dopaminergic Activity in the Medial Prefrontal Cortex Modulates Fear Conditioning

    OpenAIRE

    Parvin Babaei; Bahram Soltani Tehrani; Arsalan Alizadeh; Morteza Nakhostin

    2011-01-01

    "nThe purpose of the present study was to determine the role of medial prefrontal cortex (mPFC) dopaminergic system in fear conditioning response considering individual differences. Animals were initially counterbalanced and classified based on open field test, and then were given a single infusion of the dopamine agonist, amphetamine (AMPH) and antagonist, clozapine (CLZ) into the medial prefrontal cortex. Rats received tone-shock pairing in a classical fear conditioning test and then e...

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

    Science.gov (United States)

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

    2015-01-01

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

  17. Medial plica syndrome of the knee: diagnosis with dynamic sonography.

    Science.gov (United States)

    Paczesny, Lukasz; Kruczynski, Jacek

    2009-05-01

    To perform a feasibility study of dynamic sonography for the diagnosis of medial plica syndrome of the knee. The study design was approved by the university bioethics board, and all the participants gave informed consent. Inclusion criteria were a palpable medial band, history of painful aching, and giving way or locking, which limited the subject's activity for at least 6 months. Exclusion criteria were a history of trauma with hemarthrosis, previous knee surgery, and arthrosis detectable on radiographs. A prospective evaluation in 88 subjects (56 female subjects, 32 male subjects; mean age, 20 years; range, 7-47 years) who were suspected of having a medial plica and 91 knees was performed. Three sonographic criteria were assessed during patellar movement by using a 12-MHz 38-mm linear transducer: (a) continuous echo sliding over the medial femoral condyle during medial and lateral movement of the patella, (b) entry of the echo under the patella during medial movement of the patella, and (c) pain or discomfort during dynamic sonography. Arthroscopy was the reference standard. An asymptomatic control group consisting of 32 volunteers (mean age, 28 years; range, 10-52 years) and 60 knees was also assessed. Arthroscopy revealed 68 plicae with pathologic findings, 61 of which met all three sonographic criteria. Medial plicae with pathologic findings were absent in 23 knees; 19 plicae were correctly diagnosed by using sonography. Diagnostic accuracy was 88%, sensitivity was 90%, and specificity was 83%. In the asymptomatic control group, there were 37 knees without a plica echo, 16 knees with a plica echo that met one criterion, and seven knees that met two criteria. Dynamic sonography allows detection of abnormalities of medial plicae in the knee, with good sensitivity and specificity.

  18. Sensory modulation of the medial preoptic area neuronal activity by dorsal penile nerve stimulation in rats.

    Science.gov (United States)

    Mallick, H N; Manchanda, S K; Kumar, V M

    1994-03-01

    The study was aimed at finding out the influence exerted by the genital afferents on the medial preoptic area (mPOA), which plays a pivotal role in the regulation of male sex behavior. To fulfil this objective, the effects of stimulation of the dorsal penile nerve (DPN) on the activity of 82 mPOA neurons were studied. The base line firing rates of the mPOA neurons, studied by extracellular recording, ranged between 0.5 and 38.5 Hz (mean 7.18 +/- 7.91). The stimulation of the DPN (20 Hz, 0.4 msec. 70 microA) influenced 79.69% of the neurons studied. Though increased firing was the predominant influence produced (50%), decreased firing was also seen in a few (29.69%). The excited and inhibited neurons were randomly distributed within the mPOA. Neurons located in the lateral and posterior hypothalamus were not affected by the DPN stimulation. The stimulation parameters used in this study did not produce any change in the systemic arterial pressure and heart rate. The results provide electrophysiological evidence of afferent inputs from the male sex organ to the mPOA, which is an important area controlling male sex behavior.

  19. Brief Report: Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment

    Science.gov (United States)

    Ventola, Pamela E.; Yang, Daniel; Abdullahi, Sebiha M.; Paisley, Courtney A.; Braconnier, Megan L.; Sukhodolsky, Denis G.

    2016-01-01

    Children with ASD show high frequency of restricted and repetitive behaviors (RRBs); however, higher-order RRBs, such as restricted interests, have remained largely resistant to treatment. This study evaluated change in severity of RRBs following a 16-weeks open trial of Pivotal Response Treatment (PRT). Participants included 15 children with ASD…

  20. Insights from a cross-disciplinary seminar: 10 pivotal papers for ecological restoration

    Science.gov (United States)

    Melissa V. Eitzel; Sibyl Diver; Hillary Sardiñas; Lauren M. Hallett; Jessica J. Olson; Adam Romero; Gustavo de L. T. Oliveira; Alex T. Schuknecht; Rob Tidmore; Katharine N. Suding

    2011-01-01

    Restoration ecology is a deepening and diversifying field with current research incorporating multiple disciplines and infusing long-standing ideas with fresh perspectives. We present a list of 10 recent pivotal papers exemplifying new directions in ecological restoration that were selected by students in a cross-disciplinary graduate seminar at the University of...

  1. LU Factorization with Partial Pivoting for a Multi-CPU, Multi-GPU Shared Memory System

    Energy Technology Data Exchange (ETDEWEB)

    Kurzak, Jakub [Univ. of Tennessee, Knoxville, TN (United States); Luszczek, Pitior [Univ. of Tennessee, Knoxville, TN (United States); Faverge, Mathieu [Univ. of Tennessee, Knoxville, TN (United States); Dongarra, Jack [Univ. of Tennessee, Knoxville, TN (United States); Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Univ. of Manchester (United Kingdom)

    2012-03-01

    LU factorization with partial pivoting is a canonical numerical procedure and the main component of the High Performance LINPACK benchmark. This article presents an implementation of the algorithm for a hybrid, shared memory, system with standard CPU cores and GPU accelerators. Performance in excess of one TeraFLOPS is achieved using four AMD Magny Cours CPUs and four NVIDIA Fermi GPUs.

  2. Evaluation of water distribution under pivot irrigation systems using remote sensing imagery in eastern Nile delta

    Directory of Open Access Journals (Sweden)

    E. Farg

    2017-04-01

    Full Text Available Traditional methods for center pivot evaluation depend on the water depth distribution along the pivot arm. Estimation and mapping the water depth under pivot irrigation systems using remote sensing data is essential for calculating the coefficient of uniformity (CU of water distribution. This study focuses on estimating and mapping water depth using Landsat OLI 8 satellite data integrated with Heerman and Hein (1968 modified equation for center pivot evaluation. Landsat OLI 8 image was geometrically and radiometrically corrected to calculate the vegetation and water indices (NDVI and NDWI in addition to land surface temperature. Results of the statistical analysis showed that the collected water depth in catchment cans is also highly correlated negatively with NDVI. On the other hand water, depth was positively correlated with NDWI and LST. Multi-linear regression analysis using stepwise selection method was applied to estimate and map the water depth distribution. The results showed R2 and adjusted R2 0.93 and 0.88 respectively. Study area or field level verification was applied for estimation equation with correlation 0.93 between the collected water depth and estimated values.

  3. Experimental Evaluation of the Discharge Coefficient of a Centre-Pivot Roof Window

    DEFF Research Database (Denmark)

    Iqbal, Ahsan; Afshari, Alireza; Heiselberg, Per

    2013-01-01

    Windows are a component of naturally ventilated buildings. The scientific knowledge of how to estimate of airflow rates through windows is limited, especially in the case of centre-pivot roof windows. The flow through this type of windows is traditionally characterized by the orifice plate flow e...

  4. Experimental analysis of single sided ventilation through a centre pivot roof window

    DEFF Research Database (Denmark)

    Iqbal, Ahsan; Afshari, Alireza; Heiselberg, Per

    2015-01-01

    In the present study bidirectional airflow characteristics of a centre-pivot roof window were analysed in-situ. Both wind and temperature differences were present at the time of measurements. Tracer gas technique using N2O gas was used to estimate the air change rates in the experimental space. L...

  5. Single-sided natural ventilation through a centre-pivot roof window

    DEFF Research Database (Denmark)

    Iqbal, Ahsan; Nielsen, Peter V.; Gunner, Amalie

    2014-01-01

    systems. In this study, numerical methods were used to characterise a centre-pivot roof window for wind-driven single-sided ventilation. A 1:20 scale model house of the Energy Flex House (Denmark) was used in this study. The roof slope was 36o. It was found that the single-sided ventilation through...

  6. Peer-Mediated Pivotal Response Treatment for Young Children with Autism Spectrum Disorders: A Systematic Review

    Science.gov (United States)

    Boudreau, Ainsley M.; Corkum, Penny; Meko, Katelyn; Smith, Isabel M.

    2015-01-01

    This review examined the effectiveness of peer-mediated pivotal response treatment (PM-PRT) to increase social-communication skills for children with autism spectrum disorders (ASD). A systematic review was conducted of all published studies examining PM-PRT in school-aged children with ASD, based on an established rubric. Five PM-PRT studies…

  7. Pivotal Response Treatment for Children with Autism: Core Principles and Applications for School Psychologists

    Science.gov (United States)

    Renshaw, Tyler L.; Kuriakose, Sarah

    2011-01-01

    During the past 2 decades, pivotal response treatment (PRT) has emerged as an evidence-based methodology for intervening with the behavioral, communicative, social, and academic impairments of children with autism. Unlike other highly structured behavioral interventions for autism, PRT emphasizes principles over procedures and focuses on enhancing…

  8. Pivotal Response Treatment Parent Training for Autism: Findings from a 3-Month Follow-Up Evaluation

    Science.gov (United States)

    Gengoux, Grace W.; Berquist, Kari L.; Salzman, Emma; Schapp, Salena; Phillips, Jennifer M.; Frazier, Thomas W.; Minjarez, Mendy B.; Hardan, Antonio Y.

    2015-01-01

    This study's objective was to assess maintenance of treatment effects 3 months after completion of a 12-week Pivotal Response Treatment (PRT) parent education group. Families who completed the active treatment (N = 23) were followed for an additional 12 weeks to measure changes in language and cognitive skills. Results indicated a significant…

  9. The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders

    Science.gov (United States)

    Koegel, Robert L.; Koegel, Lynn Kern

    2012-01-01

    What is Pivotal Response Treatment? What's the research behind it, what does it look like in practice, and what are some good examples of how to use it? Now one concise book gives professionals and parents all the basics of the widely used PRT--one of a select group of highly effective, evidence-based treatments for autism. great resource for…

  10. Pivotal Response Treatment for Infants At-Risk for Autism Spectrum Disorders: A Pilot Study

    Science.gov (United States)

    Steiner, Amanda Mossman; Gengoux, Grace W.; Klin, Ami; Chawarska, Katarzyna

    2013-01-01

    Presently there is limited research to suggest efficacious interventions for infants at-risk for autism. Pivotal response treatment (PRT) has empirical support for use with preschool children with autism, but there are no reports in the literature utilizing this approach with infants. In the current study, a developmental adaptation of PRT was…

  11. Technique determinants of knee abduction moments during pivoting in female soccer players.

    Science.gov (United States)

    Jones, Paul A; Herrington, Lee C; Graham-Smith, Philip

    2016-01-01

    No previous studies have investigated the optimal technique for pivoting with regard to reducing peak knee abduction moments and potential knee injury risk. The aim of this study was to investigate the relationships between technique characteristics and peak knee abduction moments during pivoting. Twenty-seven female soccer players [mean (SD); age: 21 (3.8) years, height: 1.67 (0.07) m, and mass: 60.0 (7.2) kg] participated in the study. Three dimensional motion analyses of pivots on the right leg were performed using 10 Qualysis 'Pro reflex' infrared cameras (240Hz). Ground reaction forces were collected from two AMTI force platforms (1200Hz) embedded into the running track to examine penultimate and final contact. Pearson's correlation coefficients, co-efficients of determination and stepwise multiple regression were used to explore relationships between a range of technique parameters and peak knee abduction moments. Significance was set at Pangles together could explain 35% (30% adjusted) of the variation in peak knee abduction moments (F(2,26)=6.499, P=0.006). The results of the present study suggest that initial-foot progression and knee abduction angles are potential technique factors to lower knee abduction moments during pivoting. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Pivotal periods for pregnancy loss during the first trimester of gestation in lactating dairy cows.

    Science.gov (United States)

    Wiltbank, Milo C; Baez, Giovanni M; Garcia-Guerra, Alvaro; Toledo, Mateus Z; Monteiro, Pedro L J; Melo, Leonardo F; Ochoa, Julian C; Santos, José E P; Sartori, Roberto

    2016-07-01

    Loss of pregnancy can occur at many different stages of gestation and for a variety of causes but clearly produces a negative impact for reproductive and economic performances of dairy herds. This review describes four pivotal periods for pregnancy loss during the first trimester of gestation and discusses possible causes for pregnancy failure during these periods. The first period occurs during the first week after breeding with lack of fertilization and death of the early embryo producing major losses in pregnancy, particularly under specific environmental and hormonal conditions. In general, 20%-50% of high-producing lactating dairy cows have already experienced pregnancy loss during the first week of gestation with methods to decrease pregnancy loss during this period targeting improved oocyte quality by alleviating heat stress, inflammatory diseases, and body condition loss, and by increasing progesterone concentrations during preovulatory follicle development. The second pivotal period, from Days 8 to 27, encompasses embryo elongation and the classical "maternal recognition of pregnancy" period with losses averaging ∼30% but with surprising variation between farms (25%-41%). Maintenance of the CL of pregnancy is produced by the embryonic signal interferon-tau and alteration in uterine secretory patterns of prostaglandins F2α, E1, and E2. Failures or delays in trophoblast elongation and/or embryonic development result in loss of pregnancy during the second pivotal period possibly due to suboptimal histotroph. The third pivotal period is during the second month of pregnancy, Days 28 to 60, with losses of ∼12% based on a summary of published results from more than 20,000 pregnancies in high-producing dairy cows. Delays or defects in development of the chorioallantoic placentomes or embryo result in CL regression or embryo death during this pivotal period. Finally, a fourth period during the third month of pregnancy has reduced pregnancy losses (∼2

  13. Efficient Storage and Querying of Horizontal Tables Using a PIVOT Operation in Commercial Relational DBMSs

    Science.gov (United States)

    Shin, Sung-Hyun; Moon, Yang-Sae; Kim, Jinho; Kim, Sang-Wook

    In recent years, a horizontal table with a large number of attributes is widely used in OLAP or e-business applications to analyze multidimensional data efficiently. For efficient storing and querying of horizontal tables, recent works have tried to transform a horizontal table to a traditional vertical table. Existing works, however, have the drawback of not considering an optimized PIVOT operation provided (or to be provided) in recent commercial RDBMSs. In this paper we propose a formal approach that exploits the optimized PIVOT operation of commercial RDBMSs for storing and querying of horizontal tables. To achieve this goal, we first provide an overall framework that stores and queries a horizontal table using an equivalent vertical table. Under the proposed framework, we then formally define 1) a method that stores a horizontal table in an equivalent vertical table and 2) a PIVOT operation that converts a stored vertical table to an equivalent horizontal view. Next, we propose a novel method that transforms a user-specified query on horizontal tables to an equivalent PIVOT-included query on vertical tables. In particular, by providing transformation rules for all five elementary operations in relational algebra as theorems, we prove our method is theoretically applicable to commercial RDBMSs. Experimental results show that, compared with the earlier work, our method reduces storage space significantly and also improves average performance by several orders of magnitude. These results indicate that our method provides an excellent framework to maximize performance in handling horizontal tables by exploiting the optimized PIVOT operation in commercial RDBMSs.

  14. Temporary hemiepiphysiodesis of the distal medial femur: MPFL in danger.

    Science.gov (United States)

    Bachmann, M; Rutz, E; Brunner, R; Gaston, M S; Hirschmann, M T; Camathias, C

    2014-08-01

    Temporary hemiepiphysiodesis (TH) with plate fixation is a well-accepted and common treatment for correcting leg malalignment in skeletally immature patients. The purpose of this study was to investigate any soft tissue damage caused during TH at the distal medial femur with a plate and two screws. We hypothesized that correct plate placement can affect the integrity of the medial stabilizing structures of the knee, especially the medial patellofemoral ligament (MPFL), the medial collateral ligament (MCL) or result in arthrotomy of the knee joint itself. In eight cadaveric knees of five adult humans a TH was performed with a plate and two cancellous screws at the distal medial femur using a standardized surgical technique. Subsequently the medial capsular and ligamentous structures were systematically exposed and assessed. Capsular and synovial tissue was also inspected for impingement by the plate or screws. In all knees the MPFL was present. In two specimens the MPFL was intact and the plate was lying over the dorsal part of the MPFL close to the MCL. The MPFL was completely cut in two cases in the central part of the ligament. In four cases the MPFL was partially dissected or perforated by a screw and fixed to the femur by the plate. The MCL was intact and not impinged by the implant in any case. In total four of eight knees the capsule was transected or perforated by a screw or by a part of the plate, resulting in intraarticular implant placement. Standard plate placement during TH on the distal medial femur frequently leads to damage to the MPFL, impingement of the MPFL, the capsular and synovial tissues or exposure of the knee joint.

  15. Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear.

    Science.gov (United States)

    Furumatsu, T; Kamatsuki, Y; Fujii, M; Kodama, Y; Okazaki, Y; Masuda, S; Ozaki, T

    2017-12-01

    Medial meniscus posterior root tear (MMPRT) leads to abnormal biomechanics of the knee by inducing the medial meniscus extrusion (MME). However, a time-dependent increase of the MME is not fully elucidated in patients suffering from the acute MMPRT. The aim of this study was to investigate the relationships among disease duration of the MMPRT and severity of the MME. We hypothesized that MME measurement correlates with disease duration after a sudden onset of the minor traumatic MMPRT during the short-term follow-up period. Forty-six patients who had an accurate episode of the posteromedial painful popping were investigated. All the patients were diagnosed having a symptomatic MMPRT with magnetic resonance imaging (MRI) examinations. Absolute MME was measured using MRI scans within 12 months after painful popping events. A correlation coefficient between duration from injury to MRI examination and absolute MME was evaluated. Mean absolute MME was 4.5±1.6mm (range, 1.1-8.8mm) on MRI measurements. A good correlation was observed between MME measurement and duration from injury to MRI examination (R2=0.612). The best-fit equation for predicting each value was: MME=0.014×disease duration+3.288mm. This study demonstrated that absolute MME increases progressively within the short duration after the onset of symptomatic MMPRT. Our results suggest that preoperative MME assessment may be important in determining disease duration and treatment strategy of the MMPRT. Retrospective cohort study level IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  19. [EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE].

    Science.gov (United States)

    Zhang, Hangzhou; Bai, Xizhuang; Liang, Qingwei; Wang, Yanfeng; Liu, Xiangnan; You, Fuli

    2016-03-01

    To compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. Between August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. All patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t = 0.26, P = 0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t = 5.22, P = 0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P 0.05). Whether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.

  20. On the Controllability and Observability of Actively Lubricated Journal Bearings with Pads Featuring Different Nozzle-Pivot Configurations

    DEFF Research Database (Denmark)

    Salazar, Jorge Andrés González; Santos, Ilmar

    2017-01-01

    tilt angle, (iii) the vertical pad movement-due to the pivot flexibility, and (iv) the controllable force as the hydraulic DOF. The test rig consists of a rigid rotor supported by a single rocker-pivoted rigid pad. A thorough parametric study is carried out by investigating the effects of: (a) nozzle...

  1. Isolated medial foot compartment syndrome after ankle sprain.

    Science.gov (United States)

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

    2014-03-01

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

  2. Subquadratic medial-axis approximation in $\\mathbb{R}^3$

    Directory of Open Access Journals (Sweden)

    Christian Scheffer

    2015-09-01

    Full Text Available We present an algorithm that approximates the medial axis of a smooth manifold in $\\mathbb{R}^3$ which is given by a sufficiently dense point sample. The resulting, non-discrete approximation is shown to converge to the medial axis as the sampling density approaches infinity. While all previous algorithms guaranteeing convergence have a running time quadratic in the size $n$ of the point sample, we achieve a running time of at most $\\mathcal{O}(n\\log^3 n$. While there is no subquadratic upper bound on the output complexity of previous algorithms for non-discrete medial axis approximation, the output of our algorithm is guaranteed to be of linear size.

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

    Science.gov (United States)

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

    2003-10-01

    Medial tibial stress syndrome is a common chronic sports injury characterized by exercise-induced pain along the posteromedial border of the tibia. The reported outcomes of surgical treatment of this condition have varied. Of seventy-eight patients who underwent surgery for medial tibial stress syndrome, forty-six (thirty-one men and fifteen women) returned for follow-up. The outcomes of the surgery were determined by comparing preoperative and postoperative pain levels as indicated on a visual analog pain scale and ascertaining the ability of the athletes to return to presymptom levels of exercise. The mean duration of postoperative follow-up was thirty months (range, six to sixty-three months). Surgery significantly reduced pain levels (p medial tibial stress syndrome. Despite this reduction in pain, athletes should be counseled that a full uninhibited return to sports is not always achieved.

  4. Efficiency of Medial Rectus Advancement Surgery in Consecutive Exotropia

    Directory of Open Access Journals (Sweden)

    Kemal Yar

    2015-12-01

    Full Text Available Purpose: To evaluate the efficiency of medial rectus advancement surgery in consecutive exotropia. Material and Methods: The study group consisted of 20 cases, 10 male, 10 female, who were diagnosed as consecutive exotropia and underwent surgery between 2008-2013 at Cukurova University Medical Faculty Ophthalmology Department. Records of the patients were investigated retrospectively. We evaluated best corrected visual acuity, existence of ambliopia, postoperative duration following the first surgery and applied surgical procedures. Postoperative deviation lower than 10 PD were assesed as successful. Mean follow up period was 29,8 +/- 21,36 (8-80 months, patients with inadequate follow up period were dismissed from the study group. Results: We only applied bilateral medial rectus advancement surgery to 6 and unilateral medial rectus advancement surgery to 5 patients and obtained intended surgical result in these 11 cases. The other patients underwent lateral rectus recession or/and medial rectus resection operations inorder to reach projected deviation degrees. Deviation was found to be 46,4+/-9,24 (40-70 PD in cases who only underwent advancement surgery and was 65,56 +/- 18,78 (40-90 PD in cases who underwent additional surgical procedure. 16 (%80 of the cases had hypermetropi various dioptries and 7 (%35 had ambliopia. Discussion: Consecutive exotropia can appear years after surgery and is an important late period complication. In this study achievement of %55 success with medial rectus advancement surgery indicates that this is a preferable procedure. But in wide angle deviations additional lateral rectus recession or/and medial rectus resection operations can be applied inorder to reach intended adjustment. Accurrate prediction of the propotion of advancement surgery and adjustment is not always possible because of intensive fybrosis in operated muscles and enviroment tissue. [Cukurova Med J 2015; 40(4.000: 707-713

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

    Science.gov (United States)

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

    2014-07-01

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

  6. Improvement of effective solid angle using virtual-pivot holder and large EDS detector.

    Science.gov (United States)

    Koshiya, Shogo; Kimoto, Koji

    2017-02-01

    This paper describes the effective solid angle improvement achieved using a large-area silicon drift detector together with a virtual-pivot double-tilt specimen holder. The virtual-pivot mechanism enables various designs of specimen-retaining and can reduce the shadowing effect. Energy-dispersive X-ray spectra were measured and converted into effective solid angles using different types of specimen holders and specimens. The investigated shadowing-free mechanical system yielded effective solid angles approaching the nominal solid angle of 0.464sr. In addition, we have demonstrated the availability of the plastic (polyetheretherketone) specimen holder for low system noise. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. In Vitro Durability - Pivot bearing with Diamond Like Carbon for Ventricular Assist Devices

    CERN Document Server

    de Sá, Rosa Corrêa Leoncio; Leão, Tarcísio Fernandes; da Silva, Evandro Drigo; da Fonseca, Jeison Willian Gomes; da Silva, Bruno Utiyama; Leal, Edir Branzoni; Moro, João Roberto; de Andrade, Aron José Pazin; Bock, Eduardo Guy Perpétuo

    2015-01-01

    Institute Dante Pazzanese of Cardiology (IDPC) develops Ventricular Assist Devices (VAD) that can stabilize the hemodynamics of patients with severe heart failure before, during and/or after the medical practice; can be temporary or permanent. The ADV's centrifugal basically consist of a rotor suspended for system pivoting bearing; the PIVOT is the axis with movement of rotational and the bearing is the bearing surface. As a whole system of an implantable VAD should be made of long-life biomaterial so that there is no degradation or deformation during application time; surface modification techniques have been widely studied and implemented to improve properties such as biocompatibility and durability of applicable materials. The Chemical Vapour Deposition technique allows substrates having melting point higher than 300 {\\deg}C to be coated, encapsulated, with a diamond like carbon film (DLC); The test simulated the actual conditions in which the system of support remains while applying a ADV. The results hav...

  8. Pivotal temperature and sexual dimorphism of Podocnemis expansa hatchlings (Testudines: Podocnemididae from Bananal Island, Brazil

    Directory of Open Access Journals (Sweden)

    Adélio Lubiana

    2009-09-01

    Full Text Available A common problem when trying to identify the sex of hatchling turtles is that juveniles are not obviously externally dimorphic and current techniques to identify sex are often invasive. In this paper, 300 eggs of Podocnemis expansa from Bananal Island, state of Tocantins (Brazil, were incubated at constant temperatures. The carapaces of the hatchlings were photographed and subjected to geometric morphometric analysis. The hatchlings were subsequently euthanized and had their gonads removed for sex determination. The pivotal temperature of P. expansa was 33.5ºC, confirming that this species has the highest pivotal temperature among reptiles. Geometric morphometric analysis of the shape of the carapace proved efficient in differentiating the sex of the hatchlings and confirmed that this methodology can be efficient for studies that need to ascertain the sex ratio in P. expansa hatchlings.

  9. Use of a gyroscope sensor to quantify tibial motions during a pivot shift test.

    Science.gov (United States)

    Borgstrom, Per Henrik; Markolf, Keith L; Foster, Brock; Petrigliano, Frank A; McAllister, David R

    2014-09-01

    The purpose of this preliminary study was to evaluate the use of a gyroscope sensor to record rotations of the tibia about its long axis during a clinical pivot shift examination. Ten patients with a unilateral ACL injury were tested under anaesthesia prior to surgery. Each ankle was placed in neutral position, wrapped and stabilized with athletic tape, and a small aluminium plate was taped to the bottom of the foot. A data recovery module was attached to the bottom of each plate using a swivel bracket that allowed alignment of the gyro axis with the long axis of the tibia. The module contained a triaxial gyroscope, battery and circuitry for wireless data broadcast to a laptop computer. Ten pivot shift tests were performed on both knees, and the surgeon's clinical grading of the pivot shift was noted for each limb. Mean values (10 trials) of peak tibial rotational velocity and integrated tibial rotation were compared between knees for each patient during the pivot shift reduction event (external tibial rotation during knee flexion). Five patients (50%) had significantly greater tibial rotation in their injured knee, four showed no difference between knees, and one had significantly greater rotation in the normal knee (p gyroscope measurements did not correctly identify the injured limb in all patients. Peak rotational velocity during the reduction event was a better indicator of ACL deficiency than the integrated rotation. If this technology is to be more useful clinically, gyroscope data may have to be combined with accelerometer data, perhaps with sensors mounted on both the tibia and femur. Diagnostic case-control study, Level III.

  10. Contracts as a barrier to entry when buyers are non-pivotal

    OpenAIRE

    Bedre-Defolie, Özlem; Biglaiser, Gary

    2015-01-01

    We analyze whether the use of breakup fees by an incumbent might induce an inefficient allocation of consumers and possibly foreclose efficient entry where buyers are non-pivotal (infinitesimal) and have to pay switching costs if they switch from the incumbent to an entrant. When the entrants are competitive, in the unique equilibrium the incumbent induces the efficient outcome, so there is no inefficient foreclosure. When there is a single entrant, the incumbent cannot deter the entry if it ...

  11. Pivotal Response Teaching for Children with Autism Spectrum Disorders: An Overview*

    OpenAIRE

    Bozkuş Genç, Gülden; YÜCESOY ÖZKAN, Şerife

    2015-01-01

    In recent years, the increasing of number of children diagnosed with autism spectrum disorder has led to the diversity in interventions for children with autism spectrum disorder. This diversity of interventions has brought forward evidence-based interventions, which is used in the education of children with autism spectrum disorder. Pivotal response teaching is one of the evidence-based interventions, which is used in the education of children with autism spectrum disorder. The purpose of th...

  12. Pivotal Response Treatment for Infants At-Risk for Autism Spectrum Disorders: A Pilot Study

    OpenAIRE

    Steiner, Amanda Mossman; Gengoux, Grace W.; Klin, Ami; Chawarska, Katarzyna

    2013-01-01

    Presently there is limited research to suggest efficacious interventions for infants at-risk for autism. Pivotal response treatment (PRT) has empirical support for use with preschool children with autism, but there are no reports in the literature utilizing this approach with infants. In the current study, a developmental adaptation of PRT was piloted via a brief parent training model with three infants at-risk for autism. Utilizing a multiple baseline design, the data suggest that the introd...

  13. Soil profile internal drainage for a central pivot fertigated coffee crop

    Directory of Open Access Journals (Sweden)

    Rafael Pivotto Bortolotto

    2011-12-01

    Full Text Available Coffee cultivation via central-pivot fertigation can lead to fertilizer losses by soil profile internal drainage when water application is excessive and soils have low water retention and cation adsorption capacities. This study analyses the deep water losses from the top 1 m sandy soil layer of east Bahia, Brazil, cultivated with coffee at a high technology level (central-pivot fertigation, using above normal N fertilizer rates. The deep drainage (Q estimation is made through the application of a climatologic water balance (CWB program having as input direct measures of irrigation and rainfall, climatological data from weather stations, and measured soil water retention characteristics. The aim of the study is to contribute to the understanding of the hydric regime of coffee crops managed by central-pivot irrigation, analyzing three scenarios (Sc: i rainfall only, ii rainfall and irrigation full year, and iii rainfall and irrigation dry season only. Annual Q values for the 2008/2009 agricultural year were: Sc i = 811.5 mm; Sc ii = 1010.5 mm; and Sc iii = 873.1 mm, so that the irrigation interruption in the wet season reduced Q by 15.7%, without the appearance of water deficit periods. Results show that the use of the CWB program is a convenient tool for the evaluation of Q under the cited conditions.

  14. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair.

    Science.gov (United States)

    Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N

    2009-11-01

    There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in

  15. Medial-frontal cortex hypometabolism in chronic phencyclidine exposed rats assessed by high resolution magic angle spin 11.7T proton magnetic resonance spectroscopy

    Science.gov (United States)

    Bustillo, Juan; Galloway, Matthew P; Ghoddoussi, Farhad; Bolognani, Federico; Perrone-Bizzozero, Nora

    2012-01-01

    Background Proton magnetic resonance spectroscopy (1H-MRS) clinical studies of patients with schizophrenia document prefrontal N-acetylaspartate (NAA) reductions, suggesting an effect of the disease or of antipsychotic medications. We studied in the rat the effect of prolonged exposure to a low-dose of the NMDA glutamate receptor antagonist phencyclidine (PCP) on levels of NAA, glutamate and glutamine in several brain regions where metabolite reductions have been reported in chronically medicated patients with schizophrenia. Methods Two groups of ten rats each were treated with PCP (2.58 mg/kg/day) or vehicle and were sacrificed after 1 month treatment. Concentrations of neurochemicals were determined with high resolution magic angle (HR-MAS) 1H-MRS at 11.7Tesla in ex-vivo punch biopsies from the medial frontal and cingulate cortex, striatum, nucleus accumbens, amygdala and ventral hippocampus. Results PCP treatment reduced NAA, glutamate, glycine, aspartate, creatine, lactate and GABA in medial frontal cortex. In the nucleus accumbens, PCP reduced levels of NAA, aspartate and glycine; similarly aspartate and glycine were reduced in the striatum. Finally the amygdala and hippocampus had elevations in glutamine and choline, respectively. Conclusions Low-dose PCP in rats models prefrontal NAA and glutamate reductions documented in chronically-ill schizophrenia patients. Chronic glutamate NMDA receptor blockade in rats replicates an endophenotype in schizophrenia and may contribute to the prefrontal hypometabolic state in schizophrenia. PMID:22522288

  16. Femoroacetabular impingement negates the acetabular labral seal during pivoting maneuvers but not gait.

    Science.gov (United States)

    Dwyer, Maureen K; Jones, Hugh L; Field, Richard E; McCarthy, Joseph C; Noble, Philip C

    2015-02-01

    Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function. Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal? Using 10 fresh cadaveric specimens (mean age 50 years, ±8), we measured the capacity of the central compartment of the hip (the iliofemoral joint) to maintain a seal during fluid infusion, which may help elucidate the function of the labrum during weightbearing. Specimens with and without abnormal femoral morphology (six normal-appearing specimens and four whose geometry suggested cam-type FAI) were tested in postures observed during functional activities, including simulations of normal gait, stooping, and pivoting. Each specimen with FAI morphology exhibited secondary damage of the labrum and the adjacent chondral surface, whereas specimens of normal morphology were undamaged. Average peak central compartment pressure was reduced during pivoting for specimens with the presence of labral damage secondary to FAI. When placed in pivoting positions, hips with FAI maintained lower fluid pressures within the central compartment compared with intact specimens (15±3 versus 42±8 kPa, respectively; effect size: 1.08 [-0.36 to 2.31]; p=0.007). No differences in peak pressure were observed between groups (FAI versus normal) for postures simulating either gait (21±6 versus 22±4 kPa; p=0.902) or stooping (9±2 versus 8±3 kPa; p=0.775) with the numbers available. The acetabular seal, quantified by the maximum intraarticular pressure, was reduced during pivoting; however, the seal was maintained during simulated gait and stooping. Because degeneration is progressive with repetitive impingement, loss of the labral seal starts to be seen during pivoting and may progress from there, but in this

  17. Implication on the Cytoarchitectural Profile of the Medial Prefrontal ...

    African Journals Online (AJOL)

    asus

    2017-11-12

    Nov 12, 2017 ... of the medial prefrontal cortex (mPFC) and cerebellar cortex; hence this study was aimed at evaluating ... It was observed from this study that exposure to Pentazocine-Alcohol combination triggers ..... violet stain in the molecular layer, though the Purkinje neurons are deeply stained, they have lost their.

  18. Medial supracondylar stress fracture in an adolescent pitcher

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego Medical Center, San Diego, CA (United States); Fronek, Jan [Scripps Healthcare, La Jolla, CA (United States)

    2014-01-15

    We report the occurrence of a medial supracondylar stress fracture in an adolescent pitcher. To our knowledge, this fracture has not been described in the literature, and awareness of this entity allows initiation of therapy and precludes further unnecessary work-up. The radiographic, computed tomography, and magnetic resonance imaging appearances are reviewed and the mechanism of injury is discussed. (orig.)

  19. Anatomical and magnetic resonance imaging study of the medial ...

    African Journals Online (AJOL)

    Sally Mahmood Mohamed Hussin Omar

    2015-07-10

    Jul 10, 2015 ... Anatomical and magnetic resonance imaging study of the medial collateral ligament of the ankle joint. Sally Mahmood Mohamed Hussin Omar a. , Fardos Ahmed El-Kalaa a. ,. El Sebai Farag Ali b. , Ali Ali Abd El-Karim c. , Nancy Mohamed El Sekily d,. * a Department of Anatomy and Embryology, Faculty of ...

  20. Anatomical and magnetic resonance imaging study of the medial ...

    African Journals Online (AJOL)

    Anatomical and magnetic resonance imaging study of the medial collateral ligament of the ankle joint. Sally Mahmood Mohamed Hussin Omar, Fardos Ahmed El-Kalaa, El Sebai Farag Ali, Ali Ali Abd El-Karim, Nancy Mohamed El Sekily ...

  1. Medial and lateral antebrachial nerve conductions: Orthodromic or antidromic?

    Directory of Open Access Journals (Sweden)

    Kunam Sanjeeva Reddy

    2014-01-01

    Full Text Available Introduction: Antidromic stimulation is usually used in the evaluation of lateral antebrachial cutaneous nerve (LABCN and medial antebrachial cutaneous nerve (MABCN. This study was conducted to evaluate the relationship between orthodromic and antidromic stimulations of these nerves. Materials and Methods: Medial and lateral antebrachial conduction studies by antidromic and orthodromic stimulation. Results: Sensory nerve action potential (SNAP amplitudes were larger with antidromic stimulation in the majority of subjects. The lateral antebrachial SNAP amplitude was 20.5 ± 9.29 μV with antidromic stimulation and 14.6 ± 6.13 μV with orthodromic stimulation (P < 0.001. Medial antebrachial SNAP amplitudes were 12.8 ± 4.93 μV using antidromic stimulation and 6.5 ± 3.84 μV with orthodromic stimulation (P < 0.001. Sensory conduction velocities were faster with orthodromic lateral antebrachial stimulation (P = 0.002 whereas velocities were similar in medial antebrachial nerve. Supramaximal stimulation of MABCN was not possible in half of the nerves sampled to avoid the muscle artifact. Conclusion: Orthodromic stimulation of LABCN and MABCN are easy to perform and can be supplanted for antidromic stimulation in which Supramaximal stimulation may not be possible in some individuals.

  2. Default Network Connectivity in Medial Temporal Lobe Amnesia

    Science.gov (United States)

    Hayes, Scott M.; Salat, David H.; Verfaellie, Mieke

    2012-01-01

    There is substantial overlap between the brain regions supporting episodic memory and the default network. However, in humans the impact of bilateral medial temporal lobe (MTL) damage on a large-scale neural network such as the default mode network is unknown. To examine this issue, resting functional magnetic resonance imaging (fMRI) was performed with amnesic patients and control participants. Seed-based functional connectivity analyses revealed robust default network connectivity in amnesia in cortical default network regions such as medial prefrontal cortex, posterior medial cortex, and lateral parietal cortex, as well as evidence of connectivity to residual MTL tissue. Relative to control participants, decreased posterior cingulate cortex connectivity to MTL and increased connectivity to cortical default network regions including lateral parietal and medial prefrontal cortex was observed in amnesia. In contrast, somatomotor network connectivity was intact in amnesia, indicating bilateral MTL lesions may selectively impact the default network. Changes in default network connectivity in amnesia were largely restricted to the MTL subsystem, providing preliminary support from MTL amnesic patients that the default network can be fractionated into functionally and structurally distinct components. To our knowledge, this is the first examination of the default network in amnesia. PMID:23077048

  3. Stiffness of the healing medial collateral ligament of the mouse.

    NARCIS (Netherlands)

    Gijssen, Y.; Sierevelt, I.N.; Kooloos, J.G.M.; Blankevoort, L.

    2004-01-01

    The knee joints of mice can serve as a model for studying knee ligament properties. The goal of our study was to measure the structural stiffness of the medial collateral ligament (MCL) of the murine knee. A tensile test was developed for this purpose. First 84 femur-MCL-tibia complexes of

  4. MR imaging findings of medial tibial crest friction

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E., E-mail: miklontzas@gmail.com; Akoumianakis, Ioannis D., E-mail: ioannis.akoumianakis@gmail.com; Vagios, Ilias, E-mail: iliasvagios@gmail.com; Karantanas, Apostolos H., E-mail: akarantanas@gmail.com

    2013-11-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis.

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

    Science.gov (United States)

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

    2017-03-01

    The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency. Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components. KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components. IV.

  6. Intrinsic factors associated with medial tibial stress syndrome in ...

    African Journals Online (AJOL)

    Background. Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by bony overload. To prevent MTSS, both pathophysiological and aetiological factors specific to MTSS need to be identified. The intrinsic risk factors that contribute to the development of MTSS are ...

  7. [Medial unicompartmental knee prosthesis for patients with unicompartmental gonarthrosis

    NARCIS (Netherlands)

    Kort, N.P.; Deutman, R.; Raay, J.J. van; Horn, J.R. van

    2004-01-01

    The function and survival time of unicompartmental knee prostheses for patients with severe gonarthrosis have been improved the past few years by developments in their design, the instrumentarium and the surgical technique. A medial unicompartmental knee prosthesis may be indicated in patients with

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

    NARCIS (Netherlands)

    Klucharev, V.; Munneke, M.; Smidts, A.; Fernandez, G.S.E.

    2011-01-01

    We often change our behavior to conform to real or imagined group pressure. Social influence on our behavior has been extensively studied in social psychology, but its neural mechanisms have remained largely unknown. Here we demonstrate that the transient downregulation of the posterior medial

  9. Medial Malleolar Fractures: An Anatomic Survey Determining the ...

    African Journals Online (AJOL)

    Medial Malleolar Fractures: An Anatomic Survey. Determining the Ideal Screw Length. Labronici PJ1,2, Pires RE3, Franco MV2, Freitas R2, Araújo GC1, Pires e Albuquerque RS1,. Gameiro VS1, Jeray K4. 1Department of Orthopedic Surgery and Traumatology ‑ Federal Fluminense University, Niterói, 2Department of.

  10. Comparison of Medial and Posterior Surgical Approaches in ...

    African Journals Online (AJOL)

    2017-10-26

    Oct 26, 2017 ... Lateral. K-wire fixation was applied through the lateral epicondyle .... Table 3: Evaluation of pediatric supracondylar fractures in the literature. Author. Exposure. Perfect–good functional results. Perfect-good cosmetic results. Barlas K. Medial. 95.4% .... their identity, but anonymity cannot be guaranteed.

  11. Coupled Shape Modeling of the Medial Temporal Lobe

    DEFF Research Database (Denmark)

    Dissing, Bjørn Skovlund; Larsen, Rasmus; Skimminge, Arnold Jesper Møller

    Here we investigate how regions in the Medial Temporal Lobe(MTL) in a dataset consisting of 13 di®erent people changes us- ing a Principal Component Analysis(PCA). The regions investigated are the Temporopolar, Parahippocampal, Entorhinal, Hippocampal, Perirhi- nal and Amygdalar regions. The MTL...

  12. Anatomical and magnetic resonance imaging study of the medial ...

    African Journals Online (AJOL)

    Sally Mahmood Mohamed Hussin Omar

    2015-07-10

    Jul 10, 2015 ... Materials and methods: Twenty preserved cadaveric adult ankle specimens were collected from the dissecting room, Anatomy Department, Faculty of Medicine, Alexandria University. MR imaging of ten ankles was performed before and after disruption of every band of the ligament of medial side.

  13. Medial Tibial Stress Syndrome : Diagnosis, Treatment and Outcome Assessment

    NARCIS (Netherlands)

    Winters, Marinus

    2017-01-01

    Medial tibial stress syndrome (MTSS), also known as shin splints, is one of the most common sports injuries. Although 20% of the jumping and running athletes have MTSS at some point while engaging in sporting activities, we know little about it. There is a lack of knowledge regarding making the

  14. Treatment of medial tibial stress syndrome: a systematic review

    NARCIS (Netherlands)

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H.; Backx, Frank J. G.; Bakker, Eric W. P.

    2013-01-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the

  15. Aetiology, imaging and treatment of medial tibial stress syndrome

    NARCIS (Netherlands)

    Moen, M.H.

    2012-01-01

    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the

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

    NARCIS (Netherlands)

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

    2012-01-01

    The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee

  17. Scene-selectivity and retinotopy in medial parietal cortex

    Directory of Open Access Journals (Sweden)

    Edward Harry Silson

    2016-08-01

    Full Text Available Functional imaging studies in human reliably identify a trio of scene-selective regions, one on each of the lateral (occipital place area, OPA, ventral (parahippocampal place area, PPA, and medial (retrosplenial complex, RSC cortical surfaces. Recently, we demonstrated differential retinotopic biases for the contralateral lower and upper visual fields within OPA and PPA, respectively. Here, using fMRI, we combine detailed mapping of both population receptive fields (pRF and category-selectivity, with independently acquired resting-state functional connectivity analyses, to examine scene and retinotopic processing within medial parietal cortex. We identified a medial scene-selective region, which was contained largely within the posterior and ventral bank of the parieto-occipital sulcus (POS. While this region is typically referred to as RSC, the spatial extent of our scene-selective region typically did not extend into retrosplenial cortex, and thus we adopt the term medial place area (MPA to refer to this visually defined scene-selective region. Intriguingly MPA co-localized with a region identified solely on the basis of retinotopic sensitivity using pRF analyses. We found that MPA demonstrates a significant contralateral visual field bias, coupled with large pRF sizes. Unlike OPA and PPA, MPA did not show a consistent bias to a single visual quadrant. MPA also co-localized with a region identified by strong differential functional connectivity with PPA and FFA, commensurate with its functional selectivity. Functional connectivity with OPA was much weaker than with PPA, and similar to that with face-selective OFA, suggesting a closer link with ventral then lateral cortex. Consistent with prior research, we also observed differential functional connectivity in medial parietal cortex for anterior over posterior PPA, as well as a region on the lateral surface, the caudal inferior parietal lobule (cIPL. However, the differential connectivity in

  18. The effect of medial meniscal horn injury on knee stability.

    Science.gov (United States)

    Chen, Lianxu; Linde-Rosen, Monica; Hwang, Sun Chul; Zhou, Jingbin; Xie, Qiang; Smolinski, Patrick; Fu, Freddie H

    2015-01-01

    This study investigated the effect of damage of the posterior and anterior horns of the medial meniscus on knee stability. Twenty fresh-frozen porcine knees were divided into two groups (anterior horn and posterior horn injury). Each group was tested in three states: intact medial meniscus, posterior or anterior horn of medial meniscus resection and total medial meniscectomy. A robotic testing system was used to test anterior tibial translation (ATT) at 30° (full extension), 60° and 90° of knee flexion with an external anterior tibial load of 89 N, internal rotation (IR) and external rotation (ER) at 30° and 60° of knee flexion under a 4 N m tibial rotation torque. In response to an IR torque, there was a significant difference between the state of intact medial meniscus and anterior and posterior horn damage, except for anterior horn resection at 60° of knee flexion. In response to an ER torque, there were no significant differences between the state of intact meniscus and horn damage except for anterior horn resection at 30° of knee flexion. Meniscal damage had no significant effect on ATT. The results indicated that the posterior horn was more important in controlling the IR stability than the anterior horn with knee flexion, and the anterior horn was more important in controlling the ER stability than the posterior horn at full knee extension in the anterior cruciate ligament-intact knee. These findings further the understanding of the mechanisms, the prevention of injuries and rehabilitation of meniscal horn injury in clinical practice.

  19. Medial approach for drainage of the obturator musculature in children.

    Science.gov (United States)

    Menge, Travis J; Cole, Heather A; Mignemi, Megan E; Corn, William C; Martus, Jeffrey E; Lovejoy, Steven A; Stutz, Christopher M; Mencio, Gregory A; Schoenecker, Jonathan G

    2014-01-01

    In a recent study designed to determine the anatomic location of infection in children presenting with acute hip pain, fever, and elevated inflammatory markers, we demonstrated the incidence of infection of the musculature surrounding the hip to be greater than twice that of septic arthritis. Importantly, the obturator musculature was infected in >60% of cases. Situated deep in the pelvis, surrounding the obturator foramen, debridement of these muscles and placement of a drain traditionally requires an extensive ilioinguinal or Pfannenstiel approach, placing significant risk to the surrounding neurovascular structures. We hypothesized that the obturator internus and externus could be successfully debrided using a limited medial approach. An IRB-approved prospective study of children (0 to 18 y) evaluated in the pediatric emergency department by an orthopaedic surgeon to rule out septic hip arthritis at a tertiary care children's hospital (July 1, 2010 to June 30, 2012) was conducted. Infected obturator musculature was identified and confirmed using magnetic resonance imaging. Cadaveric dissection was performed comparing the ilioinguinal, Pfannenstiel, and proposed minimally invasive medial approach. The proposed approach was utilized to debride and place drains in 7 consecutive patients. Anatomic information gained from magnetic resonance images of patients with abscess within the obturator musculature, and from the results of cadaveric studies, allowed for planning of a novel surgical approach. We found that through the surgical approach used to perform an osteotomy of the ischium (Tonnis) the obturator externus could be debrided through the adductor brevis and the obturator internus could be debrided through the obturator foramen. Using our medial approach, resolution of symptoms in all children who underwent surgical drainage resulted without complication. Our medial approach can safely access the obturator musculature for abscess decompression and drain

  20. Formation of median nerve without the medial root of medial cord and associated variations of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Bhanu SP

    2010-02-01

    Full Text Available The anatomical variations in the formation, course and termination of brachial plexus are well documented and have clinical significance to surgeons, neurologists and anatomists. The present case report describes the unusual origin of median nerve, arising directly from the lateral cord without the union of lateral and medial roots of brachial plexus. A communicating branch existed between the ulnar nerve and anterior division of middle trunk. The lateral pectoral nerve was arising from anterior divisions of upper and middle trunks as two separate branches instead from lateral cord. The branches then joined together to form the lateral pectoral nerve. The medial cord instead of its five terminal branches, had only three branches, the ulnar nerve, medial pectoral nerve and a single trunk for the medial cutaneous nerve of arm and forearm which got separated at the middle of the arm. The variations of the lateral cord and its branches make it a complicated clinical and surgical approach which is discussed with the developmental background.

  1. Counting Zeros in Random Walks on the Integers and Analysis of Optimal Dual-Pivot Quicksort

    DEFF Research Database (Denmark)

    Aumüller, Martin; Dietzfelbinger, Martin; Heuberger, Clemens

    2016-01-01

    We present an average case analysis of two variants of dual-pivot quicksort, one with a non-algorithmic comparison-optimal partitioning strategy, the other with a closely related algorithmic strategy. For both we calculate the expected number of comparisons exactly as well as asymptotically......, in particular, we provide exact expressions for the linear, logarithmic, and constant terms. An essential step is the analysis of zeros of lattice paths in a certain probability model. Along the way a combinatorial identity is proven....

  2. Tropical grasslands: A pivotal place for a more multi-functional agriculture.

    Science.gov (United States)

    Boval, Maryline; Angeon, Valérie; Rudel, Tom

    2017-02-01

    Tropical grasslands represent a pivotal arena for the sustainable intensification of agriculture in the coming decades. The abundant ecosystem services provided by the grasslands, coupled with the aversion to further forest destruction, makes sustainable intensification of tropical grasslands a high policy priority. In this article, we provide an inventory of agricultural initiatives that would contribute to the sustainable intensification of the tropical grassland agro-ecosystem, and we recommend a shift in the scientific priorities of animal scientists that would contribute to realization of a more agro-ecological and multi-functional agriculture in the world's tropical grasslands.

  3. Clusters and pivots for evaluating a large numberof alternatives in AHP

    Directory of Open Access Journals (Sweden)

    Alessio Ishizaka

    2012-04-01

    Full Text Available AHP has been successful in many cases but it has a major limitation: a larger number of alternatives requires a high number of judgements in the comparison matrices. In order to reduce this problem,we present a method with clusters and pivots. This method also helps with a further four problems of the Analytic Hierarchy Process. It enlarges the comparison scale, facilitates the construction of a consistent or near consistent matrix, eliminates the problem of the choice of the priorities derivation method and allows the use of incomparable alternatives.

  4. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Science.gov (United States)

    Zhang, Wen; Zeng, Langqing; Liu, Yanjie; Pan, Yao; Zhang, Wei; Zhang, Changqing; Zeng, Bingfang; Chen, Yunfeng

    2014-01-01

    The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures. Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (Pproximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  5. Posterior horn medial meniscal root tear: the prequel

    Energy Technology Data Exchange (ETDEWEB)

    Umans, H. [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Morrison, W. [Thomas Jefferson University Hospital, Philadelphia, PA (United States); DiFelice, G.S. [Hospital for Special Surgery, New York, NY (United States); Vaidya, N. [Crystal Run Healthcare, Middletown, NY (United States); Winalski, C.S. [Cleveland Clinic, Imaging Institute, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

    2014-06-15

    To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging centers over a 7-year period. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. MRI in 11 of 15 (73 %) cases with subsequent PHMMR tear demonstrated linear subcortical marrow edema deep to the meniscal root anchor on the antecedent MRI compared to only 1 of 29 (3 %) non-tear controls (p < 0.0001). The abnormal signal resolved on post-tear MRI in all but two patients. Cyst-like changes deep to the PHMMR were present on initial MRI in three of 15 (23 %) cases and three of 29 (10 %) controls, persisting in all but one case on follow-up imaging. The PHMMR was gray on the initial MRI in seven of 15 (47 %) of cases that developed tears compared to four of 29 (14 %) controls (p < 0.0001). There was medial meniscal extrusion (MME) prior to tear in two of 15 (13 %) patients and in ten of 15 (67 %) patients after PHMMR failure. In the control group, MME was present in one (3 %) and three (10 %) of 29 subjects on the initial and follow-up MRIs, respectively. Articular cartilage loss was noted in two of 15 (15 %) cases before tear and nine of 15 (69 %) on follow-up imaging, as compared to one (3 %) and four (14 %) of 29 subjects in the control group. Subcortical marrow edema deep to the PHMMR may result from abnormal stresses and thus be a harbinger of meniscal root failure. This hypothesis is supported by resolution of these marrow signal changes after root tear. Following tear, extrusion of the

  6. Protection of the Medial Femoral Condyle Articular Cartilage During Drilling of the Femoral Tunnel Through the Accessory Medial Portal in Anatomic Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Abdelkafy, Ashraf

    2012-01-01

    Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL ...

  7. Preauricular full-thickness skin grafting in medial canthal reconstruction

    Directory of Open Access Journals (Sweden)

    Rafael Corredor-Osorio

    2018-02-01

    Full Text Available Basal cell carcinoma in medial canthal is a surgical challenge to oculoplastic surgeon. We report a case an 80 –year-old woman who presented with a vegetative tumor in the right inferior medial canthus that increased slowly in size over the past two years. An excisional biopsy from the tumor was suggestive of a basal cell carcinoma. A full-thickness excision of the tumor within the oncologic safety limits, was performed. A wide range of reconstruction techniques should be customized to the individual patient. In this case, the use of a preauricular full. Thickness skin graft was a favorable option, without complications, and with acceptable functional and cosmetic results. The aim of the treatment is to restore anatomy, functional and cosmetic of the patients.

  8. Dopaminergic Activity in the Medial Prefrontal Cortex Modulates Fear Conditioning

    Directory of Open Access Journals (Sweden)

    Parvin Babaei

    2011-07-01

    Full Text Available "nThe purpose of the present study was to determine the role of medial prefrontal cortex (mPFC dopaminergic system in fear conditioning response considering individual differences. Animals were initially counterbalanced and classified based on open field test, and then were given a single infusion of the dopamine agonist, amphetamine (AMPH and antagonist, clozapine (CLZ into the medial prefrontal cortex. Rats received tone-shock pairing in a classical fear conditioning test and then exposed to the tone alone. Freezing responses were measured as conditioned fear index. The results showed that both AMPH and CLZ infusion in mPFC reduced the expression of conditioned fear. This finding indicates that elevation or reduction in the dopaminergic activity is associated with the decrease of fear responses, despite preexisting individual-typological differences.

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

    Science.gov (United States)

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

    2014-12-01

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

  10. Medial patellofemoral ligament reconstruction: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Baer MR

    2017-09-01

    Full Text Available Michael R. Baer, Jeffrey A. Macalena Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint. When planning MPFL reconstruction for instability, it is imperative to consider the patient’s unique anatomy including the tibial tuberosity–trochlear groove (TT–TG distance, trochlear dysplasia, and patella alta. Additionally, it is important to individualize surgical treatment in the skeletally immature, hypermobile, and athletic populations. Keywords: MPFL, indications, considerations, contraindications

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

    Science.gov (United States)

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

    2011-08-17

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

  12. A Virtual Pivot Point MEMS Actuator with Externally Mounted Mirror: Design, Fabrication and Characterization

    Directory of Open Access Journals (Sweden)

    T. M. Fahim AMIN

    2014-12-01

    Full Text Available In this paper, the design, fabrication, and characterization of a virtual pivot point micro electromechanical systems (MEMS electrostatic actuator with externally mounted mirror is presented. The point of rotation of the movable arm of the actuator is distant from the physical actuator. This is a requirement for certain applications, such as an external cavity laser in Littman configuration. A maximum rotational radius of 5 mm from the virtual pivot point was achieved. A detailed analytical analysis for the displacement of the structure is presented. The dynamic characterization of the device with a finite element analysis simulation shows that the resonance frequency of the in-plane rotational mode is well separated from that of the out-of-plane bending mode, confirming high in-plane stability. The devices were fabricated on a silicon-on-insulator wafer with device layer thickness of 100 µm. Thin mirrors were fabricated by dicing a 100 µm thick silicon wafer. A resonance frequency of about 5.9 ´ 102 Hz for the maximum sized mounted mirror (1.7 mm ´ 100 µm ´ 1.0 mm was determined by optical characterization.

  13. The pivotal role of malic enzyme in enhancing oil accumulation in green microalga Chlorella pyrenoidosa.

    Science.gov (United States)

    Xue, Jiao; Wang, Lan; Zhang, Lin; Balamurugan, Srinivasan; Li, Da-Wei; Zeng, Hao; Yang, Wei-Dong; Liu, Jie-Sheng; Li, Hong-Ye

    2016-07-07

    The fast growing photosynthetic microalgae have been widely used in aquaculture, food, health, and biofuels. Recent findings in the diatom has proposed a pivotal role of NADP-malic enzyme in generation of NADPH as an important supply of reducing power for fatty acid biosynthesis. To test the lipogenic malic enzyme for fatty acid synthesis in green algae, here the malic enzyme gene PtME from the oleaginous diatom Phaeodactylum tricornutum was expressed in a representative green microalga Chlorella pyrenoidosa. The engineered C. pyrenoidosa strain showed higher enzymatic activity of malic enzyme which subsequently promoted fatty acid synthesis. The neutral lipid content was significantly increased by up to 3.2-fold than wild type determined by Nile red staining, and total lipid content reached 40.9 % (dry cell weight). The engineered strain exhibited further lipid accumulation subjected to nitrogen deprivation condition. Upon nitrogen deprivation, engineered microalgae accumulated total lipid up to 58.7 % (dry cell weight), a 4.6-fold increase over the wild type cells under normal culture condition. At cellular level, increased volume and number of oil bodies were observed in the engineered microalgal cells. These findings suggested that malic enzyme is a pivotal regulator in lipid accumulation in green microalga C. pyrenoidosa, and presenting a breakthrough of generating ideal algal strains for algal nutrition and biofuels.

  14. FLOW DYNAMIC COMPARISON BETWEEN RECESSED HINGE AND OPEN PIVOT BI-LEAFLET HEART VALVE DESIGNS.

    Science.gov (United States)

    Govindarajan, V; Udaykumar, H S; Chandran, K B

    2009-06-01

    The flow dynamics through the peripheral and hinge regions of a bi-leaflet mechanical heart valve are complex and result in abnormally high shear stresses particularly during the closing phase of the valve function. It has been observed that, the late stages of closure is more significant in the dynamics of platelet activation; therefore, the later stages of closure is simulated by solving the two-dimensional Navier-Stokes equations using an Eulerian Levelset based sharp interface Cartesian grid method. Using a fixed Cartesian mesh incorporating local mesh refinement for solution accuracy and efficiency, the flow through and within a recessed hinge design and an open pivot hinge design is compared. Platelets are modelled as point particles by Lagrangian particle tracking algorithm with one way coupling. A dilute particle flow is assumed and particle-particle interactions are neglected. It was observed that the hinge region of the open pivot valve indicated a lower potential for activation of platelets compared to that in valves with a recessed hinge design.

  15. Resilience Pivots: Stability and Identity in a Social-Ecological-Cultural System

    Directory of Open Access Journals (Sweden)

    Stephanie J. Rotarangi

    2014-03-01

    Full Text Available How is cultural resilience achieved in the face of significant social and ecological change? Is resilience compatible with changed structures, functions, and feedbacks as long as identity is maintained? The concept of cultural resilience has been less explored than its older siblings ecological resilience, social resilience, and social-ecological resilience. We seek to redress the balance, drawing from resilience thinking to examine how a New Zealand Māori tribal group of landowners retained strong cultural identity and connectedness to their land despite enduring significant changes in land use, economy, tenure, and governance. The landowners negotiated radical transformations in the ecology and land use of their home lands on terms that supported matters of cultural importance. The key resilience concepts of adaptation and transformation were helpful in analyzing the trajectory of change, but fell short of representing the elements of stability that supported the cultural resilience of the landowners. The concept of resilience pivots was designed to address this conceptual gap, and to offer another heuristic to resilience thinking by focusing on stability rather than change. Resilience pivots are those elements of a resilient system that remain stable despite adaptation or even transformation of other elements of that system, and in doing so support the maintenance of the system's distinctive identity.

  16. ULTRASONOGRAPHIC EVALUATION OF THE RUPTURED MEDIAL HEAD OF GASTROCNEMIUS MUSCLE

    Directory of Open Access Journals (Sweden)

    Damir Lukac

    Full Text Available ABSTRACT Introduction: Tennis leg, a common injury of the medial head of gastrocnemius muscle in the muscle-tendon junction, is usually reported in men during recreational sports. Sudden pain is the main symptom accompanied by the feeling of rupture in the calf. Clinical examination followed by ultrasound is the standard diagnostic procedure. Objective: The main objectives of this study are to compare clinical and ultrasonographic findings in cases of tennis leg, evaluate the location and type of lesion in the medial head of gastrocnemius muscle, and evaluate the edema volume and the presence of deep vein thrombosis (DVT. Second, the healing process was monitored with ultrasound to distinguish the level of recovery and to record the presence of chronic sequelae. Methods: Eighty-one subjects with clinical symptoms of rupture of the medial head of gastrocnemius muscle participated in the study. A linear probe (7-12 MHz was used for ultrasonographic (US and a Doppler was used to verify the presence of DVT. Results: In 78 of 81 subjects examined, we found obvious US changes (96.3% and three of them had no positive findings. In 67 of them, we diagnosed rupture of the medial head of the gastrocnemius muscle. Most of them had partial rupture (73.13% and the remaining had total rupture (26.87%. The edema (30.84% was found in the space between the aponeurosis of the gastrocnemius and soleus muscles. DVT with the clinical signs of tennis leg was observed in 5 of 81 patients (6.17%. Conclusion: Our findings indicate that ultrasound is very important for early diagnosis of muscle-tendon injuries in the leg. In addition, monitoring the healing process and assessing the chosen treatment showed a high efficiency. Ultrasonography is an effective method to identify and differentiate the sequelae of the injured muscles and vascular complications.

  17. Aetiology, imaging and treatment of medial tibial stress syndrome

    OpenAIRE

    Moen, M.H.

    2012-01-01

    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the most probable cause of MTSS is bone overload and not traction induced periostitis. In chapter 2 a review of the literature on MTSS is provided until 2009. Chapters 3 and 4 discuss different common a...

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

    Science.gov (United States)

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

    2005-01-01

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

  19. Analysis of 3D strain in the human medial meniscus.

    Science.gov (United States)

    Kolaczek, S; Hewison, C; Caterine, S; Ragbar, M X; Getgood, A; Gordon, K D

    2016-10-01

    This study presents a method to evaluate three-dimensional strain in meniscal tissue using medical imaging. Strain is calculated by tracking small teflon markers implanted within the meniscal tissue using computed tomography imaging. The results are presented for strains in the middle and posterior third of the medial menisci of 10 human cadaveric knees, under simulated physiologically relevant loading. In the middle position, an average compressive strain of 3.4% was found in the medial-lateral direction, and average tensile strains of 1.4% and 3.5% were found in the anterior-posterior and superior-inferior directions respectively at 5° of knee flexion with an applied load of 1× body weight. In the posterior position, under the same conditions, average compressive strains of 2.2% and 6.3% were found in the medial-lateral and superior-inferior directions respectively, and an average tensile strain of 3.8% was found in the anterior-posterior direction. No statistically significant difference between strain in the middle or posterior of the meniscus or between the global strains is uncovered. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

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

  1. Dopamine in the medial amygdala network mediates human bonding.

    Science.gov (United States)

    Atzil, Shir; Touroutoglou, Alexandra; Rudy, Tali; Salcedo, Stephanie; Feldman, Ruth; Hooker, Jacob M; Dickerson, Bradford C; Catana, Ciprian; Barrett, Lisa Feldman

    2017-02-28

    Research in humans and nonhuman animals indicates that social affiliation, and particularly maternal bonding, depends on reward circuitry. Although numerous mechanistic studies in rodents demonstrated that maternal bonding depends on striatal dopamine transmission, the neurochemistry supporting maternal behavior in humans has not been described so far. In this study, we tested the role of central dopamine in human bonding. We applied a combined functional MRI-PET scanner to simultaneously probe mothers' dopamine responses to their infants and the connectivity between the nucleus accumbens (NAcc), the amygdala, and the medial prefrontal cortex (mPFC), which form an intrinsic network (referred to as the "medial amygdala network") that supports social functioning. We also measured the mothers' behavioral synchrony with their infants and plasma oxytocin. The results of this study suggest that synchronous maternal behavior is associated with increased dopamine responses to the mother's infant and stronger intrinsic connectivity within the medial amygdala network. Moreover, stronger network connectivity is associated with increased dopamine responses within the network and decreased plasma oxytocin. Together, these data indicate that dopamine is involved in human bonding. Compared with other mammals, humans have an unusually complex social life. The complexity of human bonding cannot be fully captured in nonhuman animal models, particularly in pathological bonding, such as that in autistic spectrum disorder or postpartum depression. Thus, investigations of the neurochemistry of social bonding in humans, for which this study provides initial evidence, are warranted.

  2. Dopamine in the medial amygdala network mediates human bonding

    Science.gov (United States)

    Touroutoglou, Alexandra; Rudy, Tali; Salcedo, Stephanie; Feldman, Ruth; Hooker, Jacob M.; Dickerson, Bradford C.; Catana, Ciprian; Barrett, Lisa Feldman

    2017-01-01

    Research in humans and nonhuman animals indicates that social affiliation, and particularly maternal bonding, depends on reward circuitry. Although numerous mechanistic studies in rodents demonstrated that maternal bonding depends on striatal dopamine transmission, the neurochemistry supporting maternal behavior in humans has not been described so far. In this study, we tested the role of central dopamine in human bonding. We applied a combined functional MRI-PET scanner to simultaneously probe mothers’ dopamine responses to their infants and the connectivity between the nucleus accumbens (NAcc), the amygdala, and the medial prefrontal cortex (mPFC), which form an intrinsic network (referred to as the “medial amygdala network”) that supports social functioning. We also measured the mothers’ behavioral synchrony with their infants and plasma oxytocin. The results of this study suggest that synchronous maternal behavior is associated with increased dopamine responses to the mother’s infant and stronger intrinsic connectivity within the medial amygdala network. Moreover, stronger network connectivity is associated with increased dopamine responses within the network and decreased plasma oxytocin. Together, these data indicate that dopamine is involved in human bonding. Compared with other mammals, humans have an unusually complex social life. The complexity of human bonding cannot be fully captured in nonhuman animal models, particularly in pathological bonding, such as that in autistic spectrum disorder or postpartum depression. Thus, investigations of the neurochemistry of social bonding in humans, for which this study provides initial evidence, are warranted. PMID:28193868

  3. Medial blepharosynechioplasty: a new surgical concept for severe dry eye

    Directory of Open Access Journals (Sweden)

    Sasaki T

    2012-06-01

    Full Text Available Tsugihisa Sasaki,1,2 Taeko Ota,3 Youko Ookura,4 Kazuhisa Sugiyama11Department of Ophthalmology, Kanazawa University School of Medicine, Kanazawa, Ishikawa; 2Department of Ophthalmology, Fukui Prefectural Hospital, Fukui; 3Department of Ophthalmology, Tonami General Hospital, Tonami-city, Toyama; 4Department of Ophthamology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, JapanBackground: The purpose of this work was to report on the performance of medial blepharosynechioplasty (MBSP, a newly devised technique for treating severe dry eye.Methods: In this retrospective, nonrandomized clinical trial, three cases with severe dry eye (Sjögren’s syndrome associated with repeated punctal plug loss were treated using MBSP to create a synechia between the upper and lower lid medial borders of the puncta to suppress the lacrimal pump.Results: Postoperative follow-up showed improvement in the corneal condition in all three cases that persisted for 12–35 months. None of the patients had visual impairment.Conclusion: MBSP is a promising treatment for severe dry eye and merits further study.Keywords: dry eye, lacrimal pump suppression, medial blepharosynechioplasty

  4. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  5. Bottom-up Visual Integration in the Medial Parietal Lobe.

    Science.gov (United States)

    Pflugshaupt, Tobias; Nösberger, Myriam; Gutbrod, Klemens; Weber, Konrad P; Linnebank, Michael; Brugger, Peter

    2016-03-01

    Largely based on findings from functional neuroimaging studies, the medial parietal lobe is known to contribute to internally directed cognitive processes such as visual imagery or episodic memory. Here, we present 2 patients with behavioral impairments that extend this view. Both had chronic unilateral lesions of nearly the entire medial parietal lobe, but in opposite hemispheres. Routine neuropsychological examination conducted >4 years after the onset of brain damage showed little deficits of minor severity. In contrast, both patients reported persistent unusual visual impairment. A comprehensive series of tachistoscopic experiments with lateralized stimulus presentation and comparison with healthy participants revealed partial visual hemiagnosia for stimuli presented to their contralesional hemifield, applying inferential single-case statistics to evaluate deficits and dissociations. Double dissociations were found in 4 experiments during which participants had to integrate more than one visual element, either through comparison or formation of a global gestalt. Against the background of recent neuroimaging findings, we conclude that of all medial parietal structures, the precuneus is the most likely candidate for a crucial involvement in such bottom-up visual integration. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. MARRT: Medial Axis biased rapidly-exploring random trees

    KAUST Repository

    Denny, Jory

    2014-05-01

    © 2014 IEEE. Motion planning is a difficult and widely studied problem in robotics. Current research aims not only to find feasible paths, but to ensure paths have certain properties, e.g., shortest or safest paths. This is difficult for current state-of-the-art sampling-based techniques as they typically focus on simply finding any path. Despite this difficulty, sampling-based techniques have shown great success in planning for a wide range of applications. Among such planners, Rapidly-Exploring Random Trees (RRTs) search the planning space by biasing exploration toward unexplored regions. This paper introduces a novel RRT variant, Medial Axis RRT (MARRT), which biases tree exploration to the medial axis of free space by pushing all configurations from expansion steps towards the medial axis. We prove that this biasing increases the tree\\'s clearance from obstacles. Improving obstacle clearance is useful where path safety is important, e.g., path planning for robots performing tasks in close proximity to the elderly. Finally, we experimentally analyze MARRT, emphasizing its ability to effectively map difficult passages while increasing obstacle clearance, and compare it to contemporary RRT techniques.

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

    Science.gov (United States)

    Yushkevich, Paul A.

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Amir M. Torabi

    2013-01-01

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

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

    Science.gov (United States)

    Krenner, Bernard John

    2002-01-01

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

  10. Bipartite Medial Cuneiform: Case Report and Retrospective Review of 1000 Magnetic Resonance (MR Imaging Studies

    Directory of Open Access Journals (Sweden)

    Geraldine H. Chang

    2014-01-01

    Full Text Available Objective. To present a unique case report of a Lisfranc fracture in a patient with a bipartite medial cuneiform and to evaluate the prevalence of the bipartite medial cuneiform in a retrospective review of 1000 magnetic resonance (MR imaging studies of the foot. Materials and Methods. Case report followed by a retrospective review of 1000 MR imaging studies of the foot for the presence or absence of a bipartite medial cuneiform. Results. The incidence of the bipartite medial cuneiform is 0.1%. Conclusion. A bipartite medial cuneiform is a rare finding but one with both clinical and surgical implications.

  11. Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques.

    Science.gov (United States)

    Tudisco, Cosimo; Bisicchia, Salvatore; Cosentino, Andrea; Chiozzi, Federica; Piva, Massimo

    2015-01-01

    a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Case-control study.

  12. Sacrificing information for the greater good

    DEFF Research Database (Denmark)

    Stensbo-Smidt, Kristoffer; Gieseke, Fabian Cristian; Igel, Christian

    2017-01-01

    Large-scale surveys make huge amounts of photometric data available. Because of the sheer amount of objects, spectral data cannot be obtained for all of them. Therefore it is important to devise techniques for reliably estimating physical properties of objects from photometric information alone....... These estimates are needed to automatically identify interesting objects worth a follow-up investigation as well as to produce the required data for a statistical analysis of the space covered by a survey. We argue that machine learning techniques are suitable to compute these estimates accurately and efficiently....... This study promotes a feature selection algorithm, which selects the most informative magnitudes and colours for a given task of estimating physical quantities from photometric data alone. Using k nearest neighbours regression, a well-known non-parametric machine learning method, we show that using the found...

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

    Science.gov (United States)

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

    2013-02-01

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

  14. Comparison of Water Distribution Characteristics for Two Kinds of Sprinklers Used for Center Pivot Irrigation Systems

    Directory of Open Access Journals (Sweden)

    Jian Jiao

    2017-04-01

    Full Text Available Sprinkler selection influences the water distribution uniformity of center pivot irrigation systems. The sprinkling uniformity of the center pivot is crucial for the yield and quality of crops on a large scale. Rotating and fixed spray plate sprinklers (RSPSs and FSPSs are the two most popular types. However, sprinkler selection is mainly based on price, not on differences in performance between them. Under low-wind field conditions, the water distributions of individual RSPSs and FSPSs with different nozzles (2.78, 4.76, and 6.75 mm in diameter were measured using a catch can method. Cubic spline interpolation was used for data conversion for FSPS measurements; the nozzle configuration model was used to simulate the water distribution of the same-nozzle-sprinkler pipe section and full circular irrigated areas in a simulated center pivot under three sprinkler intervals of 1.5, 3.0, and 4.5 m respectively. Results showed that (1 individual RSPSs distributed the most water around the sprinkler, whereas individual FSPSs distributed the most water over a ring-shaped region at the periphery of the sprinkler, and the wetted radii for RSPSs and FSPSs ranged from 4.88 to 7.05 m and from 5.02 to 6.85 m, respectively; (2 same-nozzle-sprinkler pipe sections of RSPSs distributed the most water around the central axes of the pipe sections, and their sprinkling uniformities were 44.7%–51.0%, whereas FSPSs distributed the most water over both sides of the axes symmetrically, and less water around the axes, with sprinkling uniformities of 40.3%–58.0%; and (3 the sprinkling uniformities of the full circular irrigated areas were 85.8%–91.7% and 85.8%–86.2% when using RSPSs and FSPSs, respectively, under different sprinkler intervals, and the uniformities were 3.1% and 6.2% higher using RSPSs than FSPSs with sprinkler intervals of 3.0 and 4.5 m, respectively. RSPS accommodated larger sprinkler intervals (>3.0 m and maintained superior sprinkling

  15. On the Performance of Pivoted Curved Slider Bearings: Rabinowitsch Fluid Model

    Directory of Open Access Journals (Sweden)

    U.P. Singh

    2012-09-01

    Full Text Available The present theoretical analysis is to investigate the effect of nonNewtonian Pseudoplastic & Dilatant lubricants (lubricant blended with viscosity index improver–Rabinowitsch fluid model on the dynamic stiffness and damping characteristics of pivoted curved slider bearings. The modified Reynolds equation has been obtained for steady and damping states of the bearing. To analyze the steady state characteristics and dynamic characteristics, small perturbation theory has been adopted. The results for the steady state bearing performance characteristics (steady state film pressure, load carrying capacity and centre of pressure as well as dynamic stiffness and damping characteristics have been calculated numerically for various values of viscosity index improver using Mathematical 7.0 and it is concluded that these characteristics vary significantly with the non-Newtonian behavior of the fluid consistent with the real nature of the problem.

  16. Pivotal Response Treatment Parent Training for Autism: Findings from a 3-Month Follow-Up Evaluation.

    Science.gov (United States)

    Gengoux, Grace W; Berquist, Kari L; Salzman, Emma; Schapp, Salena; Phillips, Jennifer M; Frazier, Thomas W; Minjarez, Mendy B; Hardan, Antonio Y

    2015-09-01

    This study's objective was to assess maintenance of treatment effects 3 months after completion of a 12-week Pivotal Response Treatment (PRT) parent education group. Families who completed the active treatment (N = 23) were followed for an additional 12 weeks to measure changes in language and cognitive skills. Results indicated a significant improvement in frequency of functional utterances, with maintenance at 3-month follow-up [F(2, 21): 5.9, p = .009]. Children also made significant gains on the Vineland Communication Domain Standard Score [F(2, 12):11.74, p = .001] and the Mullen Scales of Early Learning Composite score [F(1, 20) = 5.43, p = .03]. These results suggest that a brief PRT parent group intervention can lead to improvements in language and cognitive functioning that are maintained 12 weeks post treatment.

  17. Teaching symbolic play skills to children with autism using pivotal response training.

    Science.gov (United States)

    Stahmer, A C

    1995-04-01

    Used Pivotal Response Training (PRT) to teach 7 children with autism to engage in symbolic play behaviors. Symbolic play, complexity of play behavior, and creativity of play were assessed. In addition, generalization measures were obtained across settings, toys, and play partners. Interaction with the play partners and comparison with typical controls were also examined. Results indicated that children with autism rarely exhibited symbolic play before training or after a control condition. After specific symbolic play training using PRT, all of the children learned to perform complex and creative symbolic play actions at levels similar to that of language-matched typical controls. In most cases the children generalized their play to new toys, environments, and play partners and continued to engage in symbolic play behavior after a 3-month follow-up period. In addition, interaction skills improved after training. Treatment implications for these findings are discussed.

  18. Pivotal response treatment for infants at-risk for autism spectrum disorders: a pilot study.

    Science.gov (United States)

    Steiner, Amanda Mossman; Gengoux, Grace W; Klin, Ami; Chawarska, Katarzyna

    2013-01-01

    Presently there is limited research to suggest efficacious interventions for infants at-risk for autism. Pivotal response treatment (PRT) has empirical support for use with preschool children with autism, but there are no reports in the literature utilizing this approach with infants. In the current study, a developmental adaptation of PRT was piloted via a brief parent training model with three infants at-risk for autism. Utilizing a multiple baseline design, the data suggest that the introduction of PRT resulted in increases in the infants' frequency of functional communication and parents' fidelity of implementation of PRT procedures. Results provide preliminary support for the feasibility and utility of PRT for very young children at-risk for autism.

  19. Achieving numerical accuracy and high performance using recursive tile LU factorization with partial pivoting

    KAUST Repository

    Dongarra, Jack

    2013-09-18

    The LU factorization is an important numerical algorithm for solving systems of linear equations in science and engineering and is a characteristic of many dense linear algebra computations. For example, it has become the de facto numerical algorithm implemented within the LINPACK benchmark to rank the most powerful supercomputers in the world, collected by the TOP500 website. Multicore processors continue to present challenges to the development of fast and robust numerical software due to the increasing levels of hardware parallelism and widening gap between core and memory speeds. In this context, the difficulty in developing new algorithms for the scientific community resides in the combination of two goals: achieving high performance while maintaining the accuracy of the numerical algorithm. This paper proposes a new approach for computing the LU factorization in parallel on multicore architectures, which not only improves the overall performance but also sustains the numerical quality of the standard LU factorization algorithm with partial pivoting. While the update of the trailing submatrix is computationally intensive and highly parallel, the inherently problematic portion of the LU factorization is the panel factorization due to its memory-bound characteristic as well as the atomicity of selecting the appropriate pivots. Our approach uses a parallel fine-grained recursive formulation of the panel factorization step and implements the update of the trailing submatrix with the tile algorithm. Based on conflict-free partitioning of the data and lockless synchronization mechanisms, our implementation lets the overall computation flow naturally without contention. The dynamic runtime system called QUARK is then able to schedule tasks with heterogeneous granularities and to transparently introduce algorithmic lookahead. The performance results of our implementation are competitive compared to the currently available software packages and libraries. For example

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

    Science.gov (United States)

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

    2011-08-01

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

  1. Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Jerabek, Seth A. [Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA (United States); Asnis, Peter D.; Poon, Steven K.; Gill, Thomas J. [Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA (United States); Bredella, Miriam A.; Ouellette, Hugue A. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2009-08-15

    To describe the correlation between medial patellar ossification and prior patella subluxation and/or dislocation. A retrospective billing database search identified 544 patients who had been diagnosed with patellar instability over a 13-year period. One hundred twenty-eight patients met the inclusion criteria. After review by a staff orthopedic surgeon and two musculoskeletal radiologists, 28 patients were found to have medial patellar ossification. The size and location of medial patellar ossification was recorded. Of the 28 patients (20 males, eight females, age 13-66 years, mean 28 years) who were found to have medial patellar ossification, 22 had radiographs, 16 had magnetic resonance imaging, and ten had both. The medial patellar ossification ranged in size from 2 to 18 mm with an average of 6.8 mm. Twelve were located in the medial patellofemoral ligament (MPFL), 14 in the medial joint capsule, and two in both the MPFL and joint capsule. Twenty-seven of 28 patients had a single ossification, and one patient had two ossifications. The timing from injury to first imaging of the lesion ranged from 10 days to a chronic history ({>=}35 years) of patellar instability. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. The presence of this lesion will prompt physicians to evaluate for patellar instability. (orig.)

  2. Fracture of an unossified humeral medial epicondyle: use of magnetic resonance imaging for diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, Katsuhisa; Miyamoto, Nao [Nishinomiya Municipal Central Hospital, Department of Orthopaedic Surgery, Nishinomiya (Japan)

    2016-10-15

    Fracture of the humeral medial epicondyle is a relatively common injury in children. Surgery is a good option for treatment, but correct diagnosis is important. Most fractures occur after the ossification of the medial epicondylar apophysis. If a fracture occurs before the ossification of the medial epicondyle, it is undetectable by radiographs. Here we report a case of an unossified medial epicondyle fracture of the humerus. A 9-year-old boy had persistent pain in the medial side of the right elbow after a fall. Despite his pain, he could move his injured elbow with a range from 60 to 90 . Radiographs and computed tomography showed neither fracture nor dislocation in the injured elbow, and soft tissue swelling was the only finding. Neither the trochlea nor the medial epicondyle was ossified. Magnetic resonance imaging showed that the medial epicondyle was separated from the medial metaphysis and displaced. This clear finding led us to surgical fixation. Under general anesthesia, valgus stress showed gross instability of the injured elbow. Two years after the operation, he had no complaints and could play sports with the same range of motion as the left elbow. It is important to keep in mind that medial epicondylar fractures may be hidden in a normal radiograph before the ossification of the medial epicondylar apophysis. (orig.)

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

    Science.gov (United States)

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

    1999-09-01

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

  4. Visualization of the medial forebrain bundle using diffusion tensor imaging

    Directory of Open Access Journals (Sweden)

    Ardian eHana

    2015-10-01

    Full Text Available Diffusion tensor imaging is a technique that enables physicians the portrayal of white matter tracts in vivo. We used this technique in order to depict the medial forebrain bundle in 15 consecutive patients between 2012 and 2015. Men and women of all ages were included. There were 6 women and 9 men. The mean age was 58,6 years (39-77. Nine patients were candidates for an eventual deep brain stimulation. Eight of them suffered from Parkinson`s disease and one had multiple sclerosis. The remaining 6 patients suffered from different lesions which were situated in the frontal lobe. These were 2 metastasis, 2 meningiomas, 1 cerebral bleeding and 1 glioblastoma. We used a 3DT1-sequence for the navigation. Furthermore T2- and DTI- sequences were performed. The FOV was 200 x 200 mm², slice thickness 2 mm, and an acquisition matrix of 96 x 96 yielding nearly isotropic voxels of 2 x 2 x 2 mm. 3-Tesla-MRI was carried out strictly axial using 32 gradient directions and one b0-image. We used Echo-Planar-Imaging (EPI and ASSET parallel imaging with an acceleration factor of 2. b-value was 800 s/mm². The maximal angle was 50°. Additional scanning time was less than 9 minutes. We were able to visualize the medial forebrain bundle in 12 of our patients bilaterally and in the remaining 3 patients we depicted the medial forebrain bundle on one side. It was the contralateral side of the lesion. These were 2 meningiomas and one metastasis. Portrayal of the medial forebrain bundle is possible for everyday routine for neurosurgical interventions. As part of the reward circuitry it might be of substantial importance for neurosurgeons during deep brain stimulation in patients with psychiatric disorders. Furthermore it might explain at a certain extent character changes in patients with lesions in the frontal lobe. Surgery in this part of the brain should always take the preservation of this white matter tract into account.

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

    OpenAIRE

    Krenner, Bernard John

    2002-01-01

    Activity or exercise-induced leg pain is a common complication among competitive and “weekend warrior” athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of “shin splints,” one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the inj...

  6. A systematic review of medial epicondylectomy as a surgical treatment for cubital tunnel syndrome.

    Science.gov (United States)

    O'Grady, Eva E; Vanat, Qureish; Power, Dominic M; Tan, Simon

    2017-11-01

    The aim of this study was to review the literature of decompression of the cubital tunnel with medial epicondylectomy and to assess outcomes and complications. Twenty-one case series reported on 886 medial epicondylectomies. The mean percentage of patients obtaining improvement of one or more McGowan grade was 79%. The mean percentage obtaining a good/excellent Wilson Krout grade of outcome was 83%. Of six comparative studies, two showed no significant differences in outcomes between medial epicondylectomy and transposition procedures, and three reported better outcomes with medial epicondylectomy. One reported similar outcomes with medial epicondylectomy and simple decompression. The existing literature on medial epicondylectomy is of limited methodological quality and does not allow for firm conclusions to be drawn regarding its efficacy compared with other surgical techniques. Further studies should aim for high methodological quality, randomized comparison with simple decompression or anterior transposition and should utilize standardized outcome measures. II.

  7. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

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

    Science.gov (United States)

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

    2011-02-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  10. Medial Orbitofrontal Cortex Is Associated with Fatigue Sensation

    Directory of Open Access Journals (Sweden)

    Seiki Tajima

    2010-01-01

    Full Text Available Fatigue is an indispensable bioalarm to avoid exhaustive state caused by overwork or stresses. It is necessary to elucidate the neural mechanism of fatigue sensation for managing fatigue properly. We performed H2O  15 positron emission tomography scans to indicate neural activations while subjects were performing 35-min fatigue-inducing task trials twice. During the positron emission tomography experiment, subjects performed advanced trail-making tests, touching the target circles in sequence located on the display of a touch-panel screen. In order to identify the brain regions associated with fatigue sensation, correlation analysis was performed using statistical parametric mapping method. The brain region exhibiting a positive correlation in activity with subjective sensation of fatigue, measured immediately after each positron emission tomography scan, was located in medial orbitofrontal cortex (Brodmann's area 10/11. Hence, the medial orbitofrontal cortex is a brain region associated with mental fatigue sensation. Our findings provide a new perspective on the neural basis of fatigue.

  11. MEDIAL FOOT LOADING ON ANKLE AND KNEE BIOMECHANICS.

    Science.gov (United States)

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

    2008-08-01

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

  12. Adaptive visual memory reorganization in right medial temporal lobe epilepsy.

    Science.gov (United States)

    Figueiredo, Patrícia; Santana, Isabel; Teixeira, João; Cunha, Catarina; Machado, Egídeo; Sales, Francisco; Almeida, Eduarda; Castelo-Branco, Miguel

    2008-08-01

    We investigated functional reorganization mechanisms of the human medial temporal lobe (MTL) for episodic memory, in patients suffering from medial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS). We used functional magnetic resonance imaging (fMRI) to measure brain activity changes during matched episodic encoding tasks of abstract words (Verbal) and line drawings (Visual), in patients with unilateral right MTLE undergoing presurgical evaluation and healthy controls. As expected, a significant interaction between material type and the side of MTL activity was present in the control group, with preferential involvement of the left hippocampus in verbal encoding and the right parahippocampal region in visual encoding. When compared with controls, right MTLE patients with intact performance activated a region in the left hippocampus more during visual encoding, which resulted in an interaction between group and hemisphere. Importantly, an effect of memory performance on visual encoding activity was observed in the patients, with greater engagement of the left MTL being associated with higher recognition scores. Interestingly, activity in the left MTL also depended on the epileptic seizure frequency, suggesting a role for this clinical parameter in the recruitment of contralateral regions. Taken together, these results indicate functional reorganization of the MTLs in right HS, through transfer of function from the right to the left hemisphere, and strongly suggest an adaptive role for such reorganization mechanism in supporting preserved visual memory.

  13. Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Malkoc Melih

    2015-03-01

    Full Text Available Plantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.

  14. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.

    Directory of Open Access Journals (Sweden)

    Wen Zhang

    Full Text Available BACKGROUND: The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs in the locking proximal humeral plate for treating proximal humerus fractures. METHODS: Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed. RESULTS: Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001. When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P ≤ 0.0207. Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture. CONCLUSIONS: Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

  15. Anterior cruciate ligament fatigue failures in knees subjected to repeated simulated pivot landings.

    Science.gov (United States)

    Lipps, David B; Wojtys, Edward M; Ashton-Miller, James A

    2013-05-01

    failure when pivot landings of 3*BW or more load the knee repeatedly within a short time span. An ACL with a smaller cross-sectional area is at greater risk for this type of failure. The results show that the human knee can only withstand a certain number of 3*BW or greater jump loading cycles within a short time period before the ACL will fail. Therefore, limiting the increase in the number and severity of pivot landing maneuvers performed over a week of training would make sense from an injury prevention viewpoint.

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

    Science.gov (United States)

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

    1986-12-01

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

  17. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2014-01-01

    Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

  18. Case report - curved femoral osteotomy for management of medial patellar luxation

    DEFF Research Database (Denmark)

    Allpass, Maja; Miles, James Edward

    2015-01-01

    Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation.......Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation....

  19. First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus.

    Science.gov (United States)

    Lenz, Robin C; Nagesh, Darshan; Park, Hannah K; Grady, John

    2016-09-02

    Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Medial eminence width was 1.12 mm larger in patients with hallux valgus (P hallux valgus (P hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

  20. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: 'SCOPEX', a randomised control trial protocol

    DEFF Research Database (Denmark)

    Hall, Michelle; Hinman, Rana S; Wrigley, Tim V

    2012-01-01

    Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential...... to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have...

  1. Rituais de sacrifício: a sobrevivência de uma antiga dimensão do corpo humano Rites of sacrifice: the survival of an ancient dimension of the human body

    Directory of Open Access Journals (Sweden)

    Andrea Lessa

    2007-09-01

    Full Text Available A força da tradição é capaz de preservar costumes que caminham na contramão da trajetória sociocultural das populações urbanas atuais. Costumes como os rituais de sacrifício, apesar de muitas vezes condenados pela sociedade e de terem sofrido um sincretismo adaptativo, ainda guardam elementos tradicionais, confirmando sua importância como mediadores entre os mundos natural e sobrenatural. Um bom exemplo são as lutas rituais Tinku, identificadas em amostras esqueléticas pré-colombianas provenientes do deserto de Atacama, Chile, e que ainda persistem entre grupos andinos, com uma abrangência temporal de pelo menos 1.200 anos. O objetivo principal dessa luta é provocar o sangramento e a morte de seus participantes, oferecidos à divindade Pachamama para propiciar a fertilidade da terra e dos animais. Os rituais de sacrifício, como símbolos de identidade social, nos ajudam a conhecer melhor o ethos de sociedades passadas e atuais.The power of tradition is capable of preserving customs that go counter to the social and cultural trends in today's urban centers. Though customs such as rites of sacrifice are often condemned by society and have undergone an adaptive syncretism, they still preserve ancient traditional elements that underline their importance as mediators between the natural and supernatural worlds. A good example of this is the Tinku ritual fight, identified in samples of Pre-Columbian skeletons from the Atacama desert in Chile, which continues to this day amongst Andean groups, having survived for at least 1,200 years. The main objective in this fight is that the participants bleed to death as offerings to the divinity, Pachamama, to assure the fertility of the land and the animals. When rites of sacrifice are understood as symbols of social identity, they give us a better understanding of the ethos of past and present societies, from a very particular perspective.

  2. Preparation of metallic pivot-based imprinted monolith for polar template.

    Science.gov (United States)

    Zhong, Dan-Dan; Huang, Yan-Ping; Xin, Xue-Lei; Liu, Zhao-Sheng; Aisa, Haji Akber

    2013-09-01

    One of the main challenges in MIPs preparation is the proper MIP monolith design for water-soluble compounds due to the difficulty in satisfying the demands of both good column permeability and affinity to polar template. A new strategy of metallic pivot in a ternary porogenic system of dimethyl sulfoxide (DMSO)-dimethylformamide (DMF)-1-butyl-3-methylimidazolium tetrafluoroborate ([Bmim]BF4) was suggested to solve this problem. An imprinted monolithic column with high porosity and good permeability was synthesized using a mixture of methyl gallate (template), 4-vinylpyridine, ethylene glycol dimethacrylate, and cobalt acetate. Some polymerization factors, such as template-monomer molar ratio and the composition of the ionic liquid, on the imprinting effect of the resulting MIPs monoliths were systematically investigated. In a mobile phase of acetonitrile-buffer, the greatest imprinting factor of 10.9 was obtained on the MIPs monolith with the optimized polymerization parameters. Thermodynamic analysis for separation demonstrated that the separation between the template and its analogs on the ion-mediated MIPs monolith is an enthalpy-controlled process. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Local fixed pivot quadratue method of moment for bubble population balance equation including coalescence and breakage

    Science.gov (United States)

    Su, J. W.; Gu, Z. L.; Jiao, J. Y.; Xu, X. Y.

    2010-03-01

    Population balance equation as an essential tool to describe micro-behaviors and resulting bubble size distribution has received considerable attention in scientific and engineering fields. Numerical solution is the only choice in most cases due to its complexity. However, it is almost impossible for the existing numerical methods to predict both bubble size distribution and its moments exactly. In this work, a new numerical method basing on the idea of short time Fourier transformation, namely local fixed pivot quadrature method of moment, is proposed for bubble coalescence and breakage. A continuous summation of Dirac Delta function as trial functions in the local domain and monomials as the weighted functions to conserve the local moments were adopted. The moments and the bubble size distribution were constructed based on the moments in the local domain. Numerical tests including pure coalescence, pure breakage and coalescence and breakage combined processes showed that both the moments and bubble size distribution were predicted accurately. A special algorithm was used to solve the vandermonde linear system, with which the influence of the ill-conditioned feature of coefficient matrix on the numerical accuracy can be avoided. In theory any number of moments can be tracked with the new method. Moreover, with it one can solely track the bubble size distribution or the moments depending on the concrete application.

  4. Intrinsic motivation: how can it play a pivotal role in changing clinician behaviour?

    Science.gov (United States)

    Nantha, Yogarabindranath Swarna

    2013-01-01

    In the light of an increasing healthcare burden, this paper seeks to offer insight about how intrinsic motivation could play a pivotal role in improving the pre-existing healthcare service delivery systems by altering clinician behaviour. The paper argues the case for four salient dimensions worth exploring through the lens of intrinsic motivation--non-financial incentives, positive affective states, organizational culture and prescribing quality. This article reviews literature from both social sciences and health management practices to provide rationale on how intrinsic motivational approaches could optimize healthcare service delivery systems. The scrutiny of the body of evidence leads to the assertion that there is neglect in the initiatives to reinforce intrinsic motivation as a method to address the ailing morale of doctors. This seems to have exacerbated negative outcomes that include job dissatisfaction, compromise in the quality of care and poor patient-doctor relationships. Diminution in positive affective states amongst doctors, largely controlled by intrinsic motivation, led to strained doctor-patient communication and poor quality of care. Barriers in a healthcare organizational culture that restricts autonomy and empowerment seem to directly undermine job satisfaction. The article argues that it is crucial to shift away from the conventional tendencies promoting tangible rewards. A more holistic approach should be adopted by conducting formal research into intrinsic motivation and how it could aid the formulation of policies tailored to meet the current demands of the healthcare system.

  5. Who is a 'healthy subject'?-consensus results on pivotal eligibility criteria for clinical trials.

    Science.gov (United States)

    Breithaupt-Groegler, Kerstin; Coch, Christoph; Coenen, Martin; Donath, Frank; Erb-Zohar, Katharina; Francke, Klaus; Goehler, Karin; Iovino, Mario; Kammerer, Klaus Peter; Mikus, Gerd; Rengelshausen, Jens; Sourgens, Hildegard; Schinzel, Reinhard; Sudhop, Thomas; Wensing, Georg

    2017-04-01

    A discussion forum was hosted by the German not-for-profit Association for Applied Human Pharmacology (AGAH e.V.) to critically review key eligibility criteria and stopping rules for clinical trials with healthy subjects, enrolling stakeholders from the pharmaceutical industry, contract research organisations, academia, ethics committees and competent authority. Pivotal eligibility criteria were defined for trials with new investigational medicinal products (IMPs) or with clinically established IMPs. In general, a pulse rate ranging between 50 and 90 beats/min is recommended for first-in-human (FIH) trials, while wider ranges seem acceptable for trials with clinically established IMPs, provided there are no indications of thyroid dysfunction. Hepatic laboratory parameters not to exceed the upper limit of normal (ULN) comprise ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in FIH trials, whereas slight elevations (10% above ULN) seem acceptable in trials with clinically established IMPs without known hepatotoxicity. A normal renal function is required for any clinical trial in healthy subjects. A risk-adapted approach for stopping rules was adopted. Stopping rules for an individual subject are one adverse event of severe intensity or one serious adverse event. In case of a severe adverse event, some stakeholders demand a causal relationship with the IMP (i.e. an adverse reaction). Stopping rules for a cohort are one serious adverse reaction or ≥50% of subjects experiencing any adverse reaction of moderate or severe intensity. The application of this consensus resulted in a reduction in protocol deficiencies issued by the competent authority.

  6. Grass shrimp (Palaemonetes spp.) play a pivotal trophic role in enhancing Ruppia maritima.

    Science.gov (United States)

    McCall, Donna Drury; Rakocinski, Chet F

    2007-03-01

    Coupled trophic-engineer interactions are potentially important for maintaining habitat function and ecosystem services. As ephemeral submerged aquatic vegetation (SAV), Ruppia maritima has a short well-defined growth-senescence cycle and should benefit from any ecological interaction that enhances its physical condition and longevity. Grass shrimp (Palaemonetes spp.) are abundant facultative grazers of epiphytic algae and conveyors of nutrients in tidal marsh and SAV habitats. Grass shrimp addition consistently enhanced Ruppia biomass and shoot density in a series of three field experiments conducted in Grand Bay National Estuarine Research Reserve, Mississippi, USA. In two experiments, epiphyte grazing by grass shrimp enhanced Ruppia by inhibiting die-back during the mid- and latter stages of the Ruppia life cycle. Despite a nonsignificant epiphyte grazing effect, grass shrimp also enhanced Ruppia during its early growth stage in a third experiment. In that experiment, nutrient addition also significantly increased epiphyte biomass. Grass shrimp may have fostered the early growth of Ruppia through direct deposition of feces to the sediment in the third experiment. Grass shrimp play a pivotal trophic role in the maintenance of Ruppia through context-dependent interactions involving stage of the SAV life cycle, season, and nutrient limitation.

  7. The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care.

    Science.gov (United States)

    McSherry, Robert; Pearce, Paddy; Grimwood, Karen; McSherry, Wilfred

    2012-01-01

    The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing. © 2012 Blackwell Publishing Ltd.

  8. Tlx3 Function in the Dorsal Root Ganglion is Pivotal to Itch and Pain Sensations

    Directory of Open Access Journals (Sweden)

    Chengcheng Huang

    2017-06-01

    Full Text Available Itch, a sensation eliciting a desire to scratch, is distinct from but not completely independent of pain. Inspiring achievements have been made in the characterization of itch-related receptors and neurotransmitters, but the molecular mechanisms controlling the development of pruriceptors remain poorly understood. Here, our RNAseq and in situ hybridization data show that the transcription factor Tlx3 is required for the expression of a majority of itch-related molecules in the dorsal root ganglion (DRG. As a result, Tlx3F/F;Nav1.8-cre mice exhibit significantly attenuated acute and dry skin-induced chronic itch. Furthermore, our study indicates that TRPV1 plays a pivotal role in the chronic itch evoked by dry skin and allergic contact dermatitis (ACD. The mutants also display impaired response to cold and inflammatory pain and elevated response to capsaicin, whereas the responses to acute mechanical, thermal stimuli and neuropathic pain remain normal. In Tlx3F/F;Nav1.8-cre mice, TRPV1 is derepressed and expands predominantly into IB4+ non-peptidergic (NP neurons. Collectively, our data reveal a molecular mechanism in regulating the development of pruriceptors and controlling itch and pain sensations.

  9. Microwave-Assisted Olefin Metathesis as Pivotal Step in the Synthesis of Bioactive Compounds.

    Science.gov (United States)

    Etsè, Koffi Sénam; Ngendera, Alice; Tshibalonza, Ntumba Nelly; Demonceau, Albert; Delaude, Lionel; Dragutan, Ileana; Dragutan, Valerian

    2017-03-14

    Over the last two decades, olefin metathesis has emerged as a new avenue in the design of new routes for the synthesis of natural products and active pharmaceutical ingredients. In many cases, syntheses based on olefin metathesis strategies provide elegant routes in terms of increasing the overall yields, improving the synthesis scope, and decreasing the number of steps. On the other hand, over the last decade, microwave-assisted chemistry has experienced an incredible development, which rapidly opened new vistas in organic synthesis and in homogeneous catalysis. In this review article, we highlight applications of microwave-heated olefin metathesis reactions as pivotal steps in the total synthesis of biologically active compounds. By drawing selected examples from the recent literature, we aim to illustrate the great synthetic power and variety of metathesis reactions, as well as the beneficial effects of microwave irradiation over conventional heating sources. The majority of the selected applications of microwave-assisted olefin metathesis cover the synthesis of medium-ring cycles, macrocycles, and peptidomimetics by means of ring-closing metathesis (RCM) and cross-metathesis (CM) routes. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  10. The Pivotal Role of Semantic Memory in Remembering the Past and Imagining the Future

    Science.gov (United States)

    Irish, Muireann; Piguet, Olivier

    2013-01-01

    Episodic memory refers to a complex and multifaceted process which enables the retrieval of richly detailed evocative memories from the past. In contrast, semantic memory is conceptualized as the retrieval of general conceptual knowledge divested of a specific spatiotemporal context. The neural substrates of the episodic and semantic memory systems have been dissociated in healthy individuals during functional imaging studies, and in clinical cohorts, leading to the prevailing view that episodic and semantic memory represent functionally distinct systems subtended by discrete neurobiological substrates. Importantly, however, converging evidence focusing on widespread neural networks now points to significant overlap between those regions essential for retrieval of autobiographical memories, episodic learning, and semantic processing. Here we review recent advances in episodic memory research focusing on neurodegenerative populations which has proved revelatory for our understanding of the complex interplay between episodic and semantic memory. Whereas episodic memory research has traditionally focused on retrieval of autobiographical events from the past, we also include evidence from the recent paradigm shift in which episodic memory is viewed as an adaptive and constructive process which facilitates the imagining of possible events in the future. We examine the available evidence which converges to highlight the pivotal role of semantic memory in providing schemas and meaning whether one is engaged in autobiographical retrieval for the past, or indeed, is endeavoring to construct a plausible scenario of an event in the future. It therefore seems plausible to contend that semantic processing may underlie most, if not all, forms of episodic memory, irrespective of temporal condition. PMID:23565081

  11. Field evaluation of centre pivot sprinkler irrigation system in the North-East of Iran

    Directory of Open Access Journals (Sweden)

    Abedinpour Meysam

    2017-09-01

    Full Text Available A field evaluation of the technical performance of centre pivot sprinkler irrigation system was carried out during the maize crop growing season and when operating with different working speeds: S1 - 40%, S2 - 60% and S3 - 80%. For this goal, four uniformity measurements are to be considered in the evaluation; coefficient of uniformity (CU, distribution uniformity (DU, potential efficiency of low quarter application (PELQ and actual efficiency of low quarter application (AELQ. The first step of evaluation of the sprinkler irrigation system is to compare the measured uniformity values with the standard values, DU ≥ 75%, CU ≥ 85%, AELQ and PELQ ≥ 90%. Effect of variation of speed produced CU values of 80.3, 82.7 and 86% for S1, S2, and S3 speed, respectively. Furthermore, DU standard value was obtained at S3 speed of 82%. Moreover, AELQ and PELQ were below the acceptable standard level of 90% for all speeds. Non-uniform water application leads to over or under irrigation in various parts of the field which can result in wasted water and energy. Therefore, regular evaluation of the irrigation equipments is needed to efficiently and effectively manage irrigation.

  12. Effect of Opening the Sash of a Centre-Pivot Roof Window on Wind Pressure Coefficients

    DEFF Research Database (Denmark)

    Iqbal, Ahsan; Wigö, Hans; Heiselberg, Per

    2014-01-01

    This paper describes the effect of outward opening the sash of a window on local and overall wind pressures. Wind tunnel experiments were used for the purpose of evaluation. A centre-pivot roof window on a pitched roof in a modelled scaled building was used in the analysis of wind pressures. The ...... pressure distribution nearby the window. The use of wind pressure coefficients from the analysis of sealed plain surface may lead to erroneous estimation of airflow rate........ The wind pressures were defined in terms of wind pressure coefficients. Traditionally wind pressure coefficients are extracted from the analysis of sealed plain surface. These wind pressure coefficients are used to estimate the natural ventilation rate through windows/openings due to wind effect. Surface...... averaged wind pressure coefficients do not accurately estimate the airflow rates. Therefore, local wind pressure coefficients are needed especially for dynamic calculation of airflow rates. From the wind tunnel experiments, it is concluded that outward opening the sash can significantly affect the wind...

  13. Base excitation testing system using spring elements to pivotally mount wind turbine blades

    Science.gov (United States)

    Cotrell, Jason; Hughes, Scott; Butterfield, Sandy; Lambert, Scott

    2013-12-10

    A system (1100) for fatigue testing wind turbine blades (1102) through forced or resonant excitation of the base (1104) of a blade (1102). The system (1100) includes a test stand (1112) and a restoring spring assembly (1120) mounted on the test stand (1112). The restoring spring assembly (1120) includes a primary spring element (1124) that extends outward from the test stand (1112) to a blade mounting plate (1130) configured to receive a base (1104) of blade (1102). During fatigue testing, a supported base (1104) of a blad (1102) may be pivotally mounted to the test stand (1112) via the restoring spring assembly (1120). The system (1100) may include an excitation input assembly (1140) that is interconnected with the blade mouting plate (1130) to selectively apply flapwise, edgewise, and/or pitch excitation forces. The restoring spring assemply (1120) may include at least one tuning spring member (1127) positioned adjacent to the primary spring element (1124) used to tune the spring constant or stiffness of the primary spring element (1124) in one of the excitation directions.

  14. Russian “Pivot to the East” Strategy: Opportunities and Challenges for Coupling with Chinese Transregional Projectsy

    Directory of Open Access Journals (Sweden)

    Ma Bo

    2017-01-01

    Full Text Available Ukrainian Crisis of 2014 is crucial for Russian pivot to the East which is considered to be a tool for tackling economic challenges and avoiding diplomatic isolation. Economically, this pivot implies cooperation with AsiaPacific region in trade and energy. Politically, it means closer ties with the states of that region. At the same time, the success of the strategy hinges on the state of affairs in energy and on promoting to Asian markets specifi c goods that turns out to be a constraint for diversifi cation of the Russian economy. Moreover, culturally and social Russia is much closer to Europe than Asia, and that is one more obstacle to “Pivot to the East” strategy realization. However, transregional projects of the recent years, including Chinese initiative “One Belt – One Road” and Russian “Pivot to the East” might be key to enhance the strategic potential of Russia-China cooperation which meets Chinese national interests.

  15. Impact of Pivotal Response Training Group Therapy on Stress and Empowerment in Parents of Children with Autism

    Science.gov (United States)

    Minjarez, Mendy Boettcher; Mercier, Emma M.; Williams, Sharon E.; Hardan, Antonio Y.

    2013-01-01

    Parents of children with autism are increasingly being considered as primary agents of intervention for their children. The goal of this study was to evaluate whether participating in a pivotal response training (PRT) group therapy program for parents of children with autism influenced related aspects of parents' lives, namely, their levels of…

  16. Behavioral Cusps: A Person-Centered Concept for Establishing Pivotal Individual, Family, and Community Behaviors and Repertoires

    Science.gov (United States)

    Smith, Garnett J.; McDougall, Dennis; Edelen-Smith, Patricia

    2006-01-01

    Cumulative-hierarchical learning (CHL) and behavior, a premise first introduced by Staats in 1975, describes how higher-level behavioral patterns and structures can emerge from interactions among a set of lower-level actions. Proponents of CHL emphasize the importance of pivotal response interventions, behavior repertoires, generative learning,…

  17. Comparison of Medial and Lateral Meniscus Root Tears.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Koo

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

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

    Science.gov (United States)

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

    2012-03-01

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

  19. Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion

    Energy Technology Data Exchange (ETDEWEB)

    Schlossberg, S. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Umans, H. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Flusser, G. [Tel Aviv Sourasky Medical Center, Department of Radiology, Tel Aviv (Israel); DiFelice, G.S. [Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Lerer, D.B. [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States)

    2007-01-15

    To determine the frequency of medial meniscal extrusion (MME) versus ''medial meniscal intrusion'' in the setting of bucket handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial tear, degenerative joint disease and joint effusion. Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME, medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded. Thirteen females and 27 males (age 12-62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present in all 41 cases. Given an intact medial meniscal root in the setting of a ''pure'' bucket handle tear, there is no MME. (orig.)

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

    Science.gov (United States)

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

    2014-06-01

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

  1. MORPHOMETRIC STUDY OF MEDIAL COLLATERAL LIGAMENTS OF ANKLE

    Directory of Open Access Journals (Sweden)

    Neelu Prasad

    2016-06-01

    Full Text Available BACKGROUND The ankle joint is one of the most frequently injured joint. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. The talocrural joint is a major weight bearing joint of the body. The weight of the body is transmitted from the tibia and fibula to the talus which distributes the weight anteriorly and posteriorly within the foot. One sixth of the static load of the leg is carried by the fibula at the tibiofibular joint. These require a high degree of stability which is determined by the passive and dynamic factors. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. Conventionally, X-ray techniques have been used to diagnose ligament injuries. Magnetic resonance (MR imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The anatomy of the deltoid ligament

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

    Stuphorn, Veit; Emeric, Erik E

    2012-01-01

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

  4. Measuring medial longitudinal arch deformation during gait. A reliability study

    DEFF Research Database (Denmark)

    Bencke, Jesper; Christiansen, Ditte; Jensen, Anne Kathrine Bendrup

    2012-01-01

    during gait and to compare this method with a static measure and a 2D dynamic method. Fifty-two feet (26 healthy male participants) were tested twice 4-9 days apart in a biomechanical gait analysis laboratory using a 3D three-marker foot model, a 2D video-based model for the measurement of MLAD during......Clinical evaluation of medial longitudinal arch deformation (MLAD) during walking gait is often estimated from static measures of e.g. navicular drop (ND) measured during quiet standing. The aim of the present study was to test the reliability of a new three-dimensional method of measuring the MLAD...... gait, and ND for measurements of MLAD during quiet standing. The 3D method showed the highest test-retest reliability among the measurements of MLAD. Furthermore, the ND showed only moderate correlation with both measurements of MLAD during gait. The new 3D method was found to be highly reliable...

  5. Functional disconnectivity of the medial temporal lobe in Asperger's syndrome.

    Science.gov (United States)

    Welchew, David E; Ashwin, Chris; Berkouk, Karim; Salvador, Raymond; Suckling, John; Baron-Cohen, Simon; Bullmore, Ed

    2005-05-01

    Autistic spectrum disorders (ASD) are neurodevelopmental conditions that may be caused by abnormal connectivity between brain regions constituting neurocognitive networks for specific aspects of social cognition. We used three-way multidimensional scaling of regionally parcellated functional magnetic resonance imaging (fMRI) data to explore the hypothesis of abnormal functional connectivity in people with ASD. Thirteen high-functioning individuals with Asperger's syndrome and 13 healthy volunteers were scanned during incidental processing of fearful facial expressions. Using permutation tests for inference, we found evidence for significant abnormality of functional integration of amygdala and parahippocampal gyrus (p Asperger's syndrome. There were less salient abnormalities in functional connectivity of anterior cingulate, inferior occipital, and inferior frontal cortex, but there was no significant difference between groups in whole brain functional connectivity. We conclude there is evidence that functional connectivity of medial temporal lobe structures specifically is abnormal in people with Asperger's syndrome during fearful face processing.

  6. Die mediale Konstruktion von Zugehörigkeit

    Directory of Open Access Journals (Sweden)

    Martin Spetsmann-Kunkel

    2008-11-01

    Full Text Available In dem Sammelband Medien – Diversität – Ungleichheit. Zur medialen Konstruktion sozialer Differenz, herausgegeben von Ulla Wischermann und Tanja Thomas, werden die Darstellung und Reproduktion sozialer Ungleichheit oder Zugehörigkeit durch Medien thematisiert. Die dreizehn Beiträge des Bandes gewähren Einblicke in laufende und abgeschlossene Forschungsarbeiten, die theoretisch und empirisch fundiert am Beispiel einzelner Medieninhalte Prozesse der medialen Konstruktion sozialer Differenz analysieren. Der theoretische Hintergrund erstreckt sich von den Postcolonial Studies über die Critical Whiteness Studies bis hin zu den Queer Studies. Die Beiträge veranschaulichen die ungebrochene Vormachtstellung des weißen, männlichen, heteronormativen und homophoben Blicks in der gegenwärtigen Gesellschaft. Der Band leistet damit einen wichtigen Beitrag bei der Analyse medialer Strategien sozialer Ausgrenzung.

  7. The medial vestibular nuclei, a vulnerable target in thiamine deficiency.

    Science.gov (United States)

    Kattah, Jorge C; Guede, Cindy; Hassanzadeh, Bahareh

    2018-01-01

    Bilateral medial vestibular nuclei (MVN) is a common target in thiamine depletion and results in acute vestibular failure. Involvement of the MVN was present in 27 out of 38 brainstem sections reported in the largest thiamine deficiency autopsy cohort with Wernicke's encephalopathy. Serial clinical, imaging and vestibulo-ocular reflex gain measured with the video head impulse (vHIT) in one patient with acute thiamine deficiency. Low horizontal VOR gain correlated with an abnormal manual head impulse and with MRI evidence of MVN in an alcohol-dependent patient with low thiamine levels. The vertical VOR gain was either normal or mildly abnormal. Thiamine replacement and normal diet restored the VOR gain and MRI signal changes to normal. This single case study provides clinical-imaging correlation for symmetric MVN compromise in thiamine deficiency, its effect on the VOR gain and the favorable response to thiamine and diet replacement when identified early.

  8. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    Science.gov (United States)

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

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

    Science.gov (United States)

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

    2012-02-01

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

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

    Science.gov (United States)

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

    2017-09-28

    To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, PPie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee joint.

  11. Neuronal coding of auditory sensorimotor gating in medial prefrontal cortex.

    Science.gov (United States)

    Tóth, Attila; Petykó, Zoltán; Gálosi, Rita; Szabó, Imre; Karádi, Kázmér; Feldmann, Ádám; Péczely, László; Kállai, Veronika; Karádi, Zoltán; Lénárd, László

    2017-05-30

    The medial prefrontal cortex (mPFC) is thought to be an essential brain region for sensorimotor gating. The exact neuronal mechanisms, however, have not been extensively investigated yet by delicate single unit recording methods Prepulse inhibition (PPI) of the startle response is a broadly used important tool to investigate the inhibitory processes of sensorimotor gating. The present study was designed to examine the neuronal mechanisms of sensorimotor gating in the mPFC in freely moving rats. In these experiments, the animals were subjected to both pulse alone and prepulse+pulse stimulations. Head acceleration and the neuronal activity of the mPFC were simultaneously recorded. To adequately measure the startle reflex, a new headstage with 3D-accelerometer was created. The duration of head acceleration was longer in pulse alone trials than in prepulse+pulse trial conditions, and the amplitude of head movements was significantly larger during the pulse alone than during the prepulse+pulse situations. Single unit activities in the mPFC were recorded by means of chronically implanted tetrodes during acoustic stimulation evoked startle response and PPI. High proportion of medial prefrontal cortical neurons responded to these stimulations by characteristic firing patterns: short duration equal and unequal excitatory, medium duration excitatory, and long duration excitatory and inhibitory responses were recorded. The present findings, first time in the literature, demonstrated the startle and PPI elicited neuronal activity changes of the mPFC, and thus, provided evidence for a key role of this limbic forebrain area in sensorimotor gating process. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2016-11-07

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

  13. Protection of the medial femoral condyle articular cartilage during drilling of the femoral tunnel through the accessory medial portal in anatomic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Abdelkafy, Ashraf

    2012-12-01

    Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL reconstructions and shifting from transtibial drilling toward transportal drilling, the risk of this injury might be increasing, especially during the beginning of their learning curve. To avoid such injury, a bio-interference screw sheath is used. It is inserted through the AMP over the guide pin until it reaches near the medial wall of the lateral femoral condyle. The drill bit is inserted over the guide pin and through the bio-interference screw sheath. Using the bio-interference screw sheath not only protects the articular cartilage of the medial femoral condyle but also protects the medial meniscus, posterior cruciate ligament, and skin of the AMP from injury because of the close proximity of the drill bit head to these structures during transportal drilling.

  14. Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique.

    Science.gov (United States)

    Zheng, Xiaozuo; Li, Tong; Wang, Juan; Dong, Jiangtao; Gao, Shijun

    2016-07-22

    The medial collateral ligament (MCL) is the main static stabilizer of the medial knee. The surgical treatment was recommended in cases with serious medial collateral ligament insufficiency combined with multi-ligament injuries and chronic symptomatic medial instability. Several surgical techniques have been described for the MCL reconstruction, while potential problems including donor site morbidity, complicated procedure, and high risk of femoral tunnel collision were reported. In order to minimize such potential limitations, we describe a new medial reconstruction technique for MCL injury using bone-patellar tendon-bone (BPTB) allograft. A longitudinal incision at the medial knee was made. The centers of femoral and tibial attachments were gained through repeated isometricity test. Then, the bone grooves were made around the femoral and tibial centers. The appropriate BPTB allograft was selected, and both ends were trimmed. The prepared bone blocks were embedded into the grooves and fixed with cancellous screws. The programmed rehabilitation exercises were performed after the operation. A strong graft and bone-to-bone healing on both femoral and tibial attachment sites were obtained, and femoral tunnel collision during multi-ligament reconstruction was avoided. Satisfactory valgus and rotatory stability were gained. This novel MCL reconstruction technique using BPTB allograft can be safely performed, and the clinical outcome was favorable with satisfactory valgus and rotatory stability. More cases and additional follow-up results are needed to verify the overall effect of this technique.

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

    NARCIS (Netherlands)

    Gerbrands, T. A.; Pisters, M. F.|info:eu-repo/dai/nl/317999303; Theeven, P. J R; Verschueren, S.; Vanwanseele, B.

    2017-01-01

    Objective To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics.

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

    NARCIS (Netherlands)

    M.F. Pisters; Drs. Ing. Tim Gerbrands; B. Vanwanseele; P.J.R. Theeven; S. Verschueren

    2016-01-01

    Objective: To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip

  17. Anterolateral Versus Medial Plating of Distal Extra-articular Tibia Fractures: A Biomechanical Model.

    Science.gov (United States)

    Pirolo, Joseph M; Behn, Anthony W; Abrams, Geoffrey D; Bishop, Julius A

    2015-09-01

    Both medial and anterolateral plate applications have been described for the treatment of distal tibia fractures, each with distinct advantages and disadvantages. The objective of this study was to compare the biomechanical properties of medial and anterolateral plating constructs used to stabilize simulated varus and valgus fracture patterns of the distal tibia. In 16 synthetic tibia models, a 45° oblique cut was made to model an Orthopedic Trauma Association type 43-A1.2 distal tibia fracture in either a varus or valgus injury pattern. Each fracture was then reduced and plated with a precontoured medial or anterolateral distal tibia plate. The specimens were biomechanically tested in axial and torsional loading, cyclic axial loading, and load to failure. For the varus fracture pattern, medial plating showed less fracture site displacement and rotation and was stiffer in both axial and torsional loading (Pfracture pattern, there was no statistically significant difference between medial and anterolateral plating. There were no significant differences between the 2 constructs for either fracture pattern with respect to ultimate load, displacement, or energy absorption in load to failure testing. When used to stabilize varus fracture patterns, medial plates showed superior biomechanical performance compared with anterolateral plates. In this application, the medial plates functioned in anti-glide mode. For valgus fracture patterns, no biomechanical differences between anterolateral and medial plating were observed. In clinical practice, surgeons should take this biomechanical evidence into account when devising a treatment strategy for fixation of distal tibia fractures. Copyright 2015, SLACK Incorporated.

  18. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Bay-Nielsen, Morten

    2012-01-01

    We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair.......We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair....

  19. Releasing the circumferential fixation of the medial meniscus does not affect its kinematics

    NARCIS (Netherlands)

    Vrancken, A.C.T.; van Tienen, T.G.; Hannink, G.; Janssen, D.; Verdonschot, Nicolaas Jacobus Joseph; Buma, P.

    2014-01-01

    Background Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical

  20. Tibial avulsion fracture of the posterior root of the medial meniscus in children

    DEFF Research Database (Denmark)

    Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

    2012-01-01

    of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures...

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

    Science.gov (United States)

    Yates, Ben; White, Shaun

    2004-01-01

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

  2. COSTRUIRE TESTI, STRUTTURARE CONVERSAZIONI: LA DIDATTICA DEI SEGNALI DISCORSIVI COME ELEMENTI PIVOT DELL'INTERAZIONE VERBALE

    Directory of Open Access Journals (Sweden)

    Paloma Pernas

    2011-07-01

    Full Text Available Questo articolo intende analizzare un aspetto importante ma spesso trascurato della didattica dell’italiano come L2/LS: i segnali discorsivi (SD nell’interazione orale spontanea. La prima parte dell’articolo riporta i risultati di uno studio sull’acquisizione dei segnali discorsivi da parte di apprendenti ispanofoni in contesto formale. Questi dati, raccolti nell’ambito di una ricerca corpus-based, sono risultati utili per migliorare la didattica di questi importanti meccanismi dell’interazione orale. La seconda parte dell’articolo passa in rassegna i manuali di italiano più usati nelle scuole spagnole che insegnano lingue straniere agli adulti, con particolare riferimento alla dimensione testuale e ai SD in particolare. Come risultato di questa rassegna critica, si propone una selezione delle attività didattiche maggiormente coerenti, da un lato, con un effettivo approccio comunicativo e, dall’altro, con i nostri risultati acquisizionali.     Constructing texts, structuring conversations: didactics of discourse markers as pivotal elements in verbal interaction   This paper aims to shed light on an important yet neglected aspect of Italian in L2/FL teaching: discourse markers in oral interaction. The first part reports the outcomes of Italian DM acquisition by Spanish learners in formal contexts, gathered  from corpus-based research, which can be useful for improving Italian DM teaching and learning. The second part is a review of the most commonly used Italian textbooks in Spanish language schools for adult learners, focusing on the oral textual dimension and specially DM. The result of this review is a selection of the DM learning activities most suited to a communicative approach and our acquisitional findings.

  3. Peptide Inhibitors Targeting the Neisseria gonorrhoeae Pivotal Anaerobic Respiration Factor AniA.

    Science.gov (United States)

    Sikora, Aleksandra E; Mills, Robert H; Weber, Jacob V; Hamza, Adel; Passow, Bryan W; Romaine, Andrew; Williamson, Zachary A; Reed, Robert W; Zielke, Ryszard A; Korotkov, Konstantin V

    2017-08-01

    Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea, which is highly prevalent worldwide and has a major impact on reproductive and neonatal health. The superbug status of N. gonorrhoeae necessitates the development of drugs with different mechanisms of action. Here, we focused on targeting the nitrite reductase AniA, which is a pivotal component of N. gonorrhoeae anaerobic respiration and biofilm formation. Our studies showed that gonococci expressing AniA containing the altered catalytic residues D137A and H280A failed to grow under anaerobic conditions, demonstrating that the nitrite reductase function is essential. To facilitate the pharmacological targeting of AniA, new crystal structures of AniA were refined to 1.90-Å and 2.35-Å resolutions, and a phage display approach with libraries expressing randomized linear dodecameric peptides or heptameric peptides flanked by a pair of cysteine residues was utilized. Biopanning experiments led to the identification of 29 unique peptides, with 1 of them, C7-3, being identified multiple times. Evaluation of their ability to interact with AniA using enzyme-linked immunosorbent assay and computational docking studies revealed that C7-3 was the most promising inhibitor, binding near the type 2 copper site of the enzyme, which is responsible for interaction with nitrite. Subsequent enzymatic assays and biolayer interferometry with a synthetic C7-3 and its derivatives, C7-3m1 and C7-3m2, demonstrated potent inhibition of AniA. Finally, the MIC50 value of C7-3 and C7-3m2 against anaerobically grown N. gonorrhoeae was 0.6 mM. We present the first peptide inhibitors of AniA, an enzyme that should be further exploited for antigonococcal drug development. Copyright © 2017 American Society for Microbiology.

  4. The glial scar-monocyte interplay: a pivotal resolution phase in spinal cord repair.

    Directory of Open Access Journals (Sweden)

    Ravid Shechter

    Full Text Available The inflammatory response in the injured spinal cord, an immune privileged site, has been mainly associated with the poor prognosis. However, recent data demonstrated that, in fact, some leukocytes, namely monocytes, are pivotal for repair due to their alternative anti-inflammatory phenotype. Given the pro-inflammatory milieu within the traumatized spinal cord, known to skew monocytes towards a classical phenotype, a pertinent question is how parenchymal-invading monocytes acquire resolving properties essential for healing, under such unfavorable conditions. In light of the spatial association between resolving (interleukin (IL-10 producing monocytes and the glial scar matrix chondroitin sulfate proteoglycan (CSPG, in this study we examined the mutual relationship between these two components. By inhibiting the de novo production of CSPG following spinal cord injury, we demonstrated that this extracellular matrix, mainly known for its ability to inhibit axonal growth, serves as a critical template skewing the entering monocytes towards the resolving phenotype. In vitro cell culture studies demonstrated that this matrix alone is sufficient to induce such monocyte polarization. Reciprocal conditional ablation of the monocyte-derived macrophages concentrated at the lesion margins, using diphtheria toxin, revealed that these cells have scar matrix-resolving properties. Replenishment of monocytic cell populations to the ablated mice demonstrated that this extracellular remodeling ability of the infiltrating monocytes requires their expression of the matrix-degrading enzyme, matrix metalloproteinase 13 (MMP-13, a property that was found here to be crucial for functional recovery. Altogether, this study demonstrates that the glial scar-matrix, a known obstacle to regeneration, is a critical component skewing the encountering monocytes towards a resolving phenotype. In an apparent feedback loop, monocytes were found to regulate scar resolution. This

  5. Brief parent training in pivotal response treatment for preschoolers with autism.

    Science.gov (United States)

    Coolican, Jamesie; Smith, Isabel M; Bryson, Susan E

    2010-12-01

    Evidence of improved outcomes with early behavioural intervention has placed the early treatment of autism as a health priority. However, long waiting lists for treatment often preclude timely access, raising the question of whether parents could be trained in the interim. Parent training in pivotal response treatment (PRT) has been shown to enhance the communication skills of children with autism. This is typically provided within a 25-hour programme, although less intensive parent training may also be effective. The main objective of the present study was to evaluate the efficacy of brief training in PRT for parents of preschoolers with autism, who were awaiting, or unable to access, more comprehensive treatment. Eight preschoolers with autism and their parents participated in the study. A non-concurrent multiple (across-participants) baseline design was used, in which parents were seen individually for three 2-hour training sessions on PRT. Child and parent outcomes were assessed before, immediately after, and 2 to 4 months following training using standardised tests, questionnaires and behaviour coded directly from video recordings. Overall, children's communication skills, namely functional utterances, increased following training. Parents' fidelity in implementing PRT techniques also improved after training, and generally these changes were maintained at follow-up. A moderate to strong relationship was found between parents' increased ability to implement PRT techniques and improvement in the children's communication skills. Our findings suggest that brief parent training in PRT promises to provide an immediate, cost-effective intervention that could be adopted widely. © 2010 The Authors. Journal of Child Psychology and Psychiatry. © 2010 Association for Child and Adolescent Mental Health.

  6. A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism.

    Science.gov (United States)

    Hardan, Antonio Y; Gengoux, Grace W; Berquist, Kari L; Libove, Robin A; Ardel, Christina M; Phillips, Jennifer; Frazier, Thomas W; Minjarez, Mendy B

    2015-08-01

    With rates of autism diagnosis continuing to rise, there is an urgent need for effective and efficient service delivery models. Pivotal Response Treatment (PRT) is considered an established treatment for autism spectrum disorder (ASD); however, there have been few well-controlled studies with adequate sample size. The aim of this study was to conduct a randomized controlled trial to evaluate PRT parent training group (PRTG) for targeting language deficits in young children with ASD. Fifty-three children with autism and significant language delay between 2 and 6 years old were randomized to PRTG (N = 27) or psychoeducation group (PEG; N = 26) for 12 weeks. The PRTG taught parents behavioral techniques to facilitate language development. The PEG taught general information about ASD (clinical trial NCT01881750; http://www.clinicaltrials.gov). Analysis of child utterances during the structured laboratory observation (primary outcome) indicated that, compared with children in the PEG, children in the PRTG demonstrated greater improvement in frequency of utterances (F(2, 43) = 3.53, p = .038, d = 0.42). Results indicated that parents were able to learn PRT in a group format, as the majority of parents in the PRTG (84%) met fidelity of implementation criteria after 12 weeks. Children also demonstrated greater improvement in adaptive communication skills (Vineland-II) following PRTG and baseline Mullen visual reception scores predicted treatment response to PRTG. This is the first randomized controlled trial of group-delivered PRT and one of the largest experimental investigations of the PRT model to date. The findings suggest that specific instruction in PRT results in greater skill acquisition for both parents and children, especially in functional and adaptive communication skills. Further research in PRT is warranted to replicate the observed results and address other core ASD symptoms. © 2014 Association for Child and Adolescent Mental Health.

  7. The pivotal role of semantic memory in remembering the past and imagining the future

    Directory of Open Access Journals (Sweden)

    Muireann eIrish

    2013-04-01

    Full Text Available Episodic memory refers to a complex and multifaceted process which enables the retrieval of richly detailed evocative memories from the past. In contrast, semantic memory is conceptualised as the retrieval of general conceptual knowledge divested of a specific spatiotemporal context. The neural substrates of the episodic and semantic memory systems have been dissociated in healthy individuals during functional imaging studies, and in clinical cohorts, leading to the prevailing view that episodic and semantic memory represent functionally distinct systems subtended by discrete neurobiological substrates. Importantly, however, converging evidence focusing on widespread neural networks now points to significant overlap between those regions essential for retrieval of autobiographical memories, episodic learning, and semantic processing. Here we review recent advances in episodic memory research focusing on neurodegenerative populations which has proved revelatory for our understanding of the complex interplay between episodic and semantic memory. Whereas episodic memory research has traditionally focused on retrieval of autobiographical events from the past, we also include evidence from the recent paradigm shift in which episodic memory is viewed as an adaptive and constructive process which facilitates the imagining of possible events in the future. We examine the available evidence which converges to highlight the pivotal role of semantic memory in providing schemas and meaning whether one is engaged in autobiographical retrieval for the past, or indeed, is endeavouring to construct a plausible scenario of an event in the future. It therefore seems plausible to contend that semantic processing may underlie most, if not all, forms of episodic memory, irrespective of temporal condition.

  8. A pivotal role of lumbar spinothalamic cells in the regulation of ejaculation via intraspinal connections.

    Science.gov (United States)

    Staudt, Michael D; Truitt, William A; McKenna, Kevin E; de Oliveira, Cleusa V R; Lehman, Michael N; Coolen, Lique M

    2012-09-01

    A population of lumbar spinothalamic cells (LSt cells) has been demonstrated to play a pivotal role in ejaculatory behavior and comprise a critical component of the spinal ejaculation generator. LSt cells are hypothesized to regulate ejaculation via their projections to autonomic and motor neurons in the lumbosacral spinal cord. The current study tested the hypothesis that ejaculatory reflexes are dependent on LSt cells via projections within the lumbosacral spinal cord. Male rats received intraspinal injections of neurotoxin saporin conjugated to substance P analog, previously shown to selectively lesion LSt cells. Two weeks later, males were anesthetized and spinal cords were transected. Subsequently, males were subjected to ejaculatory reflex paradigms, including stimulation of the dorsal penile nerve (DPN), urethrogenital stimulation or administration of D3 agonist 7-OH-DPAT. Electromyographic recordings of the bulbocavernosus muscle (BCM) were analyzed for rhythmic bursting characteristic of the expulsion phase of ejaculation. In addition, a fourth commonly used paradigm for ejaculation and erections in unanesthetized, spinal-intact male rats was utilized: the ex copula reflex paradigm. LSt cell lesions were predicted to prevent rhythmic bursting of BCM following DPN, urethral, or pharmacological stimulation, and emissions in the ex copula paradigm. In contrast, LSt cell lesions were not expected to abolish erectile function as measured in the ex copula paradigm. LSt cell lesions prevented rhythmic contractions of the BCM induced by any of the ejaculatory reflex paradigms in spinalized rats. However, LSt cell lesions did not affect erectile function nor emissions determined in the ex copula reflex paradigm. These data demonstrate that LSt cells are essential for ejaculatory, but not erectile reflexes, as previously reported for mating animals. Moreover, LSt cells mediate ejaculation via projections within the spinal cord, presumably to autonomic and motor

  9. Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review

    Science.gov (United States)

    Carreau, Joseph H.

    2017-01-01

    Abstract Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option. PMID:28852346

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

    Science.gov (United States)

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

    2017-01-01

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

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

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Richter, Camilla; Brushøj, Christoffer

    2014-01-01

    PURPOSE: To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain. METHODS: This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar...... pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total...... forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat. RESULTS: The primary outcome showed that individuals with patellofemoral pain had a 22 % higher medial-to-lateral peak force during drop jump...

  12. On the isomorphism between the medial axis and a dual of the Delaunay graph

    DEFF Research Database (Denmark)

    Sharma, Ojaswa; Anton, François; Mioc, Darka

    2009-01-01

    In this paper, we show a graph isomorphism between a dual graph of the Delaunay graph of the sampled points and the medial axis of the sampled features. This dual graph captures the fact that two Delaunay triangles share two vertices or an edge. Then, we apply it to the computation of the medial...... axis of the features selected in an image. The computation of the medial axis of images is of interest in applications such as mapping, climatology, change detection, medicine, etc. This research work provides a way to automate the computation of the medial axis transform of the features of color 2D...... images. In color images, various features can be distinguished based on their color. The features are thus extracted as object borders, which are sampled in order to compute the medial axis transform. We present also a prototype application for the completely automated or semi-automated processing...

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

    DEFF Research Database (Denmark)

    Eygendaal, D; Olsen, Bo Sanderhoff; Jensen, Steen Lund

    2000-01-01

    In this study the kinematics of partial and total ruptures of the medial collateral ligament of the elbow are investigated. After selective transection of the medial collateral ligament of 8 osteoligamentous intact elbow preparations was performed, 3-dimensional measurements of angular displacement...... ligament and was maximum between 70 degrees to 90 degrees of flexion. No radial head movement was seen after partial or total transection of the anterior bundle of the medial collateral ligament was performed. In conclusion, this study indicates that valgus or internal rotatory elbow instability should...... be evaluated at 70 degrees to 90 degrees of flexion. Detection of partial ruptures in the anterior bundle of the medial collateral ligament based on medial joint opening and increased valgus movement is impossible....

  14. Feasibility of the Medial Temporal lobe Atrophy index (MTAi and derived methods for measuring atrophy of the medial temporal lobe

    Directory of Open Access Journals (Sweden)

    Francisco eConejo Bayón

    2014-11-01

    Full Text Available Introduction: the Medial Temporal-lobe Atrophy index (MTAi, 2D-Medial Temporal Atrophy (2D-MTA, yearly rate of MTA (yrRMTA and yearly rate of relative MTA (yrRMTA are simple protocols for measuring the relative extent of atrophy in the MTL in relation to the global brain atrophy. Albeit preliminary studies showed interest of these methods in the diagnosis of AD, FTLD and correlation with cognitive impairment in PD, formal feasibility and validity studies remained pending. As a first step, we aimed to assess the feasibility. Mainly, we aimed to assess the reproducibility of measuring the areas needed to compute these indices. We also aimed to assess the efforts needed to start using these methods correctly. Methods: a series of 290 1.5T-MRI studies from 230 subjects ranging 65-85 years old who had been studied for cognitive impairment were used in this study. Six inexperienced tracers (IT plus one experienced tracer (ET traced the three areas needed to compute the indices. Finally, tracers underwent a short survey on their experience learning to compute the MTAi and experience of usage, including items relative to training time needed to understand and apply the MTAi, time to perform a study after training and overall satisfaction. Results: learning to trace the areas needed to compute the MTAi and derived methods is quick and easy. Results indicate very good intrarater ICC for the MTAi, good intrarater ICC for the 2D-MTA, yrMTA and yrRMTA and also good interrater ICC for the MTAi, 2D-MTA, yrMTA and yrRMTA.Conclusion: our data support that MTAi and derived methods (2D-MTA, yrMTA and yrRTMA have good to very good intrarater and interrater reproducibility and may be easily implemented in clinical practice even if new users have no experience tracing the area of regions of interest.

  15. Automated generation of massive image knowledge collections using Microsoft Live Labs Pivot to promote neuroimaging and translational research

    Science.gov (United States)

    2011-01-01

    Background Massive datasets comprising high-resolution images, generated in neuro-imaging studies and in clinical imaging research, are increasingly challenging our ability to analyze, share, and filter such images in clinical and basic translational research. Pivot collection exploratory analysis provides each user the ability to fully interact with the massive amounts of visual data to fully facilitate sufficient sorting, flexibility and speed to fluidly access, explore or analyze the massive image data sets of high-resolution images and their associated meta information, such as neuro-imaging databases from the Allen Brain Atlas. It is used in clustering, filtering, data sharing and classifying of the visual data into various deep zoom levels and meta information categories to detect the underlying hidden pattern within the data set that has been used. Method We deployed prototype Pivot collections using the Linux CentOS running on the Apache web server. We also tested the prototype Pivot collections on other operating systems like Windows (the most common variants) and UNIX, etc. It is demonstrated that the approach yields very good results when compared with other approaches used by some researchers for generation, creation, and clustering of massive image collections such as the coronal and horizontal sections of the mouse brain from the Allen Brain Atlas. Results Pivot visual analytics was used to analyze a prototype of dataset Dab2 co-expressed genes from the Allen Brain Atlas. The metadata along with high-resolution images were automatically extracted using the Allen Brain Atlas API. It is then used to identify the hidden information based on the various categories and conditions applied by using options generated from automated collection. A metadata category like chromosome, as well as data for individual cases like sex, age, and plan attributes of a particular gene, is used to filter, sort and to determine if there exist other genes with a similar

  16. Eye position encoding in three-dimensional space: integration of version and vergence signals in the medial posterior parietal cortex.

    Science.gov (United States)

    Breveglieri, Rossella; Hadjidimitrakis, Kostas; Bosco, Annalisa; Sabatini, Silvio P; Galletti, Claudio; Fattori, Patrizia

    2012-01-04

    Eye position signals are pivotal in the visuomotor transformations performed by the posterior parietal cortex (PPC), but to date there are few studies addressing the influence of vergence angle upon single PPC neurons. In the present study, we investigated the influence on single neurons of the medial PPC area V6A of vergence and version signals. Single-unit activity was recorded from V6A in two Macaca fascicularis fixating real targets in darkness. The fixation targets were placed at eye level and at different vergence and version angles within the peripersonal space. Few neurons were modulated by version or vergence only, while the majority of cells were affected by both signals. We advance here the hypothesis that gaze-modulated V6A cells are able to encode gazed positions in the three-dimensional space. In single cells, version and vergence influenced the discharge with variable time course. In several cases, the two gaze variables influence neural discharges during only a part of the fixation time, but, more often, their influence persisted through large parts of it. Cells discharging for the first 400-500 ms of fixation could signal the arrival of gaze (and/or of spotlight of attention) in a new position in the peripersonal space. Cells showing a more sustained activity during the fixation period could better signal the location in space of the gazed objects. Both signals are critical for the control of upcoming or ongoing arm movements, such as those needed to reach and grasp objects located in the peripersonal space.

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

    Science.gov (United States)

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

    2017-12-28

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

  18. Effects of Shoes and a Prefabricated Medial Arch Support on Medial Gastrocnemius and Tibialis Anterior Activity while doing Leg Press Exercise in Normal Feet Athletes

    Directory of Open Access Journals (Sweden)

    Maryam Sheikhi

    2017-04-01

    Full Text Available Background: Nowadays, different types of exercise machines are being used in the field of athletic training, recreation, post-injury and post-operation rehabilitation. Leg press is a commonly-used one that retrains muscles and simulates natural functional activities. In this activity, feet are in contact with a footrest to exert muscular forces. In addition, the footrest inserts reactive forces to feet and from the feet load would transfer to structures that are more proximal. Any misalignment in foot structure may interfere its function. Objective: The aim of this study was to assess the effect of shoes and using a prefabricated medial arch support on the activity of Tibialis anterior and medial gastrocnemius muscles while doing leg press exercise in normal feet subjects. Method: 14 men with normal Medial Longitudinal Arch and normal Body Mass Index aged between 18-35 years old, with at least 6 months experience of doing leg press volunteered to participate in this study.  Medial gastrocnemius and Tibialis anterior activity were measured by surface electromyography while doing leg press with 70% of subjects 1 Repetition Maximum.  To increase accuracy, motion was divided into knee flexion and knee extension phases. Peak Amplitude, Time to Peak Amplitude and Root Mean Square variables were used for analysis. Wilcoxon nonparametric test was used to compare the results. Results: No statistically significant difference was found in the electromyographic parameters of Medial gastrocnemius nor Tibialis anterior in any phases of motion, except for an increase in Tibialis anterior time to peak amplitude in shod condition compared with barefoot in knee extension phase of motion (p-value=0.008 and Tibialis anterior RMS in knee flexion phase in orthotic condition compared to shod (p-value=0.03. Conclusion: It seems that in high loads shoes or medial arch supports cannot change electromyographic parameters in Medial gastrocnemius nor Tibialis anterior in

  19. Electrical stimulation to reduce the overload in upper limbs during sitting pivot transfer in paraplegic: a preliminary study

    Directory of Open Access Journals (Sweden)

    Ana Claudia G. Lopes

    2016-08-01

    Full Text Available Transfer is a key ability and allows greater interact with the environment and social participation. Conversely, paraplegics have great risk of pain and injury in the upper limbs due to joint overloads during activities of daily living, like transfer. The main goal of this study is to verify if the use of functional electrical stimulation (FES in the lower limbs of paraplegic individuals can assist the sitting pivot transfer (SPT. The secondary objective is to verify if there is a greater participation of the lower limbs during lift pivot phase. A preliminary study was done with one complete paraplegic individual. Temporal parameters were calculated and a kinetic assessment was done during the SPT. The preliminary results showed the feasibility of FES for assisting the SPT.

  20. Location and tension of the medial palpebral ligament.

    Science.gov (United States)

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

    2013-11-01

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

  1. Influence of aging on medial olivocochlear system function

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    Lisowska G

    2014-06-01

    Full Text Available Grazyna Lisowska, Grzegorz Namyslowski, Boguslawa Orecka, Maciej MisiolekDepartment of Otolaryngology, Medical University of Silesia, Zabrze, PolandBackground: There is still controversy regarding the influence of aging on medial olivocochlear (MOC system function. The main objective of this study is to measure age-related changes of MOC system function in people with normal hearing thresholds.Method: Bilateral assessment of the MOC effect for click-evoked otoacoustic emissions (CEOAEs; at 70±3 dB peak sound pressure level [pSPL], click at 50/second, 260 repeats, 2.5–20 millisecond window and for distortion product otoacoustic emissions (DPOAEs; with [frequencies] f2/f1=1.22, [levels of primary tones] L1=65 dB SPL and L2=55 dB SPL; DP-grams for 2f1-f2 were collected for the f1 frequencies varying from 977 Hz to 5,164 kHz, with the resolution of four points per octave was performed in a group of 146 (n=292 ears healthy, right-handed subjects aged from 10–60 years with a bilateral hearing threshold from 0.25–4.0 kHz, not exceeding 20 dB hearing level; normal tympanograms; and a threshold of the contralateral stapedial reflex for broadband noise (BBN of 75 dB SPL or higher. The MOC inhibition was assessed on the basis of changes in OAE level during BBN contralateral stimulation at 50 dB sensation level (mean, 65±3 dB SPL.Results: Comparative analysis of the MOC effect for CEOAE and DPOAE showed the weakest effect in the oldest age group (41–60 years at almost all tested frequencies. Moreover, a weak, albeit significant, positive correlation between the level of OAE and the size of the MOC effect was documented.Conclusion: On the basis of our study, we have found a decrease in the strength of the MOC system with increasing age in normally hearing subjects, as reflected by a decrease of the OAE suppression effects in older individuals and an increase of the number of CEOAE and DPOAE enhancements during contralateral

  2. Comparative study regarding physical characteristics at male handball players activating on wing and pivot positions at Romanian team Steaua Bucharest

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    Ioana-Maria CURIŢIANU

    2017-02-01

    Full Text Available Aim and purpose. The main purpose of this article was to evaluate the differences between physical characteristics at wings and pivots (nine subjects, male handball experienced players, from Romanian handball team Steaua Bucharest, previous to their participation in the Romanian National League, competitive season 2013-2014. Material and methods. In order to achieve this research on the motric evaluation of the players that activate in the 6m. line at team Steaua Bucharest, that activates in Romanian National League, before competitive season 2013-2014, we used the following research methods: literature review, testing method conducted by using five control samples in order to establish the physical qualities of the handball players understudy, the data collected was used to analyze the motric performance of wing and pivot players; the statistical and mathematical method was used to underline the differences between the players that activate in the three positions on the team. Results. The interpretation of the results led to establishing the differences in terms of physical qualities between 6m line players from Romanian male handball team Steaua Bucharest. Results revealed that there are no significant differences in terms of physical qualities between wing players and pivot players. Conclusions. After processing and interpretation of results we can state that the performance of the 6m. line players of the Romanian team understudy was a good one with no significant differences between the results obtained by wings and pivots at the battery of tests (five tests but after this analysis, coaches could perfect their training program in order to achieve better physical results because it is known that motivation, tactics and technical skills play a far more important role in team sports than any other characteristics, but without a good physical training these abilities are incomplete.

  3. Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test.

    Science.gov (United States)

    Muller, Bart; Hofbauer, Marcus; Rahnemai-Azar, Amir Ata; Wolf, Megan; Araki, Daisuke; Hoshino, Yuichi; Araujo, Paulo; Debski, Richard E; Irrgang, James J; Fu, Freddie H; Musahl, Volker

    2016-01-01

    The pivot shift test is a commonly used clinical examination by orthopedic surgeons to evaluate knee function following injury. However, the test can only be graded subjectively by the examiner. Therefore, the purpose of this study is to develop software for a computer tablet to quantify anterior translation of the lateral knee compartment during the pivot shift test. Based on the simple image analysis method, software for a computer tablet was developed with the following primary design constraint - the software should be easy to use in a clinical setting and it should not slow down an outpatient visit. Translation of the lateral compartment of the intact knee was 2.0 ± 0.2 mm and for the anterior cruciate ligament-deficient knee was 8.9 ± 0.9 mm (p software provides reliable, objective, and quantitative data on translation of the lateral knee compartment during the pivot shift test and meets the design constraints posed by the clinical setting.

  4. Contacts between medial and lateral perforant pathway fibers and parvalbumin expressing neurons in the subiculum of the rat

    NARCIS (Netherlands)

    Wouterlood, F.G.; Boekel, A.J.; Aliane, V.; Belien, J.A.M.; Uylings, H.B.M.; Witter, M.P.

    2008-01-01

    The entorhinal cortex (EC) projects via the perforant pathway to all subfields in the hippocampal formation. One can distinguish medial and lateral components in the pathway, originating in corresponding medial and lateral subdivisions of EC. We analyzed the innervation by medial and lateral

  5. Medial Calcar Support and Radiographic Outcomes of Plate Fixation for Proximal Humeral Fractures

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    Shih-Jie Lin

    2015-01-01

    Full Text Available Plate fixation remains one of the most popular surgical procedures for treating proximal humeral fractures (PHFx; however, substantial rates of complications have been reported in the literature. The objectives of the study were to examine how medial calcar support (MCS affects the radiographic outcomes and to determine the prognostic factors predicting treatment failure. We performed a retrospective cohort study of 89 adult patients who had PHFx and were treated with plate fixation at our institution in 2007–2011. The enrolled patients were separated into two groups according to disruption of medial calcar. Our results revealed an increased rate of poor radiographic outcomes in patients with disrupted medial calcar. Osteonecrosis of the humeral head and redisplacement were the two radiographic outcomes which had a positive causality with disruption of medial calcar (P=0.008 and 0.050, resp.. Deficient medial calcar, inadequate reduction, diabetes mellitus, chronic kidney disease, and chronic liver disease were all significant predictors for the development of osteonecrosis in patients after PHFx surgery. Inadequate reduction was also a predictor for redisplacement. We confirmed that the restoration of medial calcar as well as comorbid conditions plays key roles in treatment of patients having PHFx with disrupted medial calcar.

  6. Elastic Intramedullary Nailing of a Medial Clavicle Fracture in a Pediatric Patient

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    Michael J. Stark

    2017-01-01

    Full Text Available Introduction. Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient. Case Presentation. A pediatric patient sustained a completely displaced fracture of the medial clavicle. The fracture was lateral to the medial physis of the clavicle and did not involve the sternoclavicular joint. Internal fixation was achieved in an anatomic position with an elastic intramedullary nail. The postoperative course was unremarkable and resulted in complete healing of the fracture in an anatomic position. The patient returned to full activities without any pain or dysfunction. Conclusion. The use of elastic intramedullary nails is a viable option for internal fixation of displaced medial clavicle fractures. Knowledge of the surgical anatomy, potential implant complications, and rehabilitation principles is essential to a successful outcome.

  7. A review of surgical and nonsurgical outcomes of medial knee injuries.

    Science.gov (United States)

    Smyth, Mark P; Koh, Jason L

    2015-06-01

    Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medial-sided knee injuries, and combined injuries. In general, most authors concur that isolated partial or complete medial collateral ligament (MCL) injuries can be treated nonoperatively with a brace and early motion with good clinical outcomes. Prospective, randomized trials support nonoperative treatment of the MCL in combined anterior cruciate ligament-MCL injuries. Knee dislocations and posterior medial corner injuries appear to have better results with surgical management including reconstruction. Multiple reconstructive techniques have been described for chronic injuries but it is difficult to compare their results.

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

    Science.gov (United States)

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

    2017-01-01

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

  9. Effects of medial and lateral displacement calcaneal osteotomies on tibiotalar joint contact stresses.

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    Steffensmeier, S J; Saltzman, C L; Berbaum, K S; Brown, T D

    1996-11-01

    Translational calcaneal osteotomies are used clinically to realign the mechanical axis of the lower limb. In this study, the effects of medial and lateral displacements of the posteroinferior fragment on tibiotalar joint contact mechanics were assessed using pressure-sensitive film. Eight osteotomized fresh-frozen cadaver specimens were loaded in each of three testing positions: neutral position (no shift), 1 cm of lateral displacement of the inferior fragment with respect to the superior fragment, and 1 cm of medial displacement of the inferior fragment. For an applied load of 1,330 N, two times body weight, a 1 cm lateral displacement shifted the center of pressure an average of 1.06 mm laterally, whereas a 1 cm medial displacement shifted the center of pressure an average of 1.58 mm medially. While global contact parameters (contact area, spatial mean contact stress, and peak local contact stress) were not appreciably altered by osteotomy, regional contact parameters changed in a reproducible and statistically significant manner. Among four nominally equal-sized, parasagittally bounded cartilage zones, lateral displacements consistently unloaded the most medial zone and increased loading of the most lateral zone; medial calcaneal displacements had the converse effect. These cadaver results suggest that translational calcaneal osteotomies may be used clinically to partially offload focal areas of cartilage along the medial and lateral borders of the tibiotalar joint.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2007-09-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Fratura avulsão do planalto tibial medial (Segond reverso Avulsion fracture of the medial tibial plateau (reverse Segond injury

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    Fabio Janson Angelini

    2007-01-01

    Full Text Available Descreve-se neste artigo um padrão de lesão descrito na literatura apenas duas vezes, num total de quatro casos, denominado Segond reverso por apresentar achados clínicos e radiológicos exatamente opostos aos da clássica lesão de Segond. Semelhantemente aos casos previamente descritos, apresentou fratura avulsão do planalto tibial medial, na inserção do ligamento colateral medial profundo, associada a lesão do ligamento cruzado posterior. Assim como em um dos casos prévios, foi constatada lesão do ligamento cruzado anterior. Entretanto, diferiu dos anteriormente relatados por não apresentar lesão do menisco medial.This article reports an injury pattern described only twice in literature, totaling four cases, and referred to as reverse Segond injury for its clinical and radiological findings are precisely opposite to those observed in the classical Segond injury. Similarly to the previously described cases, our case reported avulsion fracture of the medial tibial plateau at the insertion of the deep tibial collateral ligament, associated to posterior cruciate ligament injury. Similarly to one of the previous cases, anterior cruciate ligament injury was found in our case, although it differs from the previous ones because it does not show medial meniscal injury.

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

    Science.gov (United States)

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

    2015-11-01

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

  15. Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors.

    Science.gov (United States)

    Tanaka, Makoto; Hayashida, Kenji; Kobayashi, Atsushi; Kakiuchi, Masaaki

    2015-11-01

    To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3 months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus.

    Science.gov (United States)

    Hsi, Wei-Li

    2016-03-01

    After initial heel contact, the rearfoot everts and causes medial deviation of the center of pressure (CoP). Although rearfoot angle in single-limb stance has been associated with forefoot varus (FV) ≥ 8°, medial CoP deviation has not. After 12 participants with FV 0 kPa as when it had the most medial CoP, the medial deviations of the CoP of the array, the most medial CoP of the row, and its relative position in the row (CoP%), were compared between neutral and FV groups. The medial deviations of the most medial CoP of the row (1.1 ± 0.6 vs. 1.6 ± 0.3 mm, p = 0.049) and CoP% (2.9 ± 1.4 vs. 4.2 ± 1.1%, p = 0.023) were significantly different between neutral and FV groups, whereas that of the CoP of the array (1.1 ± 0.6 vs. 1.4 ± 0.6 mm, p = 0.36) was not. The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences. Copyright © 2015. Published by Elsevier B.V.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. The role of medial frontal gyrus in action anticipation in professional badminton players

    Directory of Open Access Journals (Sweden)

    Huan Xu

    2016-11-01

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

  19. Patella fracture after medial patellofemoral ligament reconstruction using suture anchors.

    Science.gov (United States)

    Dhinsa, Baljinder Singh; Bhamra, Jagmeet Singh; James, Chris; Dunnet, William; Zahn, Helmut

    2013-12-01

    The medial patellofemoral ligament (MPFL) acts as a soft tissue restraint to lateral subluxation of the patella, and is frequently damaged following patellar dislocation. A number of techniques for repair or reconstructions of the MPFL have been reported. We report two cases of patellar fracture following MPFL reconstruction utilizing suture anchors and bone tunnels that do not completely traverse the patella. The first case occurred seven months after surgery and the second case was at six weeks following surgery. There have been previous reports of patellar fracture following MPFL reconstruction, particularly when patellar tunnels completely traverse the patella. The authors decided to use suture anchors to reduce the risk of patellar fracture, and they feel that the fractures reported in this paper resulted from surgical error rather than system error. We feel that this is an important learning point when initially using this technique, and should be disseminated to other surgeons who undertake this surgery. Copyright © 2013 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2016-12-13

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

  1. Endogenous androgens and carotid intimal-medial thickness in women.

    Science.gov (United States)

    Bernini, G P; Sgro', M; Moretti, A; Argenio, G F; Barlascini, C O; Cristofani, R; Salvetti, A

    1999-06-01

    The influence of endogenous androgens on atherosclerotic disease in women is unknown. In this study involving 101 pre- and post-menopausal females, we evaluated the relationship between serum androgen levels and both carotid artery intimal-medial thickness (IMT) and major cardiovascular risk factors. In addition to evaluation of blood pressure, body mass index, and waist-to-hip ratio, serum dehydroepiandrosterone sulfate (DHEA-S), androstenedione (A), total testosterone (TTS), free testosterone (FTS), insulin, cholesterol (total and high density lipoproteins), triglycerides, and glucose were measured. All women underwent carotid ultrasonography. Spearman correlation coefficients showed that serum DHEA-S and A levels were negatively related (P body mass index (P < 0.02). Stepwise multiple regression analysis indicated that A and FTS showed an inverse association with IMT measures (P < 0.05-0.001). In conclusion, our data indicate that in women serum DHEA-S and androgens decline with age and that normal hormonal levels are not associated with major cardiovascular risk factors. They also show that higher DHEA-S and androgen concentrations are related to lower carotid wall thickness; for A this association is independent of cardiovascular risk factors. Our results suggest that, in the physiological range, DHEA-S and androgens in women are correlated with lower risk of carotid artery atherosclerosis.

  2. Anterior medial prefrontal cortex implements social priming of mimicry.

    Science.gov (United States)

    Wang, Yin; Hamilton, Antonia F de C

    2015-04-01

    The neural and cognitive mechanisms by which primed constructs can impact on social behavior are poorly understood. In the present study, we used functional magnetic resonance imaging (fMRI) to explore how scrambled sentence priming can impact on mimicry behavior. Sentences involving pro/antisocial events from a first/third-person point of view were presented in short blocks, followed by a reaction-time assessment of mimicry. Behavioral results showed that both prosociality and viewpoint impact on mimicry, and fMRI analysis showed this effect is implemented by anterior medial prefrontal cortex (amPFC). We suggest that social primes may subtly modulate processing in amPFC in a manner linked to the later behavior, and that this same region also implements the top-down control of mimicry responses. This priming may be linked to processing of self-schemas in amPFC. Our findings demonstrate how social priming can be studied with fMRI, and have important implications for our understanding of the underlying mechanisms of prime-to-behavior effects as well as for current theories in social psychology. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

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

    Science.gov (United States)

    Maier, Steven F; Watkins, Linda R

    2010-10-08

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

  4. Autonoetic Consciousness in Autobiographical Memories after Medial Temporal Lobe Resection

    Directory of Open Access Journals (Sweden)

    M. Noulhiane

    2008-01-01

    Full Text Available This study aims to investigate autonoetic consciousness associated with episodic autobiographical memory in patients who had undergone unilateral medial temporal lobe resection for intractable epilepsy. Autonoetic consciousness, defined as the conscious feeling of mentally travelling back in time to relive a specific event, was assessed using the Remember/Know (R/K paradigm across different time periods as proposed in the autobiographical memory task developed by Piolino et al. (TEMPau task. Results revealed that the two patient groups (left and right temporal resection gave reduced sense of reliving (R responses and more familiarity (K responses than healthy controls. This poor autonoetic consciousness was highlighted when patients were asked to justify their Remember responses by recalling sensory-perceptive, affective or spatiotemporal specific details across all life periods. These results support the bilateral MTL contribution to episodic autobiographical memory covering the entire lifespan, which is consistent with the multiple trace theory of MTL function [7,9]. This study also demonstrates the bilateral involvement of MTL structures in recalling specific details of personal events characterized by autonoetic consciousness.

  5. Transient medial prefrontal perturbation reduces false memory formation.

    Science.gov (United States)

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

    2017-03-01

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

  6. Automated measurement of medial temporal lobe atrophy by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hattori, Masumi [Tokai Memorial Hospital, Department of Radiology, Kasugai-shi, Aichi (Japan); Koyama, Shuji; Kodera, Yoshie [Nagoya University School of Health Sciences, Department of Radiological Technology, Higashi-ku, Nagoya (Japan); Kogure, Yosuke [Tokyo Metropolitan Koto Geriatric Medical Center, Department of Radiology, 3-3-20 Shinsuna, Koutou-ku, Tokyo (Japan); Ido, Yasushi; Asano, Hirofumi [Kizawa Memorial Hospital, Department of Radiology, Minokamo-shi, Gifu (Japan)

    2007-04-15

    Objects Evaluation of medial temporal lobe (MTL) atrophy is usually performed by magnetic resonance imaging (MRI). In Japan, however, the availability of computed tomography (CT) is much higher than that of MRI. The evaluation of MTL atrophy using CT may be useful when MRI is unavailable. This project developed a technique to automatically measure MTL atrophy using axial CT imaging and assessed the sensitivity of this method for diagnosing dementia of Alzheimer type (DAT). Materials and methods Linear measurements were taken for the width of the temporal horn, the width of the MTL, and the interuncal distance and the area of the temporal horn were measured. The algorithm developed employs the gray level threshold and the snake technique to process axial CT images. The algorithm was evaluated on 85 patients. Results The efficacy of this automated method was verified by a quantitative comparison of computerdetermined and manually obtained MTL measures, and based on its sensitivity and specificity in differentiating patients with DAT from control subjects. Conclusions This fully automated method of measuring MTL atrophy using CT is feasible and effective in DAT diagnosis, and simple to perform clinically. This method may be a practical alternative for MRI in some settings. (orig.)

  7. Visual working memory capacity and the medial temporal lobe

    Science.gov (United States)

    Jeneson, Annette; Wixted, John T.; Hopkins, Ramona O.; Squire, Larry R.

    2012-01-01

    Patients with medial temporal lobe (MTL) damage are sometimes impaired at remembering visual information across delays as short as a few seconds. Such impairments could reflect either impaired visual working memory capacity or impaired long-term memory (because attention has been diverted or because working memory capacity has been exceeded). Using a standard change-detection task, we asked whether visual working memory capacity is intact or impaired after MTL damage. Five patients with hippocampal lesions and one patient with large MTL lesions saw an array of 1, 2, 3, 4, or 6 colored squares, followed after 3, 4, or 8 seconds by a second array where one of the colored squares was cued. The task was to decide whether the cued square had the same color as the corresponding square in the first array or a different color. At the 1s delay typically used to assess working memory capacity, patients performed as well as controls at all array sizes. At the longer delays, patients performed as well as controls at small array sizes, thought to be within the capacity limit, and worse than controls at large array sizes, thought to exceed the capacity limit. The findings suggest that visual working memory capacity in humans is intact after damage to the MTL structures and that damage to these structures impairs performance only when visual working memory is insufficient to support performance. PMID:22399780

  8. Medial efferent mechanisms in children with auditory processing disorders

    Directory of Open Access Journals (Sweden)

    Srikanta eMishra

    2014-10-01

    Full Text Available Auditory processing disorder (APD affects about 2 to 5% of children. However, the nature of this disorder is poorly understood. Children with APD typically have difficulties in complex listening situations. One mechanism thought to aid in listening-in-noise is the medial olivocochlear (MOC inhibition. The purpose of this review was to critically analyze the published data on MOC inhibition in children with APD to determine whether the MOC efferents are involved in these individuals. The otoacoustic emission (OAE methods used to assay MOC reflex were examined in the context of the current understanding of OAE generation mechanisms. Relevant literature suggests critical differences in the study population and OAE methods. Variables currently known to influence MOC reflex measurements, for example, middle-ear muscle reflexes or OAE signal-to-noise ratio, were not controlled by most studies. The use of potentially weaker OAE methods and the remarkable heterogeneity across studies does not allow for a definite conclusion whether or not the MOC reflex is altered in children with APD. Further carefully designed studies are needed. Knowledge of efferent functioning in children with APD would be mechanistically and clinically beneficial.

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

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    Shannon B. Z. Stephens

    2017-08-01

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

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

    Science.gov (United States)

    Stephens, Shannon B Z; Kauffman, Alexander S

    2017-01-01

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

  11. Medial temporal lobe roles in human path integration.

    Directory of Open Access Journals (Sweden)

    Naohide Yamamoto

    Full Text Available Path integration is a process in which observers derive their location by integrating self-motion signals along their locomotion trajectory. Although the medial temporal lobe (MTL is thought to take part in path integration, the scope of its role for path integration remains unclear. To address this issue, we administered a variety of tasks involving path integration and other related processes to a group of neurosurgical patients whose MTL was unilaterally resected as therapy for epilepsy. These patients were unimpaired relative to neurologically intact controls in many tasks that required integration of various kinds of sensory self-motion information. However, the same patients (especially those who had lesions in the right hemisphere walked farther than the controls when attempting to walk without vision to a previewed target. Importantly, this task was unique in our test battery in that it allowed participants to form a mental representation of the target location and anticipate their upcoming walking trajectory before they began moving. Thus, these results put forth a new idea that the role of MTL structures for human path integration may stem from their participation in predicting the consequences of one's locomotor actions. The strengths of this new theoretical viewpoint are discussed.

  12. Outcomes of Medial Collateral Ligament Injuries during Total Knee Arthroplasty.

    Science.gov (United States)

    Siqueira, Marcelo B P; Haller, Kathryn; Mulder, Andrew; Goldblum, Andrew S; Klika, Alison K; Barsoum, Wael K

    2016-01-01

    Intraoperative medial collateral ligament (MCL) disruption during total knee arthroplasty (TKA) is often managed with either primary repair or use of a constrained implant. A total of 23 patients with an MCL injury during TKA between 2003 and 2009 were compared with 92 matched controls. Of the 23 patients, 10 were treated with an unconstrained implant and primary MCL repair, 8 with constrained implants, 3 with constrained implants and MCL repair, and 2 with unconstrained implants and no MCL repair. After an average 5-year follow-up, patients had lower Knee Society Scores (KSS), 79 versus 87 (p = 0.03), but similar Knee Function Scores (KFS), 68 versus 72 (p = 0.35). The improvement between preoperative and postoperative KSS and KFS did not vary among the two groups (p = 0.88 and p = 0.77, respectively). Postoperative scores did not vary significantly among the four treatment modalities. Conservative treatment can provide satisfactory outcomes and avoid potential complications of increased constraint. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Correlating Function and Imaging Measures of the Medial Longitudinal Fasciculus.

    Directory of Open Access Journals (Sweden)

    Ken Sakaie

    Full Text Available To test the validity of diffusion tensor imaging (DTI measures of tissue injury by examining such measures in a white matter structure with well-defined function, the medial longitudinal fasciculus (MLF. Injury to the MLF underlies internuclear ophthalmoparesis (INO.40 MS patients with chronic INO and 15 healthy controls were examined under an IRB-approved protocol. Tissue integrity of the MLF was characterized by DTI parameters: longitudinal diffusivity (LD, transverse diffusivity (TD, mean diffusivity (MD and fractional anisotropy (FA. Severity of INO was quantified by infrared oculography to measure versional disconjugacy index (VDI.LD was significantly lower in patients than in controls in the medulla-pons region of the MLF (p < 0.03. FA was also lower in patients in the same region (p < 0.0004. LD of the medulla-pons region correlated with VDI (R = -0.28, p < 0.05 as did FA in the midbrain section (R = 0.31, p < 0.02.This study demonstrates that DTI measures of brain tissue injury can detect injury to a functionally relevant white matter pathway, and that such measures correlate with clinically accepted evaluation indices for INO. The results validate DTI as a useful imaging measure of tissue integrity.

  14. Symptomatic Os Subtibiale Associated with Chronic Pain Around the Medial Malleolus in a Young Athlete

    Directory of Open Access Journals (Sweden)

    Iliev Alexandar A.

    2016-03-01

    Full Text Available An os subtibiale is a rare accessory bone located below or behind the medial malleolus. Herein we present a rare case of a painful os subtibiale in a young triathlete who presented with pain, redness and swelling below his left medial malleolus. Plain radiographs and three-dimensional computed tomography revealed a well-defined oval bone distal to the left medial malleolus. After conservative treatment failed, the ossicle was excised in an open surgery with complete resolution of symptoms. This case report emphasizes the need for clinical awareness of different anatomical variations of the bones of the foot.

  15. Responses of Human Medial Temporal Lobe Neurons Are Modulated by Stimulus Repetition

    Science.gov (United States)

    Pedreira, Carlos; Mormann, Florian; Kraskov, Alexander; Cerf, Moran; Fried, Itzhak; Koch, Christof

    2010-01-01

    Recent studies have reported the presence of single neurons with strong responses to visual inputs in the human medial temporal lobe. Here we show how repeated stimulus presentation—photos of celebrities and familiar individuals, landmark buildings, animals, and objects—modulates the firing rate of these cells: a consistent decrease in the neural activity was registered as images were repeatedly shown during experimental sessions. The effect of repeated stimulus presentation was not the same for all medial temporal lobe areas. These findings are consistent with the view that medial temporal lobe neurons link visual percepts to declarative memory. PMID:19864436

  16. The relationship between patellofemoral and tibiofemoral morphology and gait biomechanics following arthroscopic partial medial meniscectomy

    DEFF Research Database (Denmark)

    Dempsey, Alasdair R.; Wang, Yuanyuan; Thorlund, Jonas Bloch

    2013-01-01

    Purpose To examine the relationship between tibiofemoral and patellofemoral joint articular cartilage and subchondral bone in the medial and gait biomechanics following partial medial meniscectomy. Methods For this cross-sectional study, 122 patients aged 30–55 years, without evidence of knee...... with decreased patella cartilage volume (B = −17.9 (95 % CI −35.4, −0.4) p = 0.045) while knee adduction moment impulse was associated with increased medial tibial plateau area (B = 7.7 (95 % CI 0.9, 13.3) p = 0.025). A number of other variables approached significance. Conclusions Knee joint biomechanics...

  17. Did Failure Occur Because of Medial Column Instability That Was Not Recognized, or Did It Develop After Surgery?

    Science.gov (United States)

    Kadakia, Anish R; Kelikian, Armen S; Barbosa, Mauricio; Patel, Milap S

    2017-09-01

    Medial column instability is a primary deforming force in the setting of pes planovalgus deformity. Consideration for medial column stabilization only after correction of the hindfoot deformity may result in creating a rigid hindfoot, compromising clinical outcomes. Careful analysis of the lateral radiograph to determine whether the deformity is secondary to the medial column or true peritalar subluxation may allow superior outcomes. Iatrogenic creation of an excessively rigid medial column may lead to significant instability of the remaining joints in the short term and arthrosis in the long term. Medial column arthrodesis should be used selectively to correct gross instability. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Colgajo sural medial: un nuevo colgajo de perforantes para la reconstrucción del territorio maxilofacial Medial sural flap: a new flap for maxillofacial reconstruction

    Directory of Open Access Journals (Sweden)

    Ignacio Arribas-García

    2012-12-01

    Full Text Available Introducción: La reconstrucción microquirúrgica de defectos mucocutáneos craneofaciales se realiza con técnicas descritas desde hace muchos años y se basan fundamentalmente en el colgajo radial, el anterolateral de muslo y el lateral de brazo, entre otros. Se presenta un nuevo colgajo microvascularizado fasciocutáneo para la reconstrucción de defectos en el territorio de cabeza y cuello, el colgajo de perforantes dependiente de la arteria sural medial. Material y métodos: Se presentan 4 pacientes con carcinoma epidermoide de cavidad oral, donde se realizaron 4 colgajos dependientes de la arteria sural medial para la reconstrucción de sus defectos tras la cirugía ablativa de la lesión tumoral. Resultados: El colgajo sural medial presentó una excelente adaptabilidad y una adecuada viabilidad en todos los casos, con unos buenos resultados funcionales, estéticos y con escasa morbilidad de la zona donante. Conclusión: Se presenta una nueva técnica reconstructiva en defectos de cabeza y cuello.Introduction: Microsurgical reconstruction of craniofacial mucocutaneous defects have been performed for many years using well-known techniques, that are mainly based on flaps from the radial forearm, the anterolateral thigh and lateral arm, among others. We present the medial sural artery perforator flap, a new vascularized fasciocutaneous flap for head and neck reconstruction. Material and methods: We present four patients with oral squamous cell carcinoma. A medial sural artery flap was performed for the oral reconstruction after tumour ablation surgery. Results: The medial sural flap showed excellent adaptability and adequate viability in all cases, with good functional and aesthetic results and low donor site morbidity. Conclusion: We present a new reconstructive technique in head and neck defects.

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

    Science.gov (United States)

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

    2015-09-01

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

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

    Science.gov (United States)

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

    2014-05-01

    A medial collateral ligament (MCL) knee sprain is a prevalent injury in athletic populations that may result in significant time lost to injury. Remarkably little is known of the epidemiology of this injury. To define the incidence of MCL tears and to determine the demographic and athletic risk factors. Descriptive epidemiological study. A longitudinal cohort study was performed to examine the epidemiology of isolated MCL sprains at the United States Military Academy (USMA) between 2005 and 2009. Charts and radiographic studies were reviewed by an independent orthopaedic surgeon to identify all new isolated MCL sprains resulting in time lost to sport and activity that occurred within the study period. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated per 1000 person-years at risk and by sex, sport, and level of competition. The IR per 1000 athlete-exposures (AEs) was also determined. Incidence rate ratios (IRRs) and respective 95% CIs were calculated between male and female students, intercollegiate and intramural athletes, and male and female intercollegiate athletes involved in selected sports. Chi-square and Poisson regression analyses were used to examine the relationship between the variables of interest and the incidence of MCL sprains, with statistical significance set at P student person-years from 2005 to 2009. This resulted in an IR of approximately 7.3 per 1000 person-years. Of the 128 injuries, 114 were in male athletes (89%) and 14 were in female athletes (11%). Male cadets had a 44% higher IR than did female cadets (7.60 vs 5.36, respectively), although this was not significant (P = .212). Of 5820 at-risk intercollegiate athletes, 59 (53 male, 6 female) sustained an isolated MCL sprain during 528,523 (407,475 male, 121,048 female) AEs for an overall IR of 10.14 per 1000 person-years and 0.11 per 1000 AEs. The IRR of MCL sprains of men compared with women involved in intercollegiate athletics was 2.87 (95% CI, 1.24-8.18) per

  1. Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study

    Directory of Open Access Journals (Sweden)

    Wei Jiang

    2012-01-01

    Conclusions: Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

  2. Effect of transection of the caudal menisco-tibial ligament on medial femorotibial contact mechanics.

    Science.gov (United States)

    Pozzi, Antonio; Kim, Stanley E; Lewis, Daniel D

    2010-06-01

    To evaluate the effect of transection of the medial caudal menisco-tibial ligament on contact mechanics in a canine cadaveric model of cranial cruciate ligament (CCL) rupture and tibial plateau leveling osteotomy (TPLO). Ex vivo biomechanical study. Unpaired pelvic limbs (n=8) from 28-35 kg dogs. Cadaveric pelvic limbs with CCL-deficient stifles stabilized with TPLO were axially loaded using a material testing machine with 30% body weight and a stifle angle of 135 degrees. Medial compartment femorotibial contact force and area, peak and mean contact pressure, and peak pressure location were measured with pressure sensors. A paired t-test was used for comparison; Pmedial compartment (Pmedial meniscus and results in significant changes in medial femorotibial contact mechanics. The abnormal cartilage contact stresses after transection of the caudal menisco-tibial ligament may have a negative impact on the cartilage homeostasis and predispose to further degeneration of the medial compartment after TPLO.

  3. Are changes in conduit artery function associated with intima-medial thickness in young subjects?

    NARCIS (Netherlands)

    Hopkins, N.D.; Munckhof, I. van den; Thijssen, D.H.J.; Tinken, T.M.; Cable, N.T.; Stratton, G.; Green, D.J.

    2013-01-01

    BACKGROUND: Impaired brachial artery endothelial function, assessed by flow-mediated dilation (FMD), provides a strong prognostic index of cardiovascular events in asymptomatic adults and those with cardiovascular disease. However, the relationship between FMD and carotid intima-medial thickness

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

    Science.gov (United States)

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

    2015-02-01

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

  5. Medial calcaneal neuropathy: a missed etiology of chronic plantar heel pain

    Directory of Open Access Journals (Sweden)

    Emmanuel Kamal Aziz Saba

    2017-01-01

    Conclusion Medial calcaneal neuropathy is present in a considerable number of patients with chronic plantar heel pain. It should be taken into consideration during the assessment of any patient with chronic plantar heel pain.

  6. Medial Injury in Knee Dislocations: What Are the Common Injury Patterns and Surgical Outcomes?

    National Research Council Canada - National Science Library

    Werner, Brian C; Hadeed, Michael M; Gwathmey Jr, F Winston; Gaskin, Cree M; Hart, Joseph M; Miller, Mark D

    2014-01-01

    ... knees.Over a 12-year period, we treated 65 patients with knee dislocations involving bicruciate ligament injury and concomitant medial ligament injuries, without or with posterolateral corner injuries...

  7. Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

    National Research Council Canada - National Science Library

    Della Torre, MD, Paul; Stephens, MD, Andrew; Oh, MD, Horng Lii; Kamra, MD, Akshay; Zicat, MD, Bernard; Walker, MD, Peter

    2014-01-01

    Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation...

  8. A rare case of Elbow dislocation with medial epicondyle fracture associated to ulnar neuropraxia.

    Science.gov (United States)

    Alonzo, Francisco; Arévalo, Moisés; Cahueque, Mario

    2017-10-01

    The association between elbow dislocation, medial epicondyle fracture with intra-articular fragment entrapment and ulnar neuropraxia is very unfrequent with only a few cases reported in the literature, the mechanism of injury of the ulnar nerve is still unknown. This injury requires surgical management with stable fixation of the medial epicondyle fragment to allow early range of motion, the choice whether or not to perform an ulnar decompression and nerve transposition remains a controversy between orthopedic surgeons. We present the case of a 14-year-old patient that suffered an elbow dislocation with intra-articular entrapment of the medial epicondyle and ulnar neuropraxia that was managed with open reduction and fixation of the medial epicondyle with good functional outcomes.

  9. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial

    National Research Council Canada - National Science Library

    Moen, Maarten Hendrik; Holtslag, Leonoor; Bakker, Eric; Barten, Carl; Weir, Adam; Tol, Johannes L; Backx, Frank

    2012-01-01

    .... The treatment options investigated in this study were not previously examined in athletes. This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome (MTSS...

  10. Gating of the dorsal penile nerve inputs by norepinephrine at the medial preoptic area in rats.

    Science.gov (United States)

    Mallick, H N; Kumar, V M

    2005-01-01

    The medial preoptic area neurons related to male sexual behaviour in rats were identified by their responses to dorsal penile nerve stimulation. These neurons were further tested with norepinephrine applied iontophoretically. From the 21 medial preoptic area neurons recorded in urethane anaesthetized rats, 17 neurons responded to dorsal penile nerve stimulation. Excitatory and inhibitory responses were found in almost equal number of neurons. 14 neurons responded to norepinephrine application, out of which six neurons were excited and eight were inhibited. The direction of changes produced by dorsal penile nerve stimulation and norepinephrine application were similar in 10 neurons. The results suggest that the sensory inputs from the genitalia are possibly gated by norepinephrine at the level of the medial preoptic area. Afferent information from the genitalia carried by dorsal penile nerve and the availability of norepinephrine at the level of the medial preoptic area probably help in maintaining adequate level of sexual arousal.

  11. Fear Expression Suppresses Medial Prefrontal Cortical Firing in Rats.

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    Thomas F Giustino

    Full Text Available The medial prefrontal cortex (mPFC plays a crucial role in emotional learning and memory in rodents and humans. While many studies suggest a differential role for the prelimbic (PL and infralimbic (IL subdivisions of mPFC, few have considered the relationship between neural activity in these two brain regions recorded simultaneously in behaving animals. Importantly, how concurrent PL and IL activity relate to conditioned freezing behavior is largely unknown. Here we used single-unit recordings targeting PL and IL in awake, behaving rats during the acquisition and expression of conditioned fear. On Day 1, rats received either signaled or unsignaled footshocks in the recording chamber; an auditory conditioned stimulus (CS preceded signaled footshocks. Twenty-four hours later, animals were returned to the recording chamber (modified to create a novel context where they received 5 CS-alone trials. After fear conditioning, both signaled and unsignaled rats exhibited high levels of post-shock freezing that was associated with an enduring suppression of mPFC spontaneous firing, particularly in the IL of signaled rats. Twenty-four hours later, CS presentation produced differential conditioned freezing in signaled and unsignaled rats: freezing increased in rats that had received signaled shocks, but decreased in animals in the unsignaled condition (i.e., external inhibition. This group difference in CS-evoked freezing was mirrored in the spontaneous firing rate of neurons in both PL and IL. Interestingly, differences in PL and IL firing rate highly correlated with freezing levels. In other words, in the signaled group IL spontaneous rates were suppressed relative to PL, perhaps limiting IL-mediated suppression of fear and allowing PL activity to dominate performance, resulting in high levels of freezing. This was not observed in the unsignaled group, which exhibited low freezing. These data reveal that the activity of mPFC neurons is modulated by both

  12. Disconnection Between Amygdala and Medial Prefrontal Cortex in Psychotic Disorders.

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    Mukherjee, Prerona; Sabharwal, Amri; Kotov, Roman; Szekely, Akos; Parsey, Ramin; Barch, Deanna M; Mohanty, Aprajita

    2016-07-01

    Distracting emotional information impairs attention more in schizophrenia (SCZ) than in never-psychotic individuals. However, it is unclear whether this impairment and its neural circuitry is indicative generally of psychosis, or specifically of SCZ, and whether it is even more specific to certain SCZ symptoms (eg, deficit syndrome). It is also unclear if this abnormality contributes to impaired behavioral performance and real-world functioning. Functional imaging data were recorded while individuals with SCZ, bipolar disorder with psychosis (BDP) and no history of psychotic disorders (CON) attended to identity of faces while ignoring their emotional expressions. We examined group differences in functional connectivity between amygdala, involved in emotional evaluation, and sub-regions of medial prefrontal cortex (MPFC), involved in emotion regulation and cognitive control. Additionally, we examined correlation of this connectivity with deficit syndrome and real-world functioning. Behaviorally, SCZ showed the worst accuracy when matching the identity of emotional vs neutral faces. Neurally, SCZ showed lower amygdala-MPFC connectivity than BDP and CON. BPD did not differ from CON, neurally or behaviorally. In patients, reduced amygdala-MPFC connectivity during emotional distractors was related to worse emotional vs neutral accuracy, greater deficit syndrome severity, and unemployment. Thus, reduced amygdala-MPFC functional connectivity during emotional distractors reflects a deficit that is specific to SCZ. This reduction in connectivity is associated with worse clinical and real-world functioning. Overall, these findings provide support for the specificity and clinical utility of amygdala-MPFC functional connectivity as a potential neural marker of SCZ. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  13. Medial prefrontal cortex stimulation modulates the processing of conditioned fear.

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    Guhn, Anne; Dresler, Thomas; Andreatta, Marta; Müller, Laura D; Hahn, Tim; Tupak, Sara V; Polak, Thomas; Deckert, Jürgen; Herrmann, Martin J

    2014-01-01

    The extinction of conditioned fear depends on an efficient interplay between the amygdala and the medial prefrontal cortex (mPFC). In rats, high-frequency electrical mPFC stimulation has been shown to improve extinction by means of a reduction of amygdala activity. However, so far it is unclear whether stimulation of homologues regions in humans might have similar beneficial effects. Healthy volunteers received one session of either active or sham repetitive transcranial magnetic stimulation (rTMS) covering the mPFC while undergoing a 2-day fear conditioning and extinction paradigm. Repetitive TMS was applied offline after fear acquisition in which one of two faces (CS+ but not CS-) was associated with an aversive scream (UCS). Immediate extinction learning (day 1) and extinction recall (day 2) were conducted without UCS delivery. Conditioned responses (CR) were assessed in a multimodal approach using fear-potentiated startle (FPS), skin conductance responses (SCR), functional near-infrared spectroscopy (fNIRS), and self-report scales. Consistent with the hypothesis of a modulated processing of conditioned fear after high-frequency rTMS, the active group showed a reduced CS+/CS- discrimination during extinction learning as evident in FPS as well as in SCR and arousal ratings. FPS responses to CS+ further showed a linear decrement throughout both extinction sessions. This study describes the first experimental approach of influencing conditioned fear by using rTMS and can thus be a basis for future studies investigating a complementation of mPFC stimulation to cognitive behavioral therapy (CBT).

  14. Tinnitus, Medial Olivocochlear System, and Music Exposure in Adolescents

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    María Hinalaf

    2017-01-01

    Full Text Available Introduction: The most common cause of tinnitus is the exposure to noise; in the case of adolescents, music is the main sound source they are exposed to. Currently, one of the hypotheses about the genesis of tinnitus is related to the deterioration in the functioning of the medial olivocochlear system (MOCS. Aim: The aim of this study was to determine the presence or absence of tinnitus in adolescents with normal hearing and to relate it to: (a the functioning of the MOCS, by the contralateral suppression of the transient evoked otoacoustic emissions (TEOAEs and (b the musical general exposure (MGE. Materials and Methods: A cross-sectional descriptive correlational study was conducted. The sample was composed by adolescents with ages between 14 and 15. Two questionnaires were administered, one in relation to the subjective report of tinnitus and the other in relation to recreational activities to know the MGE. Results: The results showed that the amplitude of frequencies (1000, 1500, 2000, and 3000 Hz and global amplitude of TEOAEs, with and without acoustic contralateral stimulation, were higher in the group without tinnitus, with a statistically significant difference (P < 0.05. The suppressive effect was higher in the group without tinnitus; however, there was no statistically significant difference. Contrastingly, a significant association (P < 0.05 between exposure to music and tinnitus was observed; 72.41% of the adolescents with high exposure to music had tinnitus. Discussion and Conclusion: The results of the present investigation provide a contribution to the hypothesis of “the participation of the MOCS.” Furthermore, a high MGE can be considered a risk factor for the onset of tinnitus.

  15. Medial prefrontal cortex stimulation modulates the processing of conditioned fear

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    Anne eGuhn

    2014-02-01

    Full Text Available The extinction of conditioned fear is dependent on an efficient interplay between the amygdala and the medial prefrontal cortex (mPFC. In rats, high-frequency electrical mPFC stimulation was shown to improve extinction by a reduction of amygdala activity. However, so far it is unclear whether stimulation of homologues regions in humans might have similar beneficial effects.Healthy volunteers received one-session of either active or sham repetitive transcranial magnetic stimulation (rTMS covering the mPFC while undergoing a two-day fear conditioning and extinction paradigm. rTMS was applied offline after fear acquisition in which one of two faces (CS+ but not CS- was associated with an aversive scream (UCS. Immediate extinction learning (day 1 and extinction recall (day 2 were conducted without UCS delivery. Conditioned responses were assessed in a multimodal approach using fear-potentiated startle (FPS, skin conductance responses (SCR, functional near-infrared spectroscopy (fNIRS and self-report scales. Consistent with the hypothesis of a modulated processing of conditioned fear after high-frequency rTMS, the active group showed a reduced CS+/CS- discrimination during extinction learning as evident in FPS as well as in SCR and arousal ratings. FPS responses to CS+ further showed a linear decrement throughout both extinction sessions. This study describes the first experimental approach of influencing conditioned fear by using rTMS which can be a basis for future studies investigating a complementation of mPFC stimulation to cognitive behavioral therapy.

  16. Segregation of the human medial prefrontal cortex in social cognition

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    Danilo eBzdok

    2013-05-01

    Full Text Available While the human medial prefrontal cortex (mPFC is widely believed to be a key node of neural networks relevant for socio-emotional processing, its functional subspecialization is still poorly understood. We thus revisited the often assumed differentiation of the mPFC in social cognition along its ventral-dorsal axis. Our neuroinformatic analysis was based on a neuroimaging meta-analysis of perspective-taking that yielded two separate clusters in the ventral and dorsal mPFC, respectively. We determined each seed region’s brain-wide interaction pattern by two complementary measures of functional connectivity: co-activation across a wide range of neuroimaging studies archived in the BrainMap database and correlated signal fluctuations during unconstrained (resting cognition. Furthermore, we characterized the functions associated with these two regions using the BrainMap database. Across methods, the ventral mPFC was more strongly connected with the nucleus accumbens, hippocampus, posterior cingulate cortex, and retrosplenial cortex, while the dorsal mPFC was more strongly connected with the inferior frontal gyrus, temporo-parietal junction, and middle temporal gyrus. Further, the ventral mPFC was selectively associated with action execution, olfaction, and reward related tasks, while the dorsal mPFC was selectively associated with perspective-taking and episodic memory retrieval. The ventral mPFC is therefore predominantly involved in sensory-driven, approach/avoidance-modulating, and evaluation-related processing, whereas the dorsal mPFC is predominantly involved in internally driven, memory-informed, and metacognition-related processing in social cognition.

  17. Morphology of the medial collateral ligament of the knee

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    Gill Thomas J

    2010-09-01

    Full Text Available Abstract Background Quantitative knowledge on the anatomy of the medial collateral ligament (MCL is important for treatment of MCL injury and for MCL release during total knee arthroplasty (TKA. The objective of this study was to quantitatively determine the morphology of the MCL of human knees. Methods 10 cadaveric human knees were dissected to investigate the MCL anatomy. The specimens were fixed in full extension and this position was maintained during the dissection and morphometric measurements. The outlines of the insertion sites of the superficial MCL (sMCL and deep MCL (dMCL were digitized using a 3D digitizing system. Results The insertion areas of the superficial MCL (sMCL were 348.6 ± 42.8 mm2 and 79.7 ± 17.6 mm2 on the tibia and femur, respectively. The insertion areas of the deep MCL (dMCL were 63.6 ± 13.4 mm2 and 71.9 ± 14.8 mm2 on the tibia and femur, respectively. The distances from the centroids of the tibial and femoral insertions of the sMCL to the tibial and femoral joint line were 62.4 ± 5.5 mm and 31.1 ± 4.6 mm, respectively. The distances from the centroids of dMCL in the tibial insertion and the femoral insertion to the tibial and femoral joint line were 6.5 ± 1.3 mm and 20.5 ± 4.2 mm, respectively. The distal portion of the dMCL (meniscotibial ligament - MTL was approximately 1.7 times wider than the proximal portion of the dMCL (meniscofemoral ligament - MFL, whereas the MFL was approximately 3 times longer than the MTL. Conclusions The morphologic data on the MCL may provide useful information for improving treatments of MCL-related pathology and performing MCL release during TKA.

  18. The medial pterygoid muscle: a stabiliser of horizontal jaw movement.

    Science.gov (United States)

    Chen, H; Whittle, T; Gal, J A; Murray, G M; Klineberg, I J

    2017-10-01

    There is limited information of the normal function of the human medial pterygoid muscle (MPt). The aims were to determine whether (i) the MPt is active throughout horizontal jaw movements with the teeth apart and (ii) whether single motor units (SMUs) are active during horizontal and opening-closing jaw movements. Intramuscular electrodes were placed in the right MPt of 18 participants who performed five teeth-apart tasks: (i) postural position, (ii) ipsilateral (i.e. right) jaw movement, (iii) contralateral movement, (iv) protrusive movement and (v) opening-closing movement. Movement tasks were guided by a target and were divided into BEFORE, OUT, HOLDING, RETURN and AFTER phases according to the movement trajectories recorded by a jaw tracking system. Increased EMG activity was consistently found in the OUT, HOLDING and RETURN phases of the contralateral and protrusive movement tasks. An increased RETURN phase activity in the ipsilateral task indicates an important role for the MPt in the contralateral force vector. Of the 14 SMUs active in the opening-closing task, 64% were also active in at least one horizontal task. There were tonically active SMUs at the postural jaw position in 44% of participants. These new data point to an important role for the MPt in the fine control of low forces as required for stabilisation of vertical mandibular position not only to maintain postural position, but also throughout horizontal jaw movements with the teeth apart. These findings provide baseline information for future investigations of the possible role of this muscle in oro-facial pain conditions. © 2017 John Wiley & Sons Ltd.

  19. Lateralizing value of semiology in medial temporal lobe epilepsy.

    Science.gov (United States)

    Dupont, S; Samson, Y; Nguyen-Michel, V-H; Zavanone, C; Navarro, V; Baulac, M; Adam, C

    2015-12-01

    Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HS patients and if their presence could help to identify those patients who would be seizure free after surgery. We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery. Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom. Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Patient-based outcomes after medial patellofemoral ligament reconstruction.

    Science.gov (United States)

    Matsushita, Takehiko; Oka, Shinya; Araki, Daisuke; Nishida, Kyohei; Tanaka, Toshikazu; Kanzaki, Noriyuki; Nishida, Kotaro; Kuroda, Ryosuke

    2017-06-01

    The purpose of this study was to evaluate subjective outcomes after medial patellofemoral ligament (MPFL) reconstructions. Fifty-four knees of 46 patients who received MPFL reconstruction for recurrent patellar dislocations were examined with a minimum follow-up of two years. To assess patient-based outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Kujala score were assessed. The mean Kujala score was significantly improved from 64.6 ± 22.1 pre-operatively to 84.7 ± 11.8 post-operatively (P out of the 42 questions for the KOOS were significantly improved after surgery, except those of the question about "grinding and clicking". When the KOOS was assessed individually, the scores on one or more subscales out of the five were worsened post-operatively in eight patients, and seven of the eight patients had decreased post-operative pain subscale scores. Furthermore, those eight patients (worse group) were compared with patients without any worsened scores on any of the subscales (better group). The mean pre-operative pain and sports/recreation function subscale scores were significantly higher in the worse group whereas the mean post-operative pain and symptoms subscale scores were significantly lower in the worse group than in the better group. Overall, satisfactory patient-based outcomes were obtained after MPFL reconstruction in most of the patients. However, patients who only have mild pain pre-operatively tend to have worse subjective outcomes, and a caution may be needed when performing MPFL reconstruction on these patients.

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

    Science.gov (United States)

    Craig, Debbie I

    2008-01-01

    Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40. Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Studies were identified by searching MEDLINE (1966-2000), Current Contents (1996-2000), Biomedical Collection (1993-1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed

  2. Contributing factors to medial tibial stress syndrome: a prospective investigation.

    Science.gov (United States)

    Hubbard, Tricia J; Carpenter, Erica Mullis; Cordova, Mitchell L

    2009-03-01

    To conduct a prospective, multisite, cohort study investigating the possible risk factors for medial tibial stress syndrome (MTSS) in college athletes. One hundred and forty-six healthy, collegiate athletes from NCAA Division I and Division II institutions participated in the study. Subjects first completed a health history questionnaire to establish previous history of injury and underwent a physical examination to assess their ankle/foot strength, ankle/foot range of motion, tibial varum, and navicular drop before the start of their respective athletic season. Athletes were instructed to report to a certified athletic trainer if they developed pain on their tibia. If MTSS was present, subjects were then placed into the symptomatic group. Independent t-tests and chi-square analyses were used to determine whether differences existed between MTSS and healthy athletes for the continuous and the discrete dependent variables, respectively. The significant dependent variables were then used in the discriminant function analysis. Twenty-nine subjects developed MTSS during this study. Athletes that had been participating in athletic activity for fewer than 5 yr were significantly more likely to develop MTSS (P = 0.002). Additionally, athletes with a previous history of MTSS (P = 0.0001), a previous history of stress fracture (P = 0.039), and the use of orthotics (P = 0.031) were more likely to develop MTSS compared with those who did not develop MTSS. This study established that the factors most influencing MTSS development were previous history of MTSS and stress fracture, years of running experience, and orthotic use. These data demonstrate the importance of establishing a thorough history before the start of the season so that athletes who might be at risk for MTSS development can be identified.

  3. Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst

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    Shoji Fukuta

    2015-01-01

    Full Text Available We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. Arthroscopic fixation with a suture anchor was successful and the cystic lesion was no longer visible on postoperative images.

  4. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus

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    Thaunat, Mathieu; Fayard, Jean Marie; Guimaraes, Tales M.; Jan, Nicolas; Murphy, Colin G.; Sonnery-Cottet, Bertrand

    2016-01-01

    Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disr...

  5. Growth modulation with a medial malleolar screw for ankle valgus deformity

    OpenAIRE

    Rupprecht, Martin; Spiro, Alexander S.; Breyer, Sandra; Vettorazzi, Eik; Ridderbusch, Karsten; Stücker, Ralf

    2015-01-01

    Background and purpose Growth modulation with a medial malleolar screw is used to correct ankle valgus deformity in children with a wide spectrum of underlying etiologies. It is unclear whether the etiology of the deformity affects the angular correction rate with this procedure. Patients and methods 79 children (20 girls) with ankle valgus deformity had growth modulation by a medial malleolar screw (125 ankles). To be included, patients had to have undergone screw removal at the time of skel...

  6. Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear

    OpenAIRE

    Rabelo,Neiffer Nunes; Rabelo,Nícollas Nunes; Cunha,Aluísio Augusto Gonçalves; Correia,Francisco

    2013-01-01

    We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treat...

  7. Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

    Science.gov (United States)

    Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

    2016-01-01

    Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright

  8. Sexual experience enhances cognitive flexibility and dendritic spine density in the medial prefrontal cortex.

    Science.gov (United States)

    Glasper, Erica R; LaMarca, Elizabeth A; Bocarsly, Miriam E; Fasolino, Maria; Opendak, Maya; Gould, Elizabeth

    2015-11-01

    The medial prefrontal cortex is important for cognitive flexibility, a capability that is affected by environmental conditions and specific experiences. Aversive experience, such as chronic restraint stress, is known to impair performance on a task of cognitive flexibility, specifically attentional set-shifting, in rats. Concomitant with this performance decrement, chronic stress reduces the number of dendritic spines on pyramidal neurons in the medial prefrontal cortex. No previous studies have examined whether a rewarding experience, namely mating, affects cognitive flexibility and dendritic spines in the medial prefrontal cortex of male rats. To test this possibility, we exposed adult male rats to sexual receptive females once daily for one week, assessed attentional set-shifting performance, and then analyzed their brains for changes in dendritic spines. We found that sexual experience improved performance on extradimensional set-shifting, which is known to require the medial prefrontal cortex. Additionally, we observed increased dendritic spine density on apical and basal dendrites of pyramidal neurons in the medial prefrontal cortex, but not the orbitofrontal cortex, after sexual experience. We also found that sexual experience enhanced dendritic spine density on granule neurons of the dentate gyrus. The ventral hippocampus sends a direct projection to the medial prefrontal cortex, raising the possibility that experience-dependent changes in the hippocampus are necessary for alterations in medial prefrontal cortex structure and function. As a first attempt at investigating this, we inactivated the ventral hippocampus with the GABA agonist muscimol, after each daily bout of sexual experience to observe whether the beneficial effects on cognitive flexibility were abolished. Contrary to our hypothesis, blocking hippocampal activity after sexual experience had no impact on enhanced cognitive flexibility. Taken together, these findings indicate that sexual

  9. Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures

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    Appleton Paul

    2010-01-01

    Full Text Available Abstract Background Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter's canal. The present anatomical study evaluates the risk to the femoral artery and other medial neurovascular structures using a lateral entry approach. Methods Six embalmed cadavers (twelve femurs were obtained for dissection. Steinman pins were drilled from lateral to medial at the level of the superior pole of the patella, at 2 cm, and at 4 cm proximal to this point. Medial superficial dissection was then performed to identify the saphenous nerve, the superior medial geniculate artery, the adductor hiatus, the tendinous insertion of the adductor magnus and the femoral artery. Measurements localizing these anatomic structures relative to the pins were obtained. Results The femoral artery was relatively safe and was no closer than 29.6 mm (mean from any of the three Steinman pins. The superior medial geniculate artery was the medial structure at most risk. Conclusions Lateral femoral traction pin entry is a safe procedure with minimal risk to the saphenous nerve and femoral artery. Of the structures examined, only the superior medial geniculate artery is at a risk of iatrogenic injury due to its position. The incidence of such injury in clinical practice and its clinical significance is not known. Lateral insertion facilitates traction pin placement since it minimizes the need to move the contralateral extremity out of the way of the drilling equipment or the need to elevate or externally rotate the injured extremity relative to the contralateral extremity.

  10. Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings

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    Patel, J.J. [Dept. of Radiology, Baystate Medical Center, Springfield, MA (United States)

    1999-11-01

    Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent ''fat stripe'' sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury. (orig.)

  11. Medial and lateral osteoarthritis of the knee is related to variations of hip and pelvic anatomy.

    Science.gov (United States)

    Weidow, J; Mars, I; Kärrholm, J

    2005-06-01

    We evaluated if increased risk of combined hip and lateral knee osteoarthritis (OA) could be attributed to anatomical reasons in the hip region resulting in increased abductor moment over the knee. We measured pelvic width, femoral offset, femoral neck length and angle in 29 women with lateral knee OA (13 unilateral, 16 bilateral) and 27 women with bilateral medial OA. Twenty-one of these patients with normal hips (lateral/medial OA of the knee=12/9) and 35 with associated hip OA (lateral/medial OA of the knee=17/18) were evaluated separately. Radiographic examinations in 14 women planned for hip prosthesis because of failures after hip fracture acted as controls. Patients with lateral OA of the knee had wider pelvis than controls (13.7 mm increased distance between the medial borders of the acetabulum, P=0.001). Patients with medial OA had 11.4mm longer distance from the centre of the femoral head to the centre of the proximal part of the femoral shaft (P=0.005), corresponding to a higher offset. The pelvic and hip anatomy also differed between patients with medial and lateral OA of the knee. In the groups without hip OA, presence of lateral knee OA was associated with a wider pelvis (P=0.009), shorter femoral neck (P=0.02) and Head-Shaft distance (P=0.04). In the groups with OA of the hip associated lateral OA of the knee also implied increased Neck Shaft angle (coxa valga, P=0.008), but there was no difference in pelvic width (P=0.15). We found a shorter lever arm over the hip in lateral knee OA compared to medial knee OA (P=0.02), but not when compared to controls. Our findings suggest that occurrence of medial or lateral OA has a biomechanical background originating from pelvis and hip anatomy.

  12. The JCR:LA-cp rat: a novel rodent model of cystic medial necrosis.

    Science.gov (United States)

    Pung, Yuh Fen; Chilian, William M; Bennett, Martin R; Figg, Nichola; Kamarulzaman, Mohd Hamzah

    2017-03-01

    Although there are multiple rodent models of the metabolic syndrome, very few develop vascular complications. In contrast, the JCR:LA-cp rat develops both metabolic syndrome and early atherosclerosis in predisposed areas. However, the pathology of the normal vessel wall has not been described. We examined JCR:LA control (+/+) or cp/cp rats fed normal chow diet for 6 or 18 mo. JCR:LA-cp rats developed multiple features of advanced cystic medial necrosis including "cysts," increased collagen formation and proteoglycan deposition around cysts, apoptosis of vascular smooth muscle cells, and spotty medial calcification. These appearances began within 6 mo and were extensive by 18 mo. JCR:LA-cp rats had reduced medial cellularity, increased medial thickness, and vessel hypoxia that was most marked in the adventitia. In conclusion, the normal chow-fed JCR:LA-cp rat represents a novel rodent model of cystic medial necrosis, associated with multiple metabolic abnormalities, vascular smooth muscle cell apoptosis, and vessel hypoxia.NEW & NOTEWORTHY Triggers for cystic medial necrosis (CMN) have been difficult to study due to lack of animal models to recapitulate the pathologies seen in humans. Our study is the first description of CMN in the rat. Thus the JCR:LA-cp rat represents a useful model to investigate the underlying molecular changes leading to the development of CMN. Copyright © 2017 the American Physiological Society.

  13. Object and spatial mnemonic interference differentially engage lateral and medial entorhinal cortex in humans.

    Science.gov (United States)

    Reagh, Zachariah M; Yassa, Michael A

    2014-10-07

    Recent models of episodic memory propose a division of labor among medial temporal lobe cortices comprising the parahippocampal gyrus. Specifically, perirhinal and lateral entorhinal cortices are thought to comprise an object/item information pathway, whereas parahippocampal and medial entorhinal cortices are thought to comprise a spatial/contextual information pathway. Although several studies in human subjects have demonstrated a perirhinal/parahippocampal division, such a division among subregions of the human entorhinal cortex has been elusive. Other recent work has implicated pattern separation computations in the dentate gyrus and CA3 subregions of the hippocampus as a mechanism supporting the resolution of mnemonic interference. However, the nature of contributions of medial temporal lobe cortices to downstream hippocampal computations is largely unknown. We used high-resolution fMRI during a task selectively taxing mnemonic discrimination of object identity or spatial location, designed to differentially engage the two information pathways in the medial temporal lobes. Consistent with animal models, we demonstrate novel evidence for a domain-selective dissociation between lateral and medial entorhinal cortex in humans, and between perirhinal and parahippocampal cortex as a function of information content. Conversely, hippocampal dentate gyrus/CA3 demonstrated signals consistent with resolution of mnemonic interference across domains. These results provide insight into the information processing capacities and hierarchical interference resolution throughout the human medial temporal lobe.

  14. Anatomic variability of the vascularized composite osteomyocutaneous flap from the medial femoral condyle: an anatomical study

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    Trung-Hau Le Thua

    2014-12-01

    Full Text Available Aim: The anatomical study and clinical application for the vascularized corticoperiosteal flap from the medial femoral condyle have been performed and described previously. Although prior studies have described the composite osteomyocutaneous flap from the medial femoral condyle, a detailed analysis of the vascularity of this region has not yet been fully evaluated. Methods: This anatomical study described the variability of the arteries from the medial femoral condyle in 40 cadaveric specimens. Results: The descending genicular artery (DGA was found in 33 of 40 cases (82.5%. The  superomedial genicular artery (SGA was present in 10 cases (25%. All 33 cases (100% of the DGA had articular branches to the periosteum of the medial femoral condyle. Muscular branches and saphenous branches of the DGA were present in 25 cases (62.5% and 26 cases (70.3%, respectively. Conclusion: The current study demonstrates that the size and length of the vessels to the medial femoral condyle are sufficient for a vascularized bone flap. A careful preoperative vascular assessment is essential prior to use of the vascularized composite osteomyocutaneous flap from the medial femoral condyle, because of the considerable anatomical variations in different branches of the DGA.

  15. Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

    Science.gov (United States)

    Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-Ichi

    2017-06-18

    To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

  16. Relationship of the biceps-brachialis complex to the medial coronoid process of the canine ulna.

    Science.gov (United States)

    Hulse, D; Young, B; Beale, B; Kowaleski, M; Vannini, R

    2010-01-01

    To describe the anatomic relationship of the biceps brachii-brachialis muscle complex and the medial compartment of the canine elbow. Anatomical cadaveric study. Cadaveric forelimbs, and radius and ulna bones were examined to study the anatomy of the biceps brachii-brachialis complex and its relationship to the medial compartment of the elbow. The biceps brachii and brachialis muscles comprise a large muscular complex. The biceps brachii is a pennate fibred muscle which plays a major role in stabilising the elbow joint during the stance phase and facilitating limb acceleration during the swing phase. Additionally, the insertion of the muscular complex onto the ulnar tuberosity is such that a moment is generated which the authors hypothesise rotates the medial coronoid process against the radial head. The result is a compressive force which generates internal shear stress oblique to the long axis of the medial coronoid process. The authors further hypothesise that this may result in the microdamage or fragmentation of the medial coronoid process. The authors' conclude that contraction of the biceps brachii and brachialis complex may explain an aetiopathogenesis for fragmented medial coronoid process not associated with elbow dysplasia.

  17. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

    Science.gov (United States)

    Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

    2011-06-01

    Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. Copyright © 2010 Elsevier B.V. All rights reserved.

  18. Sacrifícios, sonhos, indústria cultural: retratos da educação do corpo no esporte escolar Sacrifices, dreams, culture industry: portraits of bodily education in school sports

    Directory of Open Access Journals (Sweden)

    Danielle Torri

    2007-12-01

    Full Text Available O artigo apresenta resultados de uma pesquisa que procurou investigar aspectos da educação do corpo, focando um programa de Esporte Escolar para meninos e meninas de uma escola pública de Florianópolis. Foram realizadas observações sistemáticas do contexto das sessões de treinamento e das competições, além de entrevistas narrativas e levantamento de alguns dados da instituição. Os resultados foram organizados em três grandes categorias de análise. Nomeamos a primeira de Castigos, punições e sacrifícios. Ela diz respeito à forma encontrada pelos treinadores para lidar com a dinâmica de repreensão e emulação de sua equipe. A segunda categoria, batizada de Formação humana X sonho de profissionalização, discorre sobre o papel das representações e expectativas sobre o futebol para as crianças em contraposição à formação que a escola e o esporte prometem lhes proporcionar. A escolha da terceira categoria se deu pela presença constante dos rituais nas práticas corporais organizadas, com especial atenção, nesse caso, ao esporte. Ela foi denominada Rituais como técnica. As considerações finais sugerem uma interpenetração entre rituais, expectativas de futuro e questões moralistas envolvidas no esporte, apontando a prevalência do interesse de controle como central. Além disso, sugerem o mimetismo das práticas do esporte convencional pela mediação da indústria cultural.This article presents results of a research that sought to investigate aspects of bodily education, focusing in a program of School Sports for boys and girls from a public school in Florianópolis, Brazil. Systematic observations were made of the contexts of training sessions and competitions, apart from discursive interviews and some data gathering about the institution. Results were organized in three major analysis categories. The first of them was called Punishments, penalties and sacrifices. It relates to the way found by coaches to

  19. Benefits and Harms in Pivotal Trials of Oral Centrally Acting Antiobesity Medicines: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Onakpoya, Igho J; Collins, Dylan R J; Bobrovitz, Niklas J H; Aronson, Jeffrey K; Heneghan, Carl J

    2018-03-01

    To evaluate the benefits and harms of oral centrally acting antiobesity medicinal products in pivotal trials. The European Medicines Agency and Federal Drug Administration websites, PubMed, and ClinicalTrials.gov were searched to identify pivotal trials used to gain marketing authorizations. Pivotal phase III trials on which marketing authorizations were based were included. The data were analyzed by using Cochrane Review Manager (RevMan), and quality assessments for each outcome were performed by using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE). Five products (16 trials with 24,555 participants) were included. Significantly more participants who took the antiobesity products achieved ≥ 5% reduction in body weight (risk ratio [RR] 2.39; 95% CI: 2.09-2.74; GRADE = low). However, the products significantly increased the risk of adverse events (RR 1.12; 95% CI: 1.07-1.17; GRADE = very low) and the risk of discontinuation because of adverse events (RR 1.52; 95% CI: 1.33-1.74; GRADE = low). There were no significant differences for most outcomes between currently approved and withdrawn products. Although oral centrally acting antiobesity products generate modest weight losses, they also increase the risks of adverse events and discontinuations because of adverse events. The premarketing benefit-to-harm profiles of currently available products and products that were later withdrawn because of harms are similar. Targeted study designs, better outcomes reporting, and improved postmarketing monitoring of harms are needed. © 2018 The Obesity Society.

  20. HTML5 PivotViewer: high-throughput visualization and querying of image data on the web.

    Science.gov (United States)

    Taylor, Stephen; Noble, Roger

    2014-09-15

    Visualization and analysis of large numbers of biological images has generated a bottle neck in research. We present HTML5 PivotViewer, a novel, open source, platform-independent viewer making use of the latest web technologies that allows seamless access to images and associated metadata for each image. This provides a powerful method to allow end users to mine their data. Documentation, examples and links to the software are available from http://www.cbrg.ox.ac.uk/data/pivotviewer/. The software is licensed under GPLv2. © The Author 2014. Published by Oxford University Press.

  1. Energy balance with Landsat images in irrigated central pivots with corn crop in the São Paulo State, Brazil

    Science.gov (United States)

    Teixeira, Antônio H. d. C.; Hernandez, Fernando B. T.; Andrade, Ricardo G.; Leivas, Janice F.; Bolfe, Edson L.

    2014-10-01

    The energy balance (EB) components were quantified in a commercial farm with corn crop, irrigated by central pivots, in the Northwestern side of São Paulo state, Southeast Brazil. The SAFER (Simple Algorithm For Evapotranspiration Retrieving) was applied to retrieve the latent heat flux (λE), considering six pivots, covering irrigated areas from 74 to 108 ha. With λE quantified and considering soil heat flux (G) as a fraction of net radiation (Rn), the sensible heat flux (H) was acquired as a residual in the energy balance equation. Seven Landsat satellite images, covering all corn crop stages from 23 April 2010 to 29 August 2010, allowed relating the energy balance components according to the accumulated degree-days (DDac) from the planting to harvest dates. The average Rn values ranging from 5.2 to 7.2 MJ m-2 day-1, represented 30 to 45% of global solar radiation (RG). Considering the variation of the energy balance components along the corn crop growing seasons, the average ranges for λE, H and G were respectively 0.0 to 6.4 MJ m-2 day-1, -1.5 to 6.7 MJ m-2 day-1 and 0.1 to 0.6 MJ m-2 day-1. The fraction of the available energy (Rn - G) used as λE was from 0.0 to 1.3 indicated a good irrigation management, insuring that the water deficit could not be the reason of any yield reduction. Although Rn did not reflected well the crop stages, its partition strongly depended on these stages. λE higher than Rn and the negative H/Rn, happening sometimes along the corn growing seasons, occurred after the vegetative growth and before the harvest times, indicated heat advection from the surrounding areas to the irrigation pivots, which represented an additional energy source for the evaporative process. The models applied here with only the visible and infrared bands of the Landsat sensor are very useful for the energy balance analyses, considering the size of the corn crop irrigation pivots in Southeast Brazil, when subsidizing a rational irrigation water application

  2. Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries.

    Science.gov (United States)

    Song, Guan-Yang; Zhang, Hui; Wu, Guan; Zhang, Jin; Liu, Xin; Xue, Zhe; Qian, Yi; Feng, Hua

    2017-04-01

    To compare the prevalence of concomitant anterolateral ligament (ALL) injury between patients with high-grade (grades II and III) pivot-shift and those with low-grade (grades 0 and I) pivot-shift phenomenon after acute anterior cruciate ligament (ACL) injuries. Sixty-eight patients with an acute ACL injury who showed high-grade (grades II and III) pivot-shift phenomenon were enrolled as the study group. They were matched in a 1:1 fashion to another 68 ACL-injured control participants who showed low-grade (grades 0 and I) pivot-shift phenomenon during the same study period. Patients were matched by age, sex, and time from injury to surgery. A standardized pivot-shift test was performed under anesthesia for all the patients. Two blinded musculoskeletal radiologists reviewed the magnetic resonance imaging (MRI) scans for the presence of concomitant ALL injury. The grade of an ALL injury was divided into grade 0 (normal), grade I (sprain), grade II (partial tear), and grade III (complete tear). The prevalence and the grade of concomitant ALL injury were further compared between the study group and the control group. Overall, the prevalence of concomitant ALL injury in the study group (94.1%, 64/68) was significantly higher than that in the control group [60.3%, (41/68), P < 0.05]. Specifically, there were 49 patients (49/64, 76.6%) who showed grade II/III (partial/complete tear) MRI evidence of concomitant ALL injury, which was also significantly higher than that in the control group (12/41, 29.3%). Patients with high-grade pivot-shift phenomenon showed higher prevalence of concomitant ALL injury compared to those with low-grade pivot-shift phenomenon after acute ACL injuries. Careful assessment and proper treatment of this concomitant injury should be considered especially in knees with high-grade pivot-shift phenomenon. III.

  3. Is It Necessary to Repair Stable Ramp Lesions of the Medial Meniscus During Anterior Cruciate Ligament Reconstruction? A Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Liu, Xin; Zhang, Hui; Feng, Hua; Hong, Lei; Wang, Xue-Song; Song, Guan-Yang

    2017-04-01

    A special type of meniscal lesion involving the peripheral attachment of the posterior horn of the medial meniscus (PHMM), termed a "ramp lesion," is commonly associated with an anterior cruciate ligament (ACL) injury. However, its treatment is still controversial. Recently, stable ramp lesions treated with abrasion and trephination alone have been shown to have good clinical outcomes after ACL reconstruction. Stable ramp lesions treated with abrasion and trephination alone during ACL reconstruction will result in similar clinical outcomes compared with those treated with surgical repair. Randomized controlled trial; Level of evidence, 2. A prospective randomized controlled study was performed in 91 consecutive patients who had complete ACL injuries and concomitant stable ramp lesions of the medial meniscus. All patients were randomly allocated to 1 of 2 groups based on whether the stable ramp lesions were surgically repaired (study group; n = 50) or only abraded and trephined (control group; n = 41) during ACL reconstruction. All surgical procedures were performed by a single surgeon who was blinded to the functional assessment findings of the patients. The Lysholm score, subjective International Knee Documentation Committee (IKDC) score, and stability assessments (pivot-shift test, Lachman test, KT-1000 arthrometer side-to-side difference, and KT-1000 arthrometer differences of 5 mm) were evaluated preoperatively and at the last follow-up. Moreover, magnetic resonance imaging (MRI) was used to evaluate the healing status of the ramp lesions. All consecutive patients who were screened for eligibility from August 2008 to April 2012 were enrolled and observed clinically. There were 40 patients in the study group and 33 patients in the control group who were observed for at least 2 years. At the final follow-up, there were no significant differences between the study group and the control group in terms of the mean Lysholm score (88.7 ± 4.8 vs 90.4 ± 5

  4. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

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    Hall Michelle

    2012-11-01

    Full Text Available Abstract Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home

  5. Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA Study

    Science.gov (United States)

    Hayashi, D; Felson, DT; Niu, J; Hunter, DJ; Roemer, FW; Aliabadi, P; Guermazi, A

    2013-01-01

    Objective To determine which subregions of the knee joint have a high prevalence of pre-radiographic osteoarthritic changes, i.e. cartilage damage and osteophytes that can only be detected by MRI, in radiographically normal knees. Methods Institutional review board approval and written informed consent from all participants was obtained. Data was collected from a community cohort in Framingham, MA, involving people aged 50–79. Participants underwent weight-bearing posteroanterior and lateral knee radiography with the fixed-flexion protocol, and 1.5T MRI. Knees without radiographic osteoarthritis (Kellgren Lawrence grade 0 for the tibiofemoral joint and absence of any osteophytes or joint space narrowing in the patellofemoral joint) were included. The knee joint was divided into 14 subregions for cartilage and 16 subregions for osteophytes, and prevalence and severity of cartilage damage (grade 0–6) and osteophytes (grade 0–7) were semiquantitatively assessed using the Whole Organ Magnetic Resonance Imaging Score. Results The mean age of 696 participants was 62.3±8.4 years, and the mean body mass index was 27.9±5.1 kg/m2. Women comprised 55.2% of the study sample (384/696). Prevalence of cartilage damage (grade ≥2) was 47.7% (332/696) in the medial patellar and 29.9% (208/696) in patellar lateral subregions, and 24.0% (167/696) in femoral medial anterior and 26.5% (184/696) in femoral medial central subregions. Prevalence of osteophytes (grade ≥2) was highest at 60.8% (423/696) in the medial femoral posterior subregion, followed by 34.0% (237/696) in patellar lateral and 24.6% (171/696) in patellar medial subregions. For all other subregions, prevalence of these lesions was lower than the aforementioned percentages. Conclusion MRI-detected cartilage damage and osteophytes are highly prevalent in the medial patellofemoral and medial posterior tibiofemoral joints in radiographically normal knees in persons aged 50–79. PMID:24185108

  6. Treatment of medial tibial stress syndrome: a systematic review.

    Science.gov (United States)

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H; Backx, Frank J G; Bakker, Eric W P

    2013-12-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS. Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect. Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports. The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The 'levels of evidence', according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality. Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] -0.06; 95 % CI -0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI -0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT

  7. Outcomes following modified oblique medial epicondylectomy for treatment of cubital tunnel syndrome.

    Science.gov (United States)

    Osei, Daniel A; Padegimas, Eric M; Calfee, Ryan P; Gelberman, Richard H

    2013-02-01

    To quantify and define objective and patient-rated outcomes after our modification of medial epicondylectomy for the treatment of cubital tunnel syndrome. Although medial epicondylectomy has been previously studied, data are lacking regarding elbow-specific outcomes after our technique that aims to minimize complications historically associated with medical epicondylectomy. A total of 27 subjects with clinical and electrodiagnostic evidence of cubital tunnel syndrome underwent a modified oblique medial epicondylectomy that was designed to minimize bony resection and preserve the origin of the ulnar collateral ligament of the elbow. Average age was 57 years, mean duration of symptoms was 24 months, and mean postoperative follow-up was 29 months. Eight patients had McGowan stage I disease, 14 had stage II, and 5 had stage III. Preoperatively, we measured intrinsic hand strength, 2-point discrimination, and residual medial elbow pain, and assessed for continuing signs and symptoms of nerve compression. Postoperatively, we added to the clinical examination elbow stability testing, elbow range of motion, and assessment of medial antebrachial cutaneous nerve injury. We collected patient-reported outcomes, including Quick Disabilities of the Shoulder, Arm, and Hand; Levine-Katz Severity Score; and Patient-Rated Elbow Evaluation. We noted improvement of at least 1 McGowan grade in 20 of 27 patients (74%). Three of the 7 patients who had no change in McGowan grade still reported excellent patient-rated outcomes. Good to excellent results were achieved in 25 of 27 patients (93%). One patient had long-term severe medial elbow pain. Three patients had postoperative medial elbow pain that resolved with a single corticosteroid injection. One patient had a 30° flexion contracture; preoperative motion was not available for comparison. No patients had signs of elbow instability or numbness in the medial antebrachial cutaneous nerve distribution. Modified oblique medial

  8. Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift.

    Science.gov (United States)

    Hardy, Alexandre; Casabianca, Laurent; Hardy, Edouard; Grimaud, Olivier; Meyer, Alain

    2017-04-01

    The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25-38% of patients. Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees. Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s(2), respectively, p difference between postoperative contralateral healthy knees and operated knees (n.s). Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift. III.

  9. The relationship between prevalent medial meniscal intrasubstance signal changes and incident medial meniscal tears in women over a 1-year period assessed with 3.0 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Crema, Michel D. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, and Department of Internal Medicine, Radiology Division, Ribeirao Preto (Brazil); Institute of Diagnostic Imaging (IDI), Ribeirao Preto (Brazil); Hunter, David J. [The University of Sydney, Sydney School of Medicine, Sydney (Australia); Roemer, Frank W. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Li, Ling [New England Baptist Hospital, Division of Research, Boston, MA (United States); Marra, Monica D. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Institute of Diagnostic Imaging (IDI), Ribeirao Preto (Brazil); Nogueira-Barbosa, Marcello H. [Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, and Department of Internal Medicine, Radiology Division, Ribeirao Preto (Brazil); Hellio Le Graverand, Marie-Pierre; Wyman, Bradley T. [Pfizer Global Research and Development, New London, CT (United States); Guermazi, Ali [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States)

    2011-08-15

    Intrasubstance meniscal signal changes not reaching the articular surface on fast spin echo (FSE) sequences are considered to represent mucoid degeneration on MRI. The aim of this study was to evaluate the association of prevalent intrasubstance signal changes with incident tears of the medial meniscus detected on 3.0 T MRI over a 1-year period. A total of 161 women aged {>=}40 years participated in a longitudinal 1-year observational study of knee osteoarthritis. MRI (3.0 T) was performed at baseline and 12-month follow-up. The anterior horn, body, and posterior horn of the medial meniscus were scored by two experienced musculoskeletal radiologists using the Boston-Leeds Osteoarthritis Knee Score (BLOKS) system. Four grades were used to describe the meniscal morphology: grade 0 (normal), grade 1 (intrasubstance signal changes not reaching the articular surface), grade 2 (single tears), and grade 3 (complex tears and maceration). Fisher's exact test and the Cochran-Armitage trend test were performed to evaluate whether baseline intrasubstance signal changes (grade 1) predict incident meniscal tears/maceration (grades 2 and/or 3) in the same subregion of the medial meniscus, when compared to subregions without pathology as the reference group (grade 0). Medial meniscal intrasubstance signal changes at baseline did not predict tears at follow-up when evaluating the anterior and posterior horns (left-sided p-values 0.06 and 0.59, respectively). No incident tears were detected in the body. We could not demonstrate an association between prevalent medial meniscal intrasubstance signal changes with incident tears over a 1-year period. (orig.)

  10. Point of optimal kinematic error: improvement of the instantaneous helical pivot method for locating centers of rotation.

    Science.gov (United States)

    De Rosario, Helios; Page, Alvaro; Mata, Vicente

    2014-05-07

    This paper proposes a variation of the instantaneous helical pivot technique for locating centers of rotation. The point of optimal kinematic error (POKE), which minimizes the velocity at the center of rotation, may be obtained by just adding a weighting factor equal to the square of angular velocity in Woltring׳s equation of the pivot of instantaneous helical axes (PIHA). Calculations are simplified with respect to the original method, since it is not necessary to make explicit calculations of the helical axis, and the effect of accidental errors is reduced. The improved performance of this method was validated by simulations based on a functional calibration task for the gleno-humeral joint center. Noisy data caused a systematic dislocation of the calculated center of rotation towards the center of the arm marker cluster. This error in PIHA could even exceed the effect of soft tissue artifacts associated to small and medium deformations, but it was successfully reduced by the POKE estimation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Estimation of surgical tool-tip tracking error distribution in coordinate reference frame involving pivot calibration uncertainty.

    Science.gov (United States)

    Min, Zhe; Ren, Hongliang; Meng, Max Q-H

    2017-10-01

    Accurate understanding of surgical tool-tip tracking error is important for decision making in image-guided surgery. In this Letter, the authors present a novel method to estimate/model surgical tool-tip tracking error in which they take pivot calibration uncertainty into consideration. First, a new type of error that is referred to as total target registration error (TTRE) is formally defined in a single-rigid registration. Target localisation error (TLE) in two spaces to be registered is considered in proposed TTRE formulation. With first-order approximation in fiducial localisation error (FLE) or TLE magnitude, TTRE statistics (mean, covariance matrix and root-mean-square (RMS)) are then derived. Second, surgical tool-tip tracking error in optical tracking system (OTS) frame is formulated using TTRE when pivot calibration uncertainty is considered. Finally, TTRE statistics of tool-tip in OTS frame are then propagated relative to a coordinate reference frame (CRF) rigid-body. Monte Carlo simulations are conducted to validate the proposed error model. The percentage passing statistical tests that there is no difference between simulated and theoretical mean and covariance matrix of tool-tip tracking error in CRF space is more than 90% in all test cases. The RMS percentage difference between simulated and theoretical tool-tip tracking error in CRF space is within 5% in all test cases.

  12. Is there a relationship between landing, cutting, and pivoting tasks in terms of the characteristics of dynamic valgus?

    Science.gov (United States)

    Jones, Paul A; Herrington, Lee C; Munro, Allan G; Graham-Smith, Philip

    2014-09-01

    Anterior cruciate ligament (ACL) injuries are a major problem among female athletes. Screening for the risk of ACL injuries tends to focus on landing tasks, which may be limited in sports where changing direction is the main action involved in noncontact ACL injuries such as soccer. To investigate whether there is a relationship between single-legged landing (SLL), cutting (90° cuts), and pivoting (180° turns) in terms of the characteristics of dynamic valgus. Controlled laboratory study. Twenty female soccer players (mean ± SD: age, 21.0 ± 3.9 years; height, 1.65 ± 0.08 m; mass, 58.4 ± 6.4 kg) performed a minimum of 6 trials of SLL from a 0.3-m drop height and cutting and pivoting all on the right leg. Kinematics and kinetics were calculated from 3-dimensional motion analysis. Strong correlations were found for peak knee abduction angles between tasks (R = 0.63-0.86, P .05) were found between tasks for peak knee abduction moments. The results suggest that female athletes who exhibit poor SLL mechanics perform the same during various changing direction tasks. The results support the use of existing screening tests that involve landing tasks to identify at-risk athletes for noncontact ACL injuries. © 2014 The Author(s).

  13. Quantitative Evaluation of the In Vivo Vocal Fold Medial Surface Shape.

    Science.gov (United States)

    Vahabzadeh-Hagh, Andrew M; Zhang, Zhaoyan; Chhetri, Dinesh K

    2017-07-01

    Glottal insufficiency is a common clinical problem in otolaryngology and medialization laryngoplasty (ML) procedures remain the primary treatment modality. Although the goal of ML is to restore physiologic glottal posture and achieve optimal phonation, this posture has not been directly measured. In this study, we assessed glottal medial surface contour changes with selective activation of the intrinsic laryngeal muscles (ILMs). Basic science study using an in vivo canine hemilarynx model. In an in vivo canine hemilarynx, India ink was used to mark fleshpoints in a grid-like fashion along the medial surface of the vocal fold and ILMs were activated in a graded manner. A right-angled prism provided two views of the medial surface, which were recorded using a high-speed camera and used to reconstruct the 3D posture deformations of the medial surface. Thyroarytenoid (TA) muscle activation results in initial inferomedial bulging and increased glottal channel thickness and then glottal adduction with a final rectangular glottal channel shape. Lateral cricoarytenoid (LCA) activation closes the posterior glottis but final posture remains slightly convergent. Together, TA + LCA forms a rectangular glottis with an increased glottal vertical thickness. Posterior cricoarytenoid activation results in abduction and a slightly divergent glottis, whereas cricothyroid activation elongates the glottis and reduces the glottal channel vertical thickness. A quantitative analysis of in vivo canine vocal fold medial surface upon activation of selective ILMs is provided. This may guide our therapeutic efforts during medialization laryngoplasty, as well as computational modeling of laryngeal physiology. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  14. Dynamic study of the medial and lateral recti capsulopalpebral fasciae using cine mode magnetic resonance imaging.

    Science.gov (United States)

    Kakizaki, Hirohiko; Selva, Dinesh; Leibovitch, Igal

    2010-02-01

    To assess the dynamic features of the medial rectus capsulopalpebral fascia (mrCPF) and the lateral rectus CPF (lrCPF) during horizontal eye movements using cine mode magnetic resonance imaging (MRI). Observational case series. Ten patients (9 males and 1 female; age range, 8-75 years; mean age, 41.1 years) diagnosed with a unilateral orbital blowout fracture (medial wall, floor, or both) and having a normal contralateral orbit. Cine mode MRI was used to examine the role of the mrCPF and the lrCPF in relation to the eyelid and horizontal recti muscles during horizontal eye movements. To assess the dynamic features of the mrCPF and the lrCPF. In medial gaze, the medial part of the eyelid moves posteromedially, in synchronicity with medial rectus muscle contraction, mediated by the mrCPF. The lateral part of the eyelid moves anteromedially, in synchronicity with lateral rectus muscle relaxation, mediated by the lrCPF. In lateral gaze, the lateral part of the eyelid moves posterolaterally, in synchronicity with the lateral rectus muscle contraction, mediated by the lrCPF. The medial part of the eyelid moves anterolaterally, in synchronicity with medial rectus muscle relaxation, mediated by the mrCPF. These findings were demonstrated in all 10 patients. Cine mode MRI was used to demonstrate the dynamic roles of the mrCPF and the lrCPF in mediating eyelid position with the corresponding horizontal recti muscles. This study may allow a better understanding of the importance of these anatomic structures and may reduce functional and cosmetic complications during common oculoplastic and strabismus surgeries. Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  15. Postburn shoulder medial-adduction contracture: anatomy and treatment with trapeze-flap plasty.

    Science.gov (United States)

    Grishkevich, Viktor M

    2013-03-01

    Shoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern. Anatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed. Eighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold. Medial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  16. The effects of medial and lateral displacement calcaneal osteotomies on ankle and subtalar joint pressure distribution.

    Science.gov (United States)

    Davitt, J S; Beals, T C; Bachus, K N

    2001-11-01

    We compared the pressure distribution in the ankle and posterior facet of the subtalar joint following 1 cm medial and lateral displacement calcaneal osteotomies to the pressure distribution in the intact foot. Six cadaver specimens were loaded in neutral alignment while pressure measurements were recorded. A 1-cm medial displacement osteotomy shifted the average center of force in the ankle 1.0 mm medially (p = 0.36) while a lateral displacement osteotomy shifted the center of force 1.1 mm laterally (p = 0.42). There was also a slight shift in the percentage of pressure toward the side of the talus to which the calcaneus was shifted. For the lateral displacement osteotomy, the pressure increased 4.0% in the lateral-most quadrant (p = 0.05), while the medial osteotomy increased the pressure 1.3% in the medial quadrant (p = 0.30). In the subtalar joint, a medial displacement osteotomy shifted the pressure distribution slightly medially (5.9%, p = 0.06) and more anteriorly (9.6%, p = 0.02) while the distribution was shifted laterally (5.9%, p = 0.17) and anteriorly (5.6%, p = 0.03) with a lateral displacement osteotomy. These shifts of percentage of pressure between quadrants of the joints were slight-less than 5% in the ankle and less than 10% in the subtalar joint. Significant translation of the calcaneal tuberosity appears to have only a small effect on pressure distribution in the ankle and posterior facet of the subtalar joint in a weighted cadaver model.

  17. The biomechanical and histological effects of posterior cruciate ligament rupture on the medial tibial plateau.

    Science.gov (United States)

    Deng, Zhenhan; Li, Yusheng; Lin, Zhangyuan; Zhu, Yong; Zhao, Ruibo

    2017-03-23

    The objective of this study was to investigate the biomechanical and histological effects of the posterior cruciate ligament (PCL) on the medial tibial plateau. A total of 12 cadaveric human knee specimens were collected and grouped as follows: the PCL intact group (n = 12), the anterolateral bundle rupture group (n = 6), the postmedial bundle rupture group (n = 6), and the PCL rupture group (n = 12). The strain on the anterior, middle, and posterior parts of the medial tibial plateau with an axial loading force at different flexion angles was measured and analyzed, respectively. Forty-eight rabbits were chosen for animal study: surgery was performed on the one side of each rabbit randomly (experimental group), while the other side was taken as control (control group). Every 12 rabbits were culled at each of the four selected time points to collect the medial tibial plateau for morphological and histological observation. The PCL rupture, either partial or complete, may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all positions. Noticeable time-dependent degenerative histological changes of the medial tibial plateau were observed in the rabbit models of PCL rupture. Compared with the control group, all the PCL rupture groups exhibited a higher expression of the matrix metalloproteinase-7 (MMP-7) and the tissue inhibitors of metalloproteinase-1 (TIMP-1) at all the time points. Either partial or complete PCL rupture may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all the positions and may cause cartilage degeneration on the medial tibial plateau.

  18. Medial and Lateral Heel Whips: Prevalence and Characteristics in Recreational Runners.

    Science.gov (United States)

    Souza, Richard B; Hatamiya, Nicolas; Martin, Carly; Aramaki, Andrew; Martinelli, Brian; Wong, Jamie; Luke, Anthony

    2015-08-01

    To investigate the prevalence and characteristics of recreational runners with medial and lateral heel whips. Observational cohort study. Clinical research laboratory. A total of 256 recreationally active runners and joggers participated. High-definition video was acquired from a posterior view while runners ran at a self-selected pace on a treadmill. Heel whips, defined as the medial or lateral rotation of the foot in the transverse plane during initial swing, were measured with Dartfish software. Subjects were stratified by direction (medial and lateral) and severity (W_5-10 = 5-10 degrees; W_10+ = >10 degrees) of heel whip. Body mass index and gender comparisons, as well as measurement reliability, also were explored. Mean heel whip angle across runners was 0.4 degrees (medial) with a standard deviation of 9.2 degrees. Of the 512 feet analyzed, 274 (54%) demonstrated a 5 degree whip or greater. There was a similar number of medial and lateral heel whips observed (27% each). Female runners were twice as likely to demonstrate a lateral heel whip of greater than 8.9 degrees. Overweight runners had more medially directed whips when compared with normal and underweight runners. More than half of the recreational runners studied were observed to have a medial or lateral heel whip of greater than 5 degrees. These data reveal the age, body mass index, and gender distribution of recreational runners with and without heel whips. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-01-01

    Tibial tuberosity (TT) transfer is a common procedure to treat patellofemoral instability in patients with elevated TT-trochlear groove (TG) distances. However, the effects of TT lateralization or medialization on patellar stability, kinematics, and contact mechanics remain unclear. Progressive medialization and lateralization will have increasingly adverse effects on patellofemoral joint kinematics, contact mechanics, and stability. Controlled laboratory study. Eight fresh-frozen cadaveric knees were placed on a testing rig, with a fixed femur and tibia mobile through 90° of flexion. Individual quadriceps heads and the iliotibial band were separated and loaded with 205 N in anatomic directions using a weighted pulley system. Patellofemoral contact pressures and patellar tracking were measured at 0°, 10°, 20°, 30°, 60°, and 90° of flexion using pressure-sensitive film behind the patella and an optical tracking system. The intact knee was measured with and without a 10-N patellar lateral displacement load, and recordings were repeated after TT transfer of 5, 10, and 15 mm medially and laterally. Statistical analysis used repeated-measures analysis of variance, Bonferroni post hoc analysis, and Pearson correlations. Tibial tuberosity lateralization significantly elevated lateral joint contact pressures, increased lateral patellar tracking, and reduced patellar stability (P.11). Progressive TT lateralization elevated lateral contact pressures, increased lateral patellar tracking, and reduced patellar stability. Medial contact pressure and tracking did alter with progressive TT medialization, but the changes were smaller. Lateral patellofemoral joint contact pressures increased with progressive lateralization of the TT; medialization of the TT reduced these effects, restoring patellar stability, and did not cause excessive peak pressures. These data provide a rationale for medial TT transfer surgery in patients with elevated TT-TG distances. © 2014 The Author(s).

  20. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique.

    Science.gov (United States)

    Harner, Christopher D; Mauro, Craig S; Lesniak, Bryson P; Romanowski, James R

    2009-10-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0 degrees , 30 degrees , 60 degrees , and 90 degrees . The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus, (3) a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak contact pressure compared with that found in the intact condition (p medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98 degrees and 0.84 mm, respectively) and the meniscectomy (4.45 degrees and 0.80 mm, respectively), and these increases were corrected by the repair. This study demonstrated significant changes in contact pressure and

  1. Medial prefrontal aberrations in major depressive disorder revealed by cytoarchitectonically informed voxel-based morphometry

    Science.gov (United States)

    Bludau, Sebastian; Bzdok, Danilo; Gruber, Oliver; Kohn, Nils; Riedl, Valentin; Sorg, Christian; Palomero-Gallagher, Nicola; Müller, Veronika I.; Hoffstaedter, Felix; Amunts, Katrin; Eickhoff, Simon B.

    2017-01-01

    Objective The heterogeneous human frontal pole has been identified as a node in the dysfunctional network of major depressive disorder. The contribution of the medial (socio-affective) versus lateral (cognitive) frontal pole to major depression pathogenesis is currently unclear. The present study performs morphometric comparison of the microstructurally informed subdivisions of human frontal pole between depressed patients and controls using both uni- and multivariate statistics. Methods Multi-site voxel- and region-based morphometric MRI analysis of 73 depressed patients and 73 matched controls without psychiatric history. Frontal pole volume was first compared between depressed patients and controls by subdivision-wise classical morphometric analysis. In a second approach, frontal pole volume was compared by subdivision-naive multivariate searchlight analysis based on support vector machines. Results Subdivision-wise morphometric analysis found a significantly smaller medial frontal pole in depressed patients with a negative correlation of disease severity and duration. Histologically uninformed multivariate voxel-wise statistics provided converging evidence for structural aberrations specific to the microstructurally defined medial area of the frontal pole in depressed patients. Conclusions Across disparate methods, we demonstrated subregion specificity in the left medial frontal pole volume in depressed patients. Indeed, the frontal pole was shown to structurally and functionally connect to other key regions in major depression pathology like the anterior cingulate cortex and the amygdala via the uncinate fasciculus. Present and previous findings consolidate the left medial portion of the frontal pole as particularly altered in major depression. PMID:26621569

  2. Current Topics Regarding the Function of the Medial Temporal Lobe Memory System.

    Science.gov (United States)

    Clark, Robert E

    2018-01-05

    The first clear insight that the medial temporal lobe of the human brain was in fact a system of anatomically connected structures that were organized into a memory system came in 1957 from the observations by Brenda Milner of the noted amnesic patient H.M. Subsequent work in humans, monkeys, and rodents has identified all of the components of the medial temporal lobe (MTL) that formed the memory system. Currently, work is ongoing to identify the specific contributions each structure in the medial temporal lobe makes towards the formation and storage of long-term declarative memory. The historical background of this work is described including what insights the study of noted neurologic patients H.M. and E.P. provided for understanding the function of the medial temporal lobe. The development of an animal model of medial temporal lobe function is described. Additionally, the insights that lead to the understanding that the brain contains multiple, anatomically discrete, memory systems are described. Finally, three current topics of debate are addressed: First, does the perirhinal cortex exclusively support memory, or does it support both memory and higher order visual perception? Second, is there an anatomical separation between recollection and familiarity ? Third, is the organization of spatial memory different between humans and rats, or perhaps the difference is between the working memory capacities of the two species?

  3. Incarceration of the medial collateral ligament in the intercondylar notch following proximal avulsion

    Energy Technology Data Exchange (ETDEWEB)

    Walton, Edward [Fiona Stanley Hospital, Department of Radiology, Perth, Western Australia (Australia); Williams, Martin [North Bristol NHS Trust, Department of Radiology, Bristol (United Kingdom); Robinson, James R. [Bristol Knee Group, Avon Orthopaedic Centre, Bristol (United Kingdom)

    2017-11-15

    Intra-articular entrapment of the medial collateral ligament (MCL) is a rare but recognised complication of traumatic injury to the posteromedial corner (PMC) of the knee. Considering the MCL is the most commonly injured ligament of the knee this complication is extremely rare with only a handful of cases describing MCL entrapment following distal avulsion of the MCL. We present the first known case of MCL entrapment following proximal avulsion of the MCL and posterior oblique ligament (POL) with the mid-substance of the MCL becoming entrapped in the joint, lying on the superior surface of the medial meniscus and extending up into the intercondylar notch. In addition, the medial patellar retinaculum was also entrapped in the medial aspect of the medial patellofemoral joint. MCL entrapment is best treated with expeditious surgical intervention and it is therefore crucial that the MRI findings are not overlooked. Details of the clinical assessment, MRI and operative findings are presented with a literature review of MCL entrapment. (orig.)

  4. Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to Avoid Ulnar Nerve Injury.

    Directory of Open Access Journals (Sweden)

    Francisco Soldado

    2015-07-01

    Full Text Available Background:  Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF owing to the risk of ulnar nerve injury.  Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization.   Methods: Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. Results:  Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions:  Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.

  5. Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study.

    Science.gov (United States)

    Jiang, Wei; Gao, Shu-Guang; Li, Kang-Hua; Luo, Ling; Li, Yu-Sheng; Luo, Wei; Lei, Guang-Hua

    2012-09-01

    The clinical relationship between medial meniscus tear and anterior cruciate ligament (ACL) rupture has been well documented. However, the mechanism of this clinical phenomenon is not exactly explained. Our aim is to investigate the biomechanical impact of partial and complete ACL rupture on different parts of medial meniscus. TWELVE FRESH HUMAN CADAVERIC KNEE SPECIMENS WERE DIVIDED INTO FOUR GROUPS: ACL intact (ACL-I), anteromedial bundle transection (AMB-T), posterolateral bundle transection (PLB-T), and ACL complete transection (ACL-T) group. Strain on the anterior horn, body part, and posterior horn of medial meniscus were measured under 200 N axial compressive tibial load at 0°, 30°, 60°, and 90° of knee flexion, respectively. Compared with the control group (ACL-I), the ACL-T group had a higher strain on whole medial meniscus at 0°, 60°, and 90° of flexion. But at 30°, it had a higher strain on posterior horn of meniscus only. As to PLB-T group, strain on whole meniscus increased at full extension, while strain increased on posterior horn at 30° and on body of meniscus at 60°. However, AMB-T only brought about higher strain at 60° of flexion on body and posterior horn of meniscus. Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

  6. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

    Science.gov (United States)

    Craft, Jason A; Kurzweil, Peter R

    2015-06-01

    The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

  7. Acquired personality traits of autism following damage to the medial prefrontal cortex.

    Science.gov (United States)

    Umeda, Satoshi; Mimura, Masaru; Kato, Motoichiro

    2010-01-01

    Recent neuroimaging studies on "theory of mind" have demonstrated that the medial prefrontal cortex (PFC) is involved when subjects are engaged in various kinds of mentalising tasks. Although a large number of neuroimaging studies have been published, a relatively small amount of neuropsychological evidence supports involvement of the medial PFC in theory of mind reasoning. We recruited two neurological cases with damage to the medial PFC and initially performed the standard neuropsychological assessments for intelligence, memory, and executive functions. To examine theory of mind performance in these two cases, four kinds of standard and advanced tests for theory of mind were used, including first- and second-order false belief tests, the strange stories test, and the faux pas recognition test. Both patients were also requested to complete the questionnaire for the autism-spectrum quotient. Neither case showed impairment on standard theory of mind tests and only mild impairments were seen on advanced theory of mind tests. This pattern of results is basically consistent with previous studies. The most interesting finding was that both cases showed personality changes after surgical operations, leading to characteristics of autism showing a lack of social interaction in everyday life. We discuss herein the possible roles of the medial PFC and emphasize the importance of using multiple approaches to understand the mechanisms of theory of mind and medial prefrontal functions.

  8. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome.

    Science.gov (United States)

    Griebert, Maggie C; Needle, Alan R; McConnell, Jennifer; Kaminski, Thomas W

    2016-03-01

    Medial tibial stress syndrome (MTSS) is an overuse injury occurring among the physically active. Linked to increased strain on the medial tendons of the ankle, studies emphasize controlling medial foot loading in the management of this condition. Kinesio taping (KT) has gained popularity for treating musculoskeletal pathologies; however, its effect on MTSS remains uninvestigated. This study aimed to determine if healthy participants and patients with current or previous history of MTSS differ in the rate of loading, and if KT affects plantar pressures in these participants. Twenty healthy participants and 20 participants with current or previous history of MTSS were recruited and walked across a plantar pressure mat prior to KT application, immediately after application, and after 24-h of continued use. Time-to-peak force was measured in 6 foot areas and compared across groups and conditions. ANOVA revealed a significant interaction between group, condition, and foot area (F = 1.990, p = 0.033). MTSS participants presented with lower medial midfoot time-to-peak force before tape application (95%CI: 0.014-0.160%, p = 0.021) that significantly increased following tape application (p < 0.05). These results suggest that KT decreases the rate of medial loading in MTSS patients. Future research might assess mechanisms by which this effect is achieved. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Effect of medial meniscal release on tibial translation after tibial plateau leveling osteotomy.

    Science.gov (United States)

    Pozzi, Antonio; Kowaleski, Michael P; Apelt, Detlef; Meadows, Cheyney; Andrews, Chad M; Johnson, Kenneth A

    2006-07-01

    To evaluate the biomechanical effects of medial meniscal release (MMR) and medial, caudal pole hemimeniscectomy (MCH) on joint stability in the cranial cruciate ligament (CCL)-deficient canine stifle before and after tibial plateau leveling osteotomy (TPLO). Experimental study. Thirty-one dogs. In experiment 1, 16 pairs of normal hindlimbs randomly assigned to an intact or transected CCL group were studied to determine the magnitude of tibial translation after MMR and MCH under 20% body weight load using radiographic imaging of radio-opaque markers. In experiment 2, 15 pairs of CCL-deficient hindlimbs were randomly assigned to a TPLO or sham TPLO group. The remainder of the experiment was performed as described for experiment 1. The effect of CCL transection, MMR, MCH and TPLO were analyzed using 2-way repeated measures ANOVA; P.05). We found a greater effect of MMR in sham TPLO than TPLO stifles (P=.0013) but no further effect of MCH after MMR (P>.05). By resisting tibial translation the medial meniscus might be at greater risk of tearing in CCL-deficient stifles. TPLO may spare the medial meniscus by neutralizing the tibial thrust and eliminating the wedge effect of the medial meniscus. MMR may not be indicated in the CCL-deficient stifle stabilized by TPLO.

  10. Dynamic Changes in Acetylcholine Output in the Medial Striatum During Place Reversal Learning

    Science.gov (United States)

    Ragozzino, Michael E.; Choi, Daniel

    2004-01-01

    The present studies explored the role of the medial striatum in learning when taskcontingencies change. Experiment 1 examined whether the medial striatum is involved in place reversal learning. Testing occurred in a modified cross-maze across two consecutive sessions. Injections of the local anesthetic, bupivacaine, into the medial striatum, did not impair place acquisition, but impaired place reversal learning. The reversal-learning deficit was due to an inability to maintain the new choice pattern following the initial shift. Experiment 2 determined whether changes in acetylcholine (ACh) output occur during the acquisition or reversal learning of a place discrimination. Extracellular ACh output from the medial striatum was assessed in samples collected at 6-min intervals using in vivo microdialysis during behavioral testing. ACh output did not change from basal levels during place acquisition. During reversal learning, ACh output significantly increased as rats began to learn the new choice pattern, and returned to near basal levels as a rat reliably executed the new place strategy. The present results suggest that the medial striatum may be critical for flexible adaptations involving spatial information, and that ACh actions in this area enable the shifting of choice patterns when environmental conditions change. PMID:14747519

  11. Aminoglycoside ototoxicity and the medial efferent system: II. Comparison of acute effects of different antibiotics.

    Science.gov (United States)

    Lima da Costa, D; Erre, J P; Pehourq, F; Aran, J M

    1998-01-01

    Gentamicin (GM) has been shown to reversibly reduce the ability of contralateral noise to suppress ipsilateral cochlear activity, in a dose-dependent manner. However, during chronic administration of lower doses (60 mg/kg) the involvement of medial efferents could not be demonstrated. The purposes of the present study were to determine whether other aminoglycosides would display the same acute effects as GM and whether there was any correlation between their specificity and degree of cochlear and vestibular toxicity and their potency of blockade of the medial efferent system. Thus, we observed changes in ipsilateral ensemble background activity (EBA) of the VIIIth nerve without and with contralateral low level (55 dB SPL) broadband noise stimulation, in awake guinea pigs (GPs), before and after one single high-dose intramuscular injection of different aminoglycoside antibiotics (AAs) (gentamicin, amikacin, neomycin, netilmicin, streptomycin, tobramycin). For comparison, the effects of strychnine, a known antagonist of the efferent transmission and of cisplatin, an antineoplastic agent with cochleotoxic properties were also studied. Netilmicin displayed blocking properties similar to GM, although less pronounced, while amikacin and neomycin had no effect on medial efferent function. With tobramycin and streptomycin a decrease in suppression was usually associated with a reduction of the EBA measured without acoustic stimulation. However, with cisplatin, suppression was still effective when EBA was severely decreased. We could not observe specific effects of strychnine on medial efferent function. In conclusion, no correlation was found between specificity and degree of AA ototoxicity and their action on the medial efferent system.

  12. Radiographic Relevance of the Distal Medial Cuneiform Angle in Hallux Valgus Assessment.

    Science.gov (United States)

    Hatch, Daniel J; Smith, Abigail; Fowler, Troy

    2016-01-01

    The angle formed by the distal articular facet of the medial cuneiform has been evaluated and discussed by various investigators. However, no consistent method has been available to radiograph and measure this entity. The wide variability of the angle is not conducive to comparative analysis. Additionally, investigators have noted that the angles observed (obliquity) vary greatly because of changes in radiographic angle, foot position, rotation of the first ray, and declination of the first metatarsal. Recognizing that these variables exist, we propose a reproducible assessment using digital radiography and application of deformity of correction principles. Our results have indicated a mean distal medial cuneiform angle of 20.69° in normal feet, 23.51° with moderate hallux valgus, and 20.41° with severe hallux valgus deformity. The radiograph beam was kept at 15° from the coronal plane. An inverse relationship was found between the distal medial cuneiform angle and bunion severity. This was in contrast to our expected hypothesis. The overall angle of the first metatarsal-medial cuneiform did, however, correlate with the severity of the bunion deformity (p hallux valgus. A better indicator appears to be the first metatarsal-medial cuneiform angle. This pathologic entity is a 3-dimensional one that incorporates the joint morphology of the first ray, triplane osseous positioning, and soft tissue imbalances. Perhaps, 3-dimensional computed tomography imaging will provide better insight into this entity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review.

    Science.gov (United States)

    Maleki, Maryam; Arazpour, Mokhtar; Joghtaei, Mahmoud; Hutchins, Stephen W; Aboutorabi, Atefeh; Pouyan, Ali

    2016-04-01

    Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented. The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients. Literature review According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria. The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee. Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis. Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2014.

  14. Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.

    Science.gov (United States)

    Tweed, Jo L; Campbell, Jackie A; Avil, Steven J

    2008-01-01

    We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation.

  15. Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis.

    Science.gov (United States)

    Hada, Shinnosuke; Ishijima, Muneaki; Kaneko, Haruka; Kinoshita, Mayuko; Liu, Lizu; Sadatsuki, Ryo; Futami, Ippei; Yusup, Anwajan; Takamura, Tomohiro; Arita, Hitoshi; Shiozawa, Jun; Aoki, Takako; Takazawa, Yuji; Ikeda, Hiroshi; Aoki, Shigeki; Kurosawa, Hisashi; Okada, Yasunori; Kaneko, Kazuo

    2017-09-12

    Medial meniscal extrusion (MME) is associated with progression of medial knee osteoarthritis (OA), but no or little information is available for relationships between MME and osteophytes, which are found in cartilage and bone parts. Because of the limitation in detectability of the cartilage part of osteophytes by radiography or conventional magnetic resonance imaging (MRI), the rate of development and size of osteophytes appear to have been underestimated. Because T2 mapping MRI may enable us to evaluate the cartilage part of osteophytes, we aimed to examine the association between MME and OA-related changes, including osteophytes, by using conventional and T2 mapping MRI. Patients with early-stage knee OA (n = 50) were examined. MRI-detected OA-related changes, in addition to MME, were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. T2 values of the medial meniscus and osteophytes were measured on T2 mapping images. Osteophytes surgically removed from patients with end-stage knee OA were histologically analyzed and compared with findings derived by radiography and MRI. Medial side osteophytes were detected by T2 mapping MRI in 98% of patients with early-stage knee OA, although the detection rate was 48% by conventional MRI and 40% by radiography. Among the OA-related changes, medial tibial osteophyte distance was most closely associated with MME, as determined by multiple logistic regression analysis, in the patients with early-stage knee OA (β = 0.711, p early-stage knee OA, who showed ≥ 3 mm of MME (r = 0.58, p = 0.003). The accuracy of osteophyte evaluation by T2 mapping MRI was confirmed by histological analysis of the osteophytes removed from patients with end-stage knee OA. Our study demonstrates that medial tibial osteophyte evaluated by T2 mapping MRI is frequently observed in the patients with early-stage knee OA, showing close association with MME, and that MME is positively correlated with the meniscal

  16. Contrasting medial moraine development at adjacent temperate, maritime glaciers: Fox and Franz Josef Glaciers, South Westland, New Zealand

    Science.gov (United States)

    Brook, Martin; Hagg, Wilfried; Winkler, Stefan

    2017-08-01

    Medial moraines form important pathways for sediment transportation in valley glaciers. Despite the existence of well-defined medial moraines on several glaciers in the New Zealand Southern Alps, medial moraines there have hitherto escaped attention. The evolving morphology and debris content of medial moraines on Franz Josef Glacier and Fox Glacier on the western flank of the Southern Alps is the focus of this study. These temperate maritime glaciers exhibit accumulation zones of multiple basins that feed narrow tongues flowing down steep valleys and terminate 400 m above sea level. The medial moraines at both glaciers become very prominent in the lower ablation zones, where the medial moraines widen, and develop steeper flanks coeval with an increase in relative relief. Medial moraine growth appears somewhat self-limiting in that relief and slope angle increase eventually lead to transport of debris away from the medial moraine by mass-movement-related processes. Despite similarities in overall morphologies, a key contrast in medial moraine formation exists between the two glaciers. At Fox Glacier, the medial moraine consists of angular rockfall-derived debris, folded to varying degrees along flow-parallel axes throughout the tongue. The debris originates above the ELA, coalesces at flow-unit boundaries, and takes a medium/high level transport pathway before subsequently emerging at point-sources aligned with gently dipping fold hinges near the snout. In contrast at Franz Josef Glacier, the medial moraine emerges farther down-glacier immediately below a prominent rock knob. Clasts show a mix of angular to rounded shapes representing high level transport and subglacially transported materials, the latter facies possibly also elevated by supraglacial routing of subglacial meltwater. Our observations confirm that a variety of different debris sources, transport pathways, and structural glaciological processes can interact to form medial moraines within New Zealand

  17. Development of an automated method to detect sitting pivot transfer phases using biomechanical variables: toward a standardized method

    Directory of Open Access Journals (Sweden)

    Desroches Guillaume

    2012-02-01

    Full Text Available Abstract Background Sitting pivot transfer (SPT is one of the most important, but at the same time strenuous at the upper extremity, functional task for spinal cord injured individuals. In order to better teach this task to those individuals and to improve performance, a better biomechanical understanding during the different SPT phases is a prerequisite. However, no consensus has yet been reached on how to depict the different phases of the SPT. The definition of the phases of the SPT, along with the events characterizing these phases, will facilitate the interpretation of biomechanical outcome measures related to the performance of SPTs as well as strengthen the evidence generated across studies. Methods Thirty-five individuals with a spinal cord injury performed two SPTs between seats of similar height using their usual SPT technique. Kinematics and kinetics were recorded using an instrumented transfer assessment system. Based on kinetic and kinematic measurements, a relative threshold-based algorithm was developed to identify four distinct phases: pre-lift, upper arm loading, lift-pivot and post-lift phases. To determine the stability of the algorithm between the two SPTs, Student t-tests for dependent samples were performed on the absolute duration of each phase. Results The mean total duration of the SPT was 2.00 ± 0.49 s. The mean duration of the pre-lift, upper arm loading, lift-pivot and post-lift phases were 0.74 ± 0.29 s, 0.28 ± 0.13 s, 0.72 ± 0.24 s, 0.27 ± 0.14 s whereas their relative contributions represented approximately 35%, 15%, 35% and 15% of the overall SPT cycle, respectively. No significant differences were found between the trials (p = 0.480-0.891. Conclusion The relative threshold-based algorithm used to automatically detect the four distinct phases of the SPT, is rapid, accurate and repeatable. A quantitative and thorough description of the precise phases of the SPT is prerequisite to better interpret biomechanical

  18. Pivotal moments and changes in the Bonny Method of Guided Imagery and Music for patients with depression.

    Science.gov (United States)

    Lin, Mei-Feng; Hsu, Mei-Chi; Chang, Hsiu-Ju; Hsu, Yu-Yun; Chou, Mei-Hsien; Crawford, Paul

    2010-04-01

    To explore pivotal moments and changes during the Bonny Method of Guided Imagery and Music from the perspective of patients with depression. Depression has been described as an extremely difficult experience for people and is characterised by emotional distress and suffering. As depression progresses, symptoms increase and gradually influence all aspects of the lives of those affected. Few studies have been undertaken into the essence of inner and pivotal experiences during Guided Imagery and Music in patients with depression. A qualitative research design and discovery-oriented approach were used as the method of both data gathering and textual analysis. This study conducted semi-structured interviews with five patients with depression after each of eight sessions of the Bonny Method of Guided Imagery and Music. Each session took place in a music therapy laboratory. Forty transcripts were organised into categories and analysed according to the discovery-oriented approach of Mahrer and Boulet, considering the dimensions of the Bonny Method of Guided Imagery and Music. Results. Nine patients with depression were recruited from a medical centre in southern Taiwan from 2004-2005. Five successfully completed eight Bonny Method of Guided Imagery and Music sessions. There were 141 statements coded into 10 subthemes and three themes describing pivotal moments: pushing aside the barrier, gaining new insight, moving forward. Each category was supported by three-four themes. The analysis also yielded three meaningful moments: releasing mind-body rigidity, awareness and inspiration, acceptance and inner transformation. Patients described personal emotional, cognitive and behavioural transformation during the Bonny Method of Guided Imagery and Music experiences. The discovery-oriented approach fulfilled the aim of gaining a valuable understanding of the psychological growth experiences of patients with depression during the Bonny Method of Guided Imagery and Music. Patients

  19. Results of a multicenter prospective pivotal trial of the first inline continuous glucose monitor in critically ill patients.

    Science.gov (United States)

    Bochicchio, Grant V; Nasraway, Stan; Moore, Laura; Furnary, Anthony; Nohra, Eden; Bochicchio, Kelly

    2017-06-01

    We have previously demonstrated that tight glycemic control (80-120 mg/dL) improves outcome in critically injured patients. However, many centers have gotten away from aggressive glucose control due to the workload and risk of hypoglycemia. The objective of this pivotal trial is to evaluate the first in human continuous inline glucose monitor (OptiScanner) in critically ill patients. A multicenter pivotal trial was conducted over a 1-year period (2014-2015) at four major academic centers in 200 critically ill patients. Three thousand seven hundred thirty-five glucose measurements were obtained and measured. A paired blood sample was then collected to coincide with the OptiScan measurement. The OptiScanner withdraws 0.13 mL of blood every 15 minutes from a central venous line, centrifuges the sample, and uses midinfrared spectroscopy to directly measure glucose levels in blood plasma. We plotted a Clarke Error Grid, calculated mean absolute relative difference (MARD) to analyze trend accuracy, and population coefficient of variation (PCV) to measure deviations. OptiScanner and Yellow Springs Instrument values were "blinded" from clinicians. Treatment was guided by the standard point of care meters. 95.4% of the data points were in zone A of the Clarke Error Grid and 4.5% in zone B. The MARD was 7.6%, the PCV 9.6%. The majority of data points achieved the benchmark for accuracy. The MARD was below 10%, which is the first inline continuous glucose monitor to achieve this result in a clinical trial. The PCV was less than 10%. We confirmed that the OptiScanner outperformed every 1- to 3-hour glucose measurements using point of care meters which prevents glucose excursions and variability and achieves a higher amount of time the patient's glucose values remain in range. This pivotal multicenter trial demonstrates that the first inline CGM monitor is safe and accurate for use in critically ill surgical and trauma patients. Diagnostic study, level I.

  20. Contralateral supraorbital keyhole approach to medial optic nerve lesions: an anatomoclinical study.

    Science.gov (United States)

    Singh, Harminder; Essayed, Walid I; Jada, Ajit; Moussazadeh, Nelson; Dhandapani, Sivashanmugam; Rote, Sarang; Schwartz, Theodore H

    2017-03-01

    OBJECTIVE The authors describe the supraorbital keyhole approach to the contralateral medial optic nerve and tract, both in a series of cadaveric dissections and in 2 patients. They also discuss the indications and contraindications for this procedure. METHODS In 3 cadaver heads, bilateral supraorbital keyhole minicraniotomies were performed to expose the ipsilateral and contralateral optic nerves. The extent of exposure of the medial optic nerve was assessed. In 2 patients, a contralateral supraorbital keyhole approach was used to remove pathology of the contralateral medial optic nerve and tract. RESULTS The supraorbital keyhole craniotomy provided better exposure of the contralateral superomedial nerve than it did of the same portion of the ipsilateral nerve. In both patients gross-total resections of the pathology was achieved. CONCLUSIONS The authors demonstrate the suitability of the contralateral supraorbital keyhole approach for lesions involving the superomedial optic nerve.

  1. Split thickness skin grafts in four cases of medial meatal fibrosis of the external auditory canal.

    Science.gov (United States)

    Ribeiro, Andreia; Leonardo, Abílio; e Rodrigues, Manuel Rodrigues; Lopes, Gustavo

    2015-01-01

    Medial meatal fibrosis is a rare condition in which the medial portion of the external auditory canal is obliterated with fibrous tissue. We selected 4 cases of patients with medial meatal fibrosis with a history of recurrent otorrhea who underwent surgery during the years of 2012 and 2013, presenting the surgical results here. Physical examination showed an obliterated external auditory canal and conductive hypoacusis. All cases were solved using a split thickness skin graft from the thigh. The surgical principles that appear to correlate with a favorable outcome are the removal of all fibrous tissue and unhealthy skin, a wide canaloplasty and the use of a split thickness skin graft. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  2. Etiologic factors in the development of medial tibial stress syndrome: a review of the literature.

    Science.gov (United States)

    Tweed, Jo L; Avil, Steven J; Campbell, Jackie A; Barnes, Mike R

    2008-01-01

    Medial tibial stress syndrome is a type of exercise-induced leg pain that is common in recreational and competitive athletes. Although various studies have attempted to find the exact pathogenesis of this common condition, it remains unknown. Various theories in literature from 1976 to 2006 were reviewed using key words. Until recently, inflammation of the periosteum due to excessive traction was thought to be the most likely cause of medial tibial stress syndrome. This periostitis has been hypothesized by some authors to be caused by the tearing away of the muscle fibers at the muscle-bone interface, although there are several suggestions as to which, if any, muscle is responsible. Recent studies have supported the view that medial tibial stress syndrome is not an inflammatory process of the periosteum but instead a stress reaction of bone that has become painful.

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

    Science.gov (United States)

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

    2014-02-21

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

  4. Fornix and medial temporal lobe lesions lead to comparable deficits in complex visual perception.

    Science.gov (United States)

    Lech, Robert K; Koch, Benno; Schwarz, Michael; Suchan, Boris

    2016-05-04

    Recent research dealing with the structures of the medial temporal lobe (MTL) has shifted away from exclusively investigating memory-related processes and has repeatedly incorporated the investigation of complex visual perception. Several studies have demonstrated that higher level visual tasks can recruit structures like the hippocampus and perirhinal cortex in order to successfully perform complex visual discriminations, leading to a perceptual-mnemonic or representational view of the medial temporal lobe. The current study employed a complex visual discrimination paradigm in two patients suffering from brain lesions with differing locations and origin. Both patients, one with extensive medial temporal lobe lesions (VG) and one with a small lesion of the anterior fornix (HJK), were impaired in complex discriminations while showing otherwise mostly intact cognitive functions. The current data confirmed previous results while also extending the perceptual-mnemonic theory of the MTL to the main output structure of the hippocampus, the fornix. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player.

    Science.gov (United States)

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-07-01

    [Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the Star Excursion Balance Test, and the weight-bearing ankle dorsiflexion were increased. [Conclusion] This study showed that ankle inversion taping using kinesiology tape may be an effective therapy for a patient with a medial ankle sprain.

  6. Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

    Science.gov (United States)

    Goldstein, W M; Barmada, R

    1984-05-01

    The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

  7. Transient medial patellar dislocation: injury patterns at US and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Le Corroller, Thomas; Champsaur, Pierre [Hopital Sainte-Marguerite, Radiology Department, Marseille (France); Faculte de Medecine de Marseille, Anatomy Department, Marseille (France); Dediu, Melania [Hopital Sainte-Marguerite, Radiology Department, Marseille (France)

    2009-05-15

    Medial dislocation of the patella is an unusual entity. It is usually an iatrogenic complication of surgical lateral retinacular release. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. MR imaging confirmed the complete tear of the lateral patellar retinaculum and disclosed contusion of the anteromedial portion of the medial femoral condyle and lateral patella. This case is noteworthy because the injury patterns of patellar soft tissue restraints differ markedly from the classical features of lateral patellar dislocation. (orig.)

  8. Medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis.

    Science.gov (United States)

    Kim, Gang Deuk; Chae, Soo Uk; Cha, Myoung Soo

    2013-11-01

    Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we report a case with a medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis. This case shows that we should be aware of the possibility of encountering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.

  9. Medial opening wedge distal femoral osteotomy for post-traumatic secondary knee osteoarthritis.

    Science.gov (United States)

    Matsui, Gen; Akiyama, Takenori; Ikemura, Satoshi; Mawatari, Taro

    2014-04-30

    Osteoarthritis of the knee secondary to femoral fracture is difficult to treat. There are some surgical options, such as total knee arthroplasty or correction osteotomy. Opening wedge high tibial osteotomy is an established treatment of gonarthrosis. However, few reports are available on the effectiveness of a medial opening wedge distal femoral osteotomy. We present a case of a medial opening wedge distal femoral osteotomy on gonarthrosis secondary to a malunited femoral fracture with varus deformity and leg length discrepancy. This osteotomy was performed at the deformed femur, with locking plate fixation and autologous bone graft. Six months after the surgery, the osteotomy site was filled with bridging callus. Two years later, the Knee Society Score improved from 45 to 90 points. Medial opening wedge distal femoral osteotomy can be a useful method to treat knee osteoarthritis associated with distal femoral deformity.

  10. Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

    Full Text Available The medial patellofemoral ligament (MPFL injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

  11. Medial Patella Femoral Ligament Reconstruction With Periosteal Tunnels and Suture Fixation.

    Science.gov (United States)

    Brand, Jefferson; Hardy, Richard; Westerberg, Paul

    2017-10-01

    Lateral patellar dislocations can damage the medial patella femoral ligament. Nonoperative care is preferred but some tears may require a surgical intervention. Patella fractures are considered a risk factor after surgery. The technique described in this Technical Note avoids any bone tunnel drilling, which may eliminate the possibility of a patella fracture. The surgical procedure uses periosteal fibro-osseous tunnels to a double-limbed gracilis graft to reconstruct the upper and lower borders as conventionally used for medial patella femoral ligament reconstruction. Once the graft is tensioned, it is sutured to the periosteal fibro-osseous tunnel with 2 sutures on the medial side and at least 1 suture on the lateral side of each periosteal fibro-osseous sleeve. Each of the 2 periosteal fibro-osseous tunnels has 3 to 4 sutures securing the graft. After surgery, the patients complete 5 phases of rehabilitation to reduce swelling and to regain their strength and range of motion.

  12. Surgical Stabilization of the Medial Capsulo-Ligamentous Envelope in Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Brandon Green, DO

    2014-10-01

    Full Text Available This study will evaluate an alternative method in which a four prong bone staple was used to repair the medial collateral ligament following over-release or avulsion injuries in (#6 cases during a total knee arthroplasty. The use of a four prong bone staple to repair medial collateral ligament injuries status post total knee replacement will provide satisfactory results with respect to post-operative knee stability and range of motion. Our retrospective review revealed that all six patients improved with regards to range of motion following the total knee arthroplasty. We feel that repair of the medial collateral ligament with a four-prong bone staple is a viable option after an over-release or avulsion injury sustained during a total knee arthroplasty.

  13. What works for you? Using teacher feedback to inform adaptations of pivotal response training for classroom use.

    Science.gov (United States)

    Stahmer, Aubyn C; Suhrheinrich, Jessica; Reed, Sarah; Schreibman, Laura

    2012-01-01

    Several evidence-based practices (EBPs) have been identified as efficacious for the education of students with autism spectrum disorders (ASD). However, effectiveness research has rarely been conducted in schools and teachers express skepticism about the clinical utility of EBPs for the classroom. Innovative methods are needed to optimally adapt EBPs for community use. This study utilizes qualitative methods to identify perceived benefits and barriers of classroom implementation of a specific EBP for ASD, Pivotal Response Training (PRT). Teachers' perspectives on the components of PRT, use of PRT as a classroom intervention strategy, and barriers to the use of PRT were identified through guided discussion. Teachers found PRT valuable; however, they also found some components challenging. Specific teacher recommendations for adaptation and resource development are discussed. This process of obtaining qualitative feedback from frontline practitioners provides a generalizable model for researchers to collaborate with teachers to optimally promote EBPs for classroom use.

  14. What Works for You? Using Teacher Feedback to Inform Adaptations of Pivotal Response Training for Classroom Use

    Directory of Open Access Journals (Sweden)

    Aubyn C. Stahmer

    2012-01-01

    Full Text Available Several evidence-based practices (EBPs have been identified as efficacious for the education of students with autism spectrum disorders (ASD. However, effectiveness research has rarely been conducted in schools and teachers express skepticism about the clinical utility of EBPs for the classroom. Innovative methods are needed to optimally adapt EBPs for community use. This study utilizes qualitative methods to identify perceived benefits and barriers of classroom implementation of a specific EBP for ASD, Pivotal Response Training (PRT. Teachers' perspectives on the components of PRT, use of PRT as a classroom intervention strategy, and barriers to the use of PRT were identified through guided discussion. Teachers found PRT valuable; however, they also found some components challenging. Specific teacher recommendations for adaptation and resource development are discussed. This process of obtaining qualitative feedback from frontline practitioners provides a generalizable model for researchers to collaborate with teachers to optimally promote EBPs for classroom use.

  15. Dynamic profile of a prototype pivoted proof-mass actuator. [damping the vibration of large space structures

    Science.gov (United States)

    Miller, D. W.

    1981-01-01

    A prototype of a linear inertial reaction actuation (damper) device employing a flexure-pivoted reaction (proof) mass is discussed. The mass is driven by an electromechanic motor using a dc electromagnetic field and an ac electromagnetic drive. During the damping process, the actuator dissipates structural kinetic energy as heat through electromagnetic damping. A model of the inertial, stiffness and damping properties is presented along with the characteristic differential equations describing the coupled response of the actuator and structure. The equations, employing the dynamic coefficients, are oriented in the form of a feedback control network in which distributed sensors are used to dictate actuator response leading to a specified amount of structural excitation or damping.

  16. Potential for Photovoltaic Solar Installation in Non-Irrigated Corners of Center Pivot Irrigation Fields in the State of Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, B.

    2011-07-01

    The State of Colorado expressed an interest in assessing the potential for photovoltaic (PV) solar installations on non-irrigated corners of center-pivot irrigation (CPI) fields throughout the state. Using aerial imagery and irrigated land data available from the Colorado Water Conservation Board, an assessment of potentially suitable sites was produced. Productivity estimates were calculated from that assessment. The total area of non-irrigated corners of CPI fields in Colorado was estimated to be 314,674 acres, which could yield 223,418 acres of installed PV panels assuming 71% coverage in triangular plots. The total potential annual electricity production for the state was estimated to be 56,821 gigawatt hours (GWH), with an average of 1.3 GWH per available plot.

  17. A comparison of 11 o'clock versus oblique femoral tunnels in the anterior cruciate ligament-reconstructed knee: knee kinematics during a simulated pivot test.

    Science.gov (United States)

    Markolf, Keith L; Jackson, Steven R; McAllister, David R

    2010-05-01

    Traditionally, a standard femoral tunnel for a single-bundle anterior cruciate ligament (ACL) reconstruction is positioned 6 to 7 mm anterior to the posterior wall at an 11 o'clock orientation in the femoral notch (right knee). However, some surgeons have advocated placing the femoral tunnel at a more oblique orientation at or near the femoral footprint of the ACL's posterolateral bundle (at approximately 9:30 to 10 o'clock in the notch) to provide the graft with a better mechanical advantage for controlling tibial rotation and eliminating the pivot shift. Moving the femoral tunnel from the standard location to an oblique position in the femoral notch will significantly reduce the magnitude of a simulated pivot shift. Controlled laboratory study. Internal-external tibial rotation and anteroposterior (AP) displacement of the lateral tibial plateau were measured in 17 fresh-frozen cadaveric knees during a simulated pivot-shift event with a single-bundle ACL reconstruction placed in standard and oblique femoral tunnels. Baseline kinematic measurements were taken with the graft tensioned to restore intact AP knee laxity at 30 degrees of flexion. The measurements were repeated as graft tension was decreased to produce approximately 2-mm incremental increases in laxity (up to +10 mm). Correlations between lateral tibial plateau displacement and tibial rotation during the pivot shift were determined for both tunnels. There were no significant differences in tibial rotations or tibial plateau displacements during the pivot shift between standard and oblique femoral tunnels when the graft was tensioned to restore intact knee laxity. The relationship between pivot-shift magnitude and AP laxity was highly linear for each knee specimen over the range of laxities tested; the mean slopes for anteromedial (AM) and posterolateral (PL) tunnels were not significantly different. There were near perfect linear correlations (mean r2 >.98) between lateral plateau displacement and tibial

  18. Comprehensive characterization of a theophylline riboswitch reveals two pivotal features of Shine-Dalgarno influencing activated translation property.

    Science.gov (United States)

    Cui, Wenjing; Cheng, Jintao; Miao, Shengnan; Zhou, Li; Liu, Zhongmei; Guo, Junling; Zhou, Zhemin

    2017-03-01

    Tuneable gene expression controlled by synthetic biological elements is of great importance to biotechnology and synthetic biology. The synthetic riboswitch is a pivotal type of elements that can easily control the heterologous gene expression in diverse bacteria. In this study, the theophylline-dependent synthetic riboswitch and the corresponding variants with varied spacings between Shine-Dalgarno (SD) sequence and start codon were employed to comprehensively characterize the induction and regulation properties through combining a strong promoter aprE in Bacillus subtilis. Amongst the sets of newly constructed expression elements, the expression element with 9-bp spacing exhibited the higher expression level, a superior induction fold performance, and a considerably lower leaky expression than those with longer or shorter spacings. The riboswitch expression element with 9-bp spacing showed an approximately linear dose dependence from 0 to 8 mM of theophylline. Modification of the SD sequence through the insertion of a single A base prior to the native sequence enables the increase of the expression level post induction while decreasing the induction fold as a result of the elevated leaky level. The riboswitch elements with the engineered SD and the optimal 9-bp spacing exhibit an altered dose dependency in which the approximately linear range shifts to 0-4 mM, although it has a similar profile to the induction process. These results not only provide comprehensive data for the induced expression by a theophylline riboswitch combined with a strong native promoter from B. subtilis but also provide the two pivotal features of SD essential to the modular design of other synthetic riboswitches.

  19. Avaliação artroscópica e macroscópica da faceta medial do semilunar Arthroscopic and macroscopic evaluation of the lunate medial facet

    Directory of Open Access Journals (Sweden)

    Edgard de Novaes França Bisneto

    2011-01-01

    Full Text Available OBJETIVO: avaliar a correlação entre a presença de uma faceta medial do semilunar e a incidência de lesões ligamentares e artrose do pólo proximal do hamato. MÉTODOS: Avaliação artroscópica e dissecação dos punhos foram efetuados em cadáveres. RESULTADOS: Houve uma correlação clara, estatisticamente significativa entre artrose do pólo proximal do hamato e a presença da faceta medial do semilunar. CONCLUSÃO: Artrose do pólo proximal do hamato está correlacionada com a presença do tipo II semilunar. Nível de Evidência III, Estudo de pacientes nãoconsecutivos; sem padrão de referência "ouro" aplicado uniformementeOBJECTIVE: To evaluate the correlation between the presence of a lunate medial facet and the incidence of ligament lesions of the wrist and arthrosis of the proximal pole of the hamate. This study was carried out on cadavers. METHODS: Arthroscopic evaluation and dissection were performed on cadaver wrists. RESULTS: There was a clear, statistically significant correlation between arthrosis of the proximal pole of the hamate and the presence of a medial facet on the lunate. CONCLUSION: Arthrosis of the proximal pole of the hamate is correlated with the presence of a type II lunate. Level of Evidence III, Study of nonconsecutive patients; without consistently applied reference ''gold'' standard.

  20. A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.

    Science.gov (United States)

    Furumatsu, Takayuki; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

    2017-07-01

    The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading. Eighty-five patients who underwent surgical treatments for the MMPRT (39 knees) and other types of MM tears (49 knees) were included. The presence of characteristic MRI findings such as cleft sign, ghost sign, radial tear sign, medial extrusion sign, and new meniscal body shape-oriented "giraffe neck sign" was evaluated in 120 MRI examinations. Giraffe neck signs were observed in 81.7% of the MMPRTs and in 3.3% of other MM tears. Cleft, ghost, and radial tear signs were highly positive in the MMPRTs compared with other MM tears. Medial extrusion signs were frequently observed in both groups. Coexistence rates of any 2 MRI signs, except for medial extrusion sign, were 91.7% in the MMPRT group and 5% in other MM tears. This study demonstrated that a new characteristic MRI finding "giraffe neck sign" was observed in 81.7% of the MMPRT. Our results suggest that the combination of giraffe neck, cleft, ghost, and radial tear signs may be important for an accurate diagnostic MRI reading of the MMPRT. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  1. Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyo-Sung; Han, Young-Min; Lee, Sang-Yong; Kim, Ki-Nam; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2006-09-15

    The purpose of this study was to demonstrate the ultrasonographic (US) findings of rupture and the healing process of the medial head of the gastrocnemius ('Tennis Leg'). Twenty-two patients (age range: 30 to 45 years) with clinically suspected ruptures of the medial head of the gastrocnemius were referred to us for US examination. All the patients underwent US of the affected limb and the contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients were performed at two-week intervals during the month after injury and at one-month intervals during the following six months. Of the 22 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in seven patients (31.8%); the remaining 15 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 20 patients (90.9%). The thickness of the fluid collection, including the hematoma in the patients with complete rupture (mean: 9.7 mm), was significantly greater than that seen in the patients with partial tear (mean: 6.8 mm) (p < 0.01). The primary union of the medial head of the gastrocnemius with the soleus muscle in all the patients with muscle rupture and fluid collection was recognized via the hypoechoic tissue after four weeks. Ultrasonography is a useful imaging modality for the diagnosis and follow-up examination for the patients suffering with rupture of the medial head of the gastrocnemius.

  2. Abnormal medial thalamic metabolism in patients with idiopathic restless legs syndrome.

    Science.gov (United States)

    Rizzo, Giovanni; Tonon, Caterina; Testa, Claudia; Manners, David; Vetrugno, Roberto; Pizza, Fabio; Marconi, Sara; Malucelli, Emil; Provini, Federica; Plazzi, Giuseppe; Montagna, Pasquale; Lodi, Raffaele

    2012-12-01

    Pathophysiology of restless legs syndrome is poorly understood. A role of the thalamus, specifically of its medial portion which is a part of the limbic system, was suggested by functional magnetic resonance imaging and positron emission tomography studies. The aim of this study was to evaluate medial thalamus metabolism and structural integrity in patients with idiopathic restless legs syndrome using a multimodal magnetic resonance approach, including proton magnetic resonance spectroscopy, diffusion tensor imaging, voxel-based morphometry and volumetric and shape analysis. Twenty-three patients and 19 healthy controls were studied in a 1.5 T system. Single voxel proton magnetic resonance spectra were acquired in the medial region of the thalamus. In diffusion tensor examination, mean diffusivity and fractional anisotropy were determined at the level of medial thalamus using regions of interest delineated to outline the same parenchyma studied by spectroscopy. Voxel-based morphometry was performed focusing the analysis on the thalamus. Thalamic volumes were obtained using FMRIB's Integrated Registration and Segmentation Tool software, and shape analysis was performed using the FMRIB Software Library tools. Proton magnetic resonance spectroscopy study disclosed a significantly reduced N-acetylaspartate:creatine ratio and N-acetylaspartate concentrations in the medial thalamus of patients with restless legs syndrome compared with healthy controls (P history of restless legs syndrome (β = -0.49; P = 0.018). On the contrary, diffusion tensor imaging, voxel-based morphometry and volumetric and shape analysis of the thalami did not show differences between the two groups. Proton magnetic resonance spectroscopic findings in patients with restless legs syndrome indicate an involvement of medial thalamic nuclei of a functional nature; however, the other structural techniques of the same region did not show any changes. These findings support the hypothesis

  3. [Anatomic study on perforating branch flap of medial vastus muscle and its clinical application].

    Science.gov (United States)

    Guo, Yongqiang; Liang, Xiaoqin; Wang, Jianli; Wang, Chenqi; Guo, Deliang; Wang, Changde; Cui, Lei

    2012-09-01

    To investigate the anatomic features of the perforating branch flap of the medial vastus muscle, so as to provide a new perforating branch flap for repairing the soft tissue defect. Six fresh donated lower limb specimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation. The integument of the thigh was dissected to observe the origin, course, size, and location of the perforating branch of the medial vastus muscle by angiography and photography. Based on the anatomic study, the free perforating branch flaps of the medial vastus muscle (14 cm x 6 cm to 20 cm x 5 cm) were used to repair skin and soft tissue defects (8 cm x 6 cm to 12 cm x 8 cm) of the feet in 4 patients between June 2009 and August 2011. The artery of the medial vastus was sent out constantly from the femoral artery, and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateral femoral circumflex artery to form prepatellar vascular network. The artery of the medial vastus sent out 3-5 musculocutaneous perforating branches into the deep fascia and then extended superficially to the overlying skin. Four flaps survived after surgery; wounds at the donor site and recipient site healed by first intention. After follow-up of 6-12 months, the flaps had good appearance and texture. All ankles had normal movement range of plantarflexion and dorsiflexion. The free perforating branch flaps of the medial vastus muscle can be harvested easily, and have the advantage of good texture and abundant donor site.

  4. Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer

    Science.gov (United States)

    Roshdy, Sameh; Hussein, Osama; Khater, Ashraf; Zuhdy, Mohammad; El-Hadaad, Hend A; Farouk, Omar; Senbel, Ahmad; Fathi, Adel; Hamed, Emadeldeen; Denewer, Adel

    2015-01-01

    Background Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations. PMID:26185469

  5. Representation of Behavioral Tactics and Tactics-Action Transformation in the Primate Medial Prefrontal Cortex.

    Science.gov (United States)

    Matsuzaka, Yoshiya; Tanji, Jun; Mushiake, Hajime

    2016-06-01

    To expedite the selection of action under a structured behavioral context, we develop an expedient to promote its efficiency: tactics for action selection. Setting up a behavioral condition for subhuman primates (Macaca fuscata) that induced the development of a behavioral tactics, we explored neuronal representation of tactics in the medial frontal cortex. Here we show that neurons in the posterior medial prefrontal cortex, but not much in the medial premotor cortex, exhibit activity representing the behavioral tactics, in advance of action-selective activity. Such activity appeared during behavioral epochs of its retrieval from instruction cues, maintenance in short-term memory, and its implementation for the achievement of action selection. At a population level, posterior medial prefrontal cortex neurons take part in transforming the tactics information into the information representing action selection. The tactics representation revealed an aspect of neural mechanisms for an adaptive behavioral control, taking place in the medial prefrontal cortex. We studied behavioral significance of neuronal activity in the posterior medial prefrontal cortex (pmPFC) and found the representation of behavioral tactics defined as specific and efficient ways to achieve objectives of actions. Neuronal activity appeared during behavioral epochs of its retrieval from instruction cues, maintenance in short-term memory, and its use preceding the achievement of action selection. We found further that pmPFC neurons take part in transforming the tactics information into the information representing action selection. A majority of individual neurons was recruited during a limited period in each behavioral epoch, constituting, as a whole, a temporal cascade of activity. Such dynamics found in behavioral-tactics specific activity characterize the participation of pmPFC neurons in executive control of purposeful behavior. Copyright © 2016 the authors 0270-6474/16/365974-14$15.00/0.

  6. Novel and successful free comments method for sensory characterization of chocolate ice cream: A comparative study between pivot profile and comment analysis.

    Science.gov (United States)

    Fonseca, Fernando G A; Esmerino, Erick A; Filho, Elson R Tavares; Ferraz, Juliana P; da Cruz, Adriano G; Bolini, Helena M A

    2016-05-01

    Rapid sensory profiling methods have gained space in the sensory evaluation field. Techniques using direct analysis of the terms generated by consumers are considered easy to perform, without specific training requirements, thus improving knowledge about consumer perceptions on various products. This study aimed to determine the sensory profile of different commercial samples of chocolate ice cream, labeled as conventional and light or diet, using the "comment analysis" and "pivot profile" methods, based on consumers' perceptions. In the comment analysis task, consumers responded to 2 separate open questions describing the sensory attributes they liked or disliked in each sample. In the pivot profile method, samples were served in pairs (consisting of a coded sample and pivot), and consumers indicated the higher and lower intensity attributes in the target sample compared with the pivot. We observed that both methods were able to characterize the different chocolate ice cream samples using consumer perception, with high correlation results and configurational similarity (regression vector coefficient=0.917) between them. However, it is worth emphasizing that comment analysis is performed intuitively by consumers, whereas the pivot profile method showed high analytical and discriminative power even using consumers, proving to be a promising technique for routine application when classical descriptive methods cannot be used. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  7. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus.

    Science.gov (United States)

    Thaunat, Mathieu; Fayard, Jean Marie; Guimaraes, Tales M; Jan, Nicolas; Murphy, Colin G; Sonnery-Cottet, Bertrand

    2016-08-01

    Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25° curved suture hook device is described.

  8. Medial Condyle Fracture (Kilfoyle Type III of the Distal Humerus with Transient Fishtail Deformity after Surgery

    Directory of Open Access Journals (Sweden)

    Motoki Sonohata

    2017-01-01

    Full Text Available A “Fishtail deformity” is one of the well-known complications following pediatric lateral condyle or supracondylar fractures of the humerus. We herein report a case of medial condyle fracture (Kilfoyle type III in an 11-year-old boy. He had a transient “fishtail deformity” of the trochlear groove after open reduction and internal fixation. As occurred in the current case, the bone remodeling and the improvement of ischemia of the trochlea after medial condyle fracture may be associated with the likelihood of recovery from transient “fishtail deformity.”

  9. Biomechanical Effects of a Horizontal Medial Meniscal Tear and Subsequent Leaflet Resection.

    Science.gov (United States)

    Brown, Matthew J; Farrell, James P; Kluczynski, Melissa A; Marzo, John M

    2016-04-01

    Horizontal, degenerative tears of the medial meniscus and subsequent meniscectomy can compromise the biomechanical function of the meniscus in load transmission and weightbearing, leading to the development of radiographic and symptomatic tibiofemoral arthritis. Resection of both leaflets of a horizontal medial meniscal tear will increase peak contact pressures and decrease contact areas in comparison with resection of only the inferior leaflet. Controlled laboratory study. Twelve fresh-frozen human cadaveric knees had tibiofemoral peak contact pressures and contact areas under an 1800-N axial load measured by Tekscan in the control state. A horizontal tear was created in the posterior horn of the medial meniscus, and the knees were retested. The knees were tested a third time after resection of the inferior leaflet (single leaflet) and a final time after resection of the superior leaflet (both leaflets). The Friedman test was used to test for group differences in peak pressure (psi) and contact area (mm(2)) between test conditions (native, tear, inferior leaflet resection, and resection of both leaflets). For the medial compartment, there was a statistically significant difference in peak pressure (P = .03) but not in contact area (P = .70) between testing conditions. Median peak pressure in the medial compartment was significantly greater for resection of both leaflets compared with the tear (406.5 vs 294.7 psi, respectively; P = .002). Median contact area in the medial compartment was greatest for resection of both leaflets (602.7 mm(2)), but there were no statistically significant differences between test conditions (P = .70). For the lateral compartment, there were no statistically significant differences in peak pressure (P = .99) or contact area (P = .77) between test conditions. Resection of a single inferior leaflet after a horizontal medial meniscal tear preserves much of the original biomechanical function of the meniscus. Resection of both leaflets

  10. The quadruple cruciate sign of simultaneous bicompartmental medial and lateral bucket-handle meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Bugnone, Alejandro N. [University of Miami School of Medicine/Jackson Memorial Hospital, Department of Radiology, Miami, FL (United States); Ramnath, R.R. [Neuroskeletal Imaging, Merritt Island, FL (United States); Davis, S.B. [Orthopedic Center, Huntsville, Alabama (United States); Sedaros, R. [Space Coast Orthopedics, Merritt Island, FL (United States)

    2005-11-01

    We report the second known case of bicompartmental bucket-handle tears of the medial and lateral menisci and the first documented case of the bucket-handle tears occurring simultaneously following trauma, which occurred after a motorcycle accident. Both bucket-handle fragments were displaced into the intercondylar notch. An anterior cruciate ligament tear was also present. Coronal images demonstrated four structures in the intercondylar notch: the anterior and posterior cruciate ligaments and the medial and lateral bucket-handle meniscal fragments. (orig.)

  11. Mechanism of the Rapid Effect of 17β -Estradiol on Medial Amygdala Neurons

    Science.gov (United States)

    Nabekura, Junichi; Oomura, Yutaka; Minami, Taketsugu; Mizuno, Yuji; Fukuda, Atsuo

    1986-07-01

    The mechanism by which sex steroids rapidly modulate the excitability of neurons was investigated by intracellular recording of neurons in rat medial amygdala brain slices. Brief hyperpolarization and increased potassium conductance were produced by 17β - estradiol. This effect persisted after elimination of synaptic input and after suppression of protein synthesis. Thus, 17β -estradiol directly changes the ionic conductance of the postsynaptic membrane of medial amygdala neurons. In addition, a greater proportion of the neurons from females than from males responded to 17β -estradiol.

  12. Island flaps in the repair of medial canthus: report of 8 cases.

    Science.gov (United States)

    Cecchi, Roberto; Fancelli, Laura; Troiano, Michela

    2013-06-15

    Reconstruction of the medial canthus following skin cancer excision is often challenging because of the complex anatomy and the cosmetic relevance of that region. The island pedicle advancement flap is an extremely versatile flap, which is commonly used to close defects in different body areas, including face, trunk, and extremities. We report our favourable experience with the use of island flaps, mobilized from the nasal saddle or lateral nasal side wall in 8 patients who had skin defects on the medial canthus region after Mohs micrographic surgery for basal cell carcinomas.

  13. The Rotterdam Foot Classification: A Classification System for Medial Polydactyly of the Foot.

    Science.gov (United States)

    Burger, Elise B; Hovius, Steven E R; Burger, Bart J; van Nieuwenhoven, Christianne A

    2016-08-03

    Polydactyly at the medial side of the foot ("medial polydactyly" of the foot) is a rare and diverse congenital anomaly. In order to plan and evaluate surgical treatment, the classification of medial polydactyly is useful. The aim of our study was to develop a reliable and valid classification system for medial polydactyly of the foot that is more useful than previous systems for preoperative evaluation and surgical planning. A review of the literature and the clinical experience of a single experienced surgeon were used to determine classification categories. We identified all patients with medial polydactyly who had preoperative radiographs and clinical photographs and were treated at our hospital between 1993 and 2014. All affected feet were assessed according to our proposed classification system, the Rotterdam foot classification. The intrarater and interrater reliability among 5 observers who evaluated 30 feet were assessed with use of the Cohen kappa (κ) statistic. We developed a classification system that describes duplication type, syndactyly, the presence of a hypoplastic ray, and deviation of the hallux. Seventy-three feet were classified according to the system. Seven duplication types were distinguished. Complete metatarsal duplication was most frequently seen (in 29%). Twelve feet showed a broad hallux without external expression of duplication. Syndactyly between medial and lateral (duplicate) halluces was present in 30 feet; between the lateral hallux and second toe, in 13 feet; and between both duplicated halluces and the lateral hallux and second toe, in 21 feet. A hypoplastic ray was seen in 75% of the feet. Intrarater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.79, 0.75, 0.59, and 0.78. Interrater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.72, 0.54, 0.48, and 0.64. The proposed classification system contains 4 categories of anatomic

  14. Diabetes mellitus, hypertension and medial temporal lobe atrophy: the LADIS study

    DEFF Research Database (Denmark)

    Korf, E S C; van Straaten, E C W; de Leeuw, F-E

    2007-01-01

    was visually scored for the left and right medial temporal lobe (score 0-4), and meaned. RESULTS: Mean age was 73.5 years (sd 5.1), 54% was female. Of the subjects, 15% had DM, and 70% had a history of hypertension. The likelihood of having MTA score 3 was significantly higher in subjects with DM (OR 2.9; 95......HYPOTHESIS: Based on recent findings on the association between vascular risk factors and hippocampal atrophy, we hypothesized that hypertension and diabetes mellitus (DM) are associated with medial temporal lobe atrophy (MTA) in subjects without disability, independent of the severity of white...

  15. Radiosurgery for Medial Temporal Lobe Epilepsy Resulting from Mesial Temporal Sclerosis.

    Science.gov (United States)

    Gianaris, Thomas; Witt, Thomas; Barbaro, Nicholas M

    2016-01-01

    Medial temporal lobe epilepsy associated with mesial temporal sclerosis (MTS) is perhaps the most well-defined epilepsy syndrome that is responsive to structural interventions such as surgery. Several minimally invasive techniques have arisen that provide additional options for the treatment of MTS while potentially avoiding many of open surgery's associated risks. By evading these risks, they also open up treatment options to patients who otherwise are poor surgical candidates. Radiosurgery is one of the most intensively studied of these alternatives and has found a growing role in the treatment of medial temporal lobe epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Subcutaneous rupture of the Achilles tendon and ipsilateral fracture of the medial malleolus

    Directory of Open Access Journals (Sweden)

    Richards Paula J

    2006-07-01

    Full Text Available Abstract Background Although ankle fractures and an Achilles tendon rupture are relatively frequent in isolation, their association in the same injury is uncommon. Case presentation A 38 year old male tree surgeon fell six meters from a tree, sustaining a subcutaneous rupture of the Achilles tendon and an ipsilateral closed fracture of the medial malleolus. The injuries were diagnosed following clinical examination and imaging. Conclusion This injury combination is infrequent, and management of the Achilles tendon rupture should take into account the necessity not to secondarily displace the fracture of the medial malleollus.

  17. Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium.

    Science.gov (United States)

    Hafezi-Nejad, Nima; Guermazi, Ali; Roemer, Frank W; Hunter, David J; Dam, Erik B; Zikria, Bashir; Kwoh, C Kent; Demehri, Shadpour

    2017-02-01

    Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study. Case and control cohorts (Biomarkers Consortium subset from the Osteoarthritis Initiative (OAI)) were defined as participants with (n=297) and without (n=303) medial JSL progression (during 24-48th months). Cartilage volume measurements (baseline and 24th month loss) were obtained at five knee plates (medial-tibial, lateral-tibial, medial-femoral, lateral-femoral and patellar), and standardized values were analysed. Multivariate logistic regression was used with adjustment for known confounders. Artificial-Neural-Network analysis was conducted by Multi-Layer-Perceptrons (MLPs) including baseline determinants, and baseline (1) and interval changes (2) in cartilage volumes. Larger baseline lateral-femoral cartilage volume was predictive of medial JSL (OR: 1.29 (1.01-1.64)). Greater initial 24th month lateral-femoral cartilage volume-loss (OR: 0.48 (0.27-0.84)) had protective effect on medial JSL during 24-48th months of study. Baseline and interval changes in lateral-femoral cartilage volume, were the most important estimators for medial JSL progression (importance values: 0.191(0.177-0.204), 0.218(0.207-0.228)) in the ANN analyses. Cartilage volumes (both at baseline and their change during the initial 24 months) in the lateral femoral plate were predictive of medial JSL progression. • Baseline lateral femoral cartilage volume is directly associated with medial JSL progression. • 24-month lateral femoral cartilage loss is inversely associated with medial JSL progression. • Lateral femoral cartilage volume is most important in association with medial JSL progression.

  18. Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting

    DEFF Research Database (Denmark)

    Bohn, Marie Bagger; Petersen, Annemette Krintel; Nielsen, Dennis Brandborg

    2016-01-01

    intact knees (ACLI) and a knee healthy control group during walking, running and 90° pivoting. We hypothesized a larger tibial internal rotation, a smaller knee joint external moment and a lower rotational stiffness in the ACLD group compared to the ACLI and the control group. METHODS: Kinematic...... and kinetic data were collected from both legs of 44 ACLD patients and 16 healthy controls during walking, running and a pivoting maneuver (descending a staircase and immediately pivoting 90° on the landing leg). Motion data were captured using 8 high-speed cameras and a force-plate. Reflective markers were...... attached to bony landmarks of the lower limb and rigid clusters on the shank and thigh (CASH model). Maximum internal tibial rotation and the corresponding rotational moment were identified for all tasks and groups and used to calculate rotational stiffness (= Δmoment /Δrotation) of the knee. RESULTS...

  19. Dietary Vitamin D Supplementation during Early Growth is not Protective for Medial Coronoid Disease Development in Labradors

    NARCIS (Netherlands)

    Corbee, R.J.|info:eu-repo/dai/nl/314838066; Tryfonidou, M.A.|info:eu-repo/dai/nl/24306599X; Grinwis, G.C.M.|info:eu-repo/dai/nl/141470909; Wolschrijn, Claudia F.; Lau, Seng Fong; Gorissen, Ben|info:eu-repo/dai/nl/372825788; Heuven, Henri C.M.; Vaandrager, Arie B.; Hazewinkel, Herman A.W.

    2015-01-01

    Introduction: Medial coronoid disease (MCD) is a common heritable disease in young large-breed dogs and is characterized by fissures and/or fragmentation of the medial coronoid process (MCP), cartilage, and/or subchondral bone. MCD development has also been attributed to disturbed endochondral

  20. Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Samani, Afshin; Olesen, Christian Gammelgaard

    2011-01-01

    Medial tibial stress syndrome is a common overuse injury characterized by pain located on the medial side of the lower leg during weight bearing activities such as gait. The purpose of this study was to apply linear and nonlinear methods to compare the structure of variability of midfoot kinematics...