Anterior Extension Research Articles

Posterior optic buttonholing of intraocular lens implantation through posterior capsulorrhexis margin: A technique of intraocular lens implantation in cases of anterior capsulorrhexis extension in pediatric cataract surgery.

This study aimed to evaluate the intra- and postoperative complications of intraocular lens (IOL) implantation with posterior optic buttonholing (POBH) in children that had undergone phacoemulsification irrigation/aspiration for congenital/developmental cataract and experienced complication of anterior capsulorrhexis extension (ACE). A total of 25 eyes of 21 patients were included in the study. A foldable three-piece IOL was implanted into the bag/ciliary sulcus with primary posterior capsulorrhexis and POBH. The visual acuity improved from 2.12 ± 0.69 log MAR to 1.38 ± 0.49 log MAR at 6 months follow-up. Postoperative complications included heightened postoperative inflammation in three patients and temporary corneal edema in two patients. Only one patient had developed posterior capsular opacification (PCO) at 6 months follow-up with mild tilt, while the rest 24 eyes had no PCO formation and adequate IOL centration. The results of this study indicate that a three-piece foldable IOL implantation with POBH is a feasible option for children who experienced ACE during pediatric cataract surgery, as it results in satisfactory surgical outcomes and very few ocular complications.

Echocardiographic and clinical outcomes of patients undergoing septal myectomy plus anterior mitral leaflet extension for hypertrophic cardiomyopathy.

Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) and intractable symptoms. Concomitant mitral valve (MV) surgery is performed for abnormalities contributing to systolic anterior motion (SAM), or for SAM-mediated mitral regurgitation (MR) with or without left ventricular outflow tract (LVOT) obstruction. One MV repair technique is anterior mitral leaflet extension (AMLE) utilizing bovine pericardium, stiffening the leaflet and enhancing coaptation posteriorly. Fifteen HCM patients who underwent combined myectomy-AMLE for LVOT obstruction or moderate-to-severe MR between 2009 and 2020 were analyzed using detailed echocardiography. The mean age was 56.6 years and 67% were female. The average peak systolic LVOT gradient and MR grade measured 73.4 mmHg and 2.3, respectively. Indications for myectomy-AMLE were LVOT obstruction and moderate-to-severe MR in 67%, MR only in 20%, and LVOT obstruction only in 13%. There was no mortality observed, and median follow-up was 1.2 years. Two patients had follow-up grade 1 mitral SAM, one of whom also had mild LVOT obstruction. No recurrent MR was observed in 93%, and mild MR in 7%. Compared with preoperative measures, there was a decrease in follow-up LV ejection fraction (68.2 vs 56.3%, p = 0.02) and maximal septal wall thickness (25.5 vs 21.3 mm, p < 0.001), and an increase in the end-diastolic diameter (21.9 vs 24.8 mm/m2, p = 0.04). There was no change in global longitudinal strain (-12.1 vs -11.6%, p = 0.73) and peak LV twist (7.4 vs 7.3°, p = 0.97). In conclusion, myectomy-AMLE is a viable treatment option for carefully selected symptomatic HCM patients with LVOT obstruction or moderate-to-severe MR.

Chronic Pseudoparalysis Needs to Be Distinguished From Pseudoparesis: A Structural and Biomechanical Analysis

Background: Chronic pseudoparalysis is generally defined as the inability to actively elevate the arm above 90° with free passive range of motion and no neurological deficits. It has been suggested that this arbitrary cutoff needs to be refined. Purpose: To analyze whether there are structural and biomechanical differences in patients with chronic pseudoparalysis and those with chronic pseudoparesis. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective study, 50 patients with chronic massive rotator cuff tears (mRCTs; ≥2 tendons) and free passive and active scapular plane abduction <90° were divided into 2 groups: pseudoparalysis group (n = 24; active scapular plane abduction, <45°) and pseudoparesis group (n = 26; active scapular plane abduction, >45° and <90°). Radiographic measurements included the critical shoulder angle, acromiohumeral distance, posterior acromial tilt, anterior and posterior acromial coverages, and posterior acromial height on outlet views. Measurements on magnetic resonance imaging (MRI) included fatty infiltration of the rotator cuff muscles, anterior (subscapularis) and posterior (infraspinatus/teres minor) tear extensions, and global (anterior + posterior) tear extension in the parasagittal plane. A published musculoskeletal model was used to simulate the effect of different mRCTs on the muscle force required for scapular plane abduction. Results: Plain radiographs revealed no differences between patients with chronic pseudoparalysis and those with pseudoparesis. MRI assessment showed significant differences between patients with chronic pseudoparalysis and those with pseudoparesis with respect to fatty infiltration of the subscapularis (2.9 vs 1.6; P < .001) and infraspinatus (3.6 vs 3.0; P < .001) muscles, and anterior (−23° vs 4°; P < .001), posterior (−23° vs −14°; P = .034), and global rotator cuff (225° vs 190°; P < .001) tear extensions. The anterior tear extension in patients with chronic pseudoparalysis always involved more than 50% of the subscapularis, which was associated with an odds ratio of 5 for inability to actively abduct more than 45°. The biomechanical model was unable to find a combination of muscles that could balance the arm in space when the tear extended beyond the supraspinatus and the cranial subscapularis. Conclusion: This study confirms that chronic pseudoparalysis and pseudoparesis are associated with different structural lesions. In the setting of a chronic mRCT, involvement of more than 50% of the subscapularis tendon with fatty infiltration of stage 3 is associated with pseudoparalysis of active scapular plane abduction <45°. The key function of the subscapularis was confirmed in the biomechanical model.

Outcome of bone–patellar tendon–bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction

Background:Many systematic reviews have compared the short-term outcomes of anterior cruciate ligment (ACL)reconstruction with hamstring and patellar tendon autograft,but few differences have been observed. The purpose of this meta-analysis was to compare the medium-term outcome of bone–patellar tendon–bone and hamstring tendon autograft for anterior cruciate ligament reconstruction in terms of clinical function, knee stability, postoperativecomplications, and osteoarthritis changes.Methods:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane Library databases were searched from inception to November 2, 2019. This meta-analysis included only randomized controlled trials that compared BPTB and HT autografts for ACL reconstruction with a 5-year minimum follow-up. The Cochrane Collaboration's risk-of-bias tool was used to estimate the risk-of-bias for all included studies. RevMan 5.3 software was used to performed statistical analysis of the outcomes.Results:Fifteen RCTs, involving 1298 patients (610 patients in the BPTB group and 688 patients in the HT group) were included. In terms of clinical function, no significant difference was found in the objective International Knee Documentation Committee score (OR = 0.94, 95%CI: 0.64–1.37, P = .75), Lysholm knee score (MD = −2.26, 95%CI: −4.56 to 0.05, P = .06), return to preinjury activity level (OR = 1.01, 95%CI: 0.67–1.52, P = .96), and Tegner activity level (OR = 0.03, 95%CI: −0.36 to 0.41, P = .89). There was no statistically significant difference in the Lachman test (OR = 0.86, 95%CI: 0.5–1.32, P = .50), pivot-shift test (OR = 0.68, 95%CI: 0.44–1.06, P = .09), and side-to-side difference (MD = −0.32, 95%CI: −0.81 to 0.16, P = .19). As for postoperative complications and OA changes, there were no statistically significant difference in flexion loss (OR = 1.09, 95%CI: 0.47–2.54, P = .85) and OA changes (OR = 0.76, 95%CI: 0.52–1.10, P = .15), but we found significant differences in favor of the HT group in the domains of kneeling pain (OR = 1.67, 95%CI: 1.04–2.69, P = .03), anterior knee pain (OR = 2.90, 95%CI: 1.46–5.77, P = .002), and extension loss (OR = 1.75, 95%CI: 1.12–2.75, P = .01). There was a significant difference in favor of the BPTB group in the domain of graft failure (OR = 0.59, 95%CI: 0.38–0.91, P = .02).Conclusions:Based on the results above, HT autograft is comparable with the BPTB autograft in terms of clinical function, postoperative knee stability, and OA changes, with a medium-term follow-up. The HT autograft for ACL reconstruction carries a lower risk of complications, such as anterior knee pain, kneeling pain, and extension loss, but an increased incidence of graft failure. Patients should be informed of the differences when deciding on graft choice with their physician.

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection.

To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection. Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system. One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm3 (range: 0.01-30.6 cm3 ), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm3 , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm3 (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm3 was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection. Tumor volume >3 cm3 is associated with worse facial nerve outcomes 12 months following surgical resection. IV Laryngoscope, 131:E1328-E1334, 2021.

Value of the Petromeatal Angle in Predicting Outcome of Translabyrinthine Resection of Vestibular Schwannomas.

Factors associated with extent of tumor resection (EOR) and facial nerve outcomes include tumor size, anterior extension of the tumor, patient age, and surgical approach. To check whether preoperative measurement of the petromeatal (PMA), petroclival (PCA), and petrous-petrous (PPA) angles can help in predicting EOR, facial nerve outcome, and cerebrospinal fluid (CSF) leak occurrence in patients undergoing vestibular schwannoma (VS) surgery via the translabyrinthine approach (TLA). A total of 75 patients were included in this retrospective study. Preoperative magnetic resonance imaging constructive interface in steady state and postcontrast T1-weighted sequences through the internal acoustic meatus were used to measure the PMA, PCA, and PPA. There was a statistically significant association between tumor size and EOR; every additional cm in tumor size decreases the odds of gross-total (GTR)/near-total (NTR) resection by 524% (P=.0000355).After controlling for tumor size, the logistic models revealed a significant effect of the angles on EOR. For example, in a patient with a 2-cm VS, every additional degree in PMA, PCA, and PPA increases the odds of GTR/NTR by 2.3% (P=.0000571), 4.05% (P=.0000397), and 0.37% (P=.0000438), respectively.After adjusting for tumor size, sex, and age, the effect of PMA on the occurrence of an immediate postoperative facial nerve deficit and CSF leak indicated a trend towards significance (P=.0581 and P=.0568, respectively). More obtuse petrous bone angles, namely PMA, PCA, and PPA, are good predictors of GTR or NTR in patients undergoing VS surgery via TLA and may be associated with better facial nerve outcomes and lower CSF leak occurrences.

Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins

BackgroundA clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and important to avoid intraoperative pulmonary vessels injury. However, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated.MethodsThe branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012.ResultsBranching types of the bronchi and pulmonary vessels failed to be independent each other. Although the combinations of anterior extension type of bronchus with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein types with the M-type were often observed. Since LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns.ConclusionsThis study found the relationship among PA, PV, and bronchus patterns, in the subsegment where the branching patterns were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.

Pencil Beam Scanning Proton Therapy Case Selection for Paediatric Abdominal Neuroblastoma: Effects of Tumour Location and Bowel Gas

AimsPencil beam scanning (PBS) proton therapy is an increasingly used radiation modality for childhood malignancies due to its ability to minimise dose to surrounding organs. However, the dosimetry is extremely sensitive to anatomical and density changes. The aims of this study were to investigate if there is a dosimetric benefit or detriment with PBS for paediatric abdominal neuroblastoma, assess gastrointestinal air variability and its dosimetric consequences, plus identify if there are factors that could assist case selection for PBS referral. Materials and methodsTwenty neuroblastoma cases were double-planned with PBS and intensity-modulated arc therapy (IMAT). Cases were divided into unilateral, midline unilateral and midline bilateral locations in relation to the kidneys. Plans were recalculated after the gastrointestinal volume was simulated as air (Hounsfield Units –700) and water (Hounsfield Units 0), then compared with nominal plans (recalculated – nominal, ΔD). Forty-three weekly cone beam computed tomography scans were analysed to quantify gastrointestinal air variability during treatment. ResultsPBS reduced the mean dose to normal tissues at all tumour locations, particularly unilateral tumours. However, 15% had better dosimetry with IMAT, all of which were midline tumours. Increased gastrointestinal air caused significant compromises to PBS versus IMAT plans for midline tumours [median/maximum ΔD95% clinical target volume (CTV) –2.4%/–15.7% PBS versus 1.4%/0% IMAT, P = 0.003], whereas minimal impact was observed for unilateral tumours (ΔD95% CTV –0.5%/–1.9% PBS versus 0.5%/–0.5% IMAT, P = 0.008). D95% CTV was significantly decreased in PBS plans if planning target volume (PTV) ≥400 cm3 (median –4.1%, P = 0.001) or PTV extension ≥60% anterior to vertebral body (–2.1%, P = 0.002). A larger variation in gastrointestinal air was observed in patients treated under general anaesthesia (median 38.4%) versus awake (11.5%); P = 0.004. ConclusionIn this planning study, tumours at the unilateral location consistently showed improved dose reductions to normal tissue with minimal dose degradation from increased gastrointestinal air with PBS plans. Tumour location, PTV volume and anterior extension of PTV are useful characteristics in facilitating patient selection for PBS.

A new species of Lecithostaphylus Odhner, 1911 (Trematoda: Zoogonidae) from the Pacific needlefish, Tylosurus pacificus, off the Pacific coast of Mexico, with a molecular assessment of the phylogenetic position of this genus within the family

A new species of Lecithostaphylus Odhner, 1911 (Zoogonidae) is described from the Pacific agujon needlefish, Tylosurus pacificus (Steindachner) (Belonidae), from two localities off the Pacific coast of Mexico. Morphologically, the new species agrees with the diagnosis of the genus Lecithostaphylus. Lecithostaphylus brayi sp. nov. differs from other congeneric species by a combination of morphological traits, including the overall body size, anterior and posterior extension of the vitelline follicles in the hindbody, and the presence/absence of papilla-like denticles on internal surface of ventral sucker. Lecithostaphylus brayi sp. nov. most closely resembles L. retroflexus (Molin, 1859), Odhner, 1911 and Lecithostaphylus tylosuri Châari, Derbel & Neifar, 2013 from Mediterranean needlefishes and Lecithostaphylus nitens (Linton, 1898) Linton, 1940 from needlefishes in multiple marine ecoregions; however, it can be distinguished by subtle morphological differences, host association, and geographical distribution. The new species will require further verification through a more detailed morphological study of L. nitens and, ideally, molecular data for L. nitens, L. retorflexus, and L. tylosuri. Newly generated 28S rDNA sequences allowed a phylogenetic assessment of the genus and show that Lecithostaphylus clades within the Zoogonidae, sister to the genera Deretrema Linton, 1910 + Proctophantastes Odhner, 1911, although the family Zoogonidae is not resolved as monophyletic. The inclusion of more representative genera in the molecular phylogenetic analysis will be needed to generate a more robust classification scheme for the Zoogonidae, and to discuss host specificity patterns for members of the family.

Predictive Factors of Central-Compartment Lymph Node Metastasis for Clinical N0 Papillary Thyroid Carcinoma With Strap Muscle Invasion.

Background: Papillary thyroid carcinoma (PTC) patients with anterior extrathyroidal extension (ETE) involving the strap muscle have a relatively better prognosis than those with posterior gross ETE involving the recurrent laryngeal nerve. Whether prophylactic central-compartment lymph node dissection (CLND) should be performed in PTCs with only strap muscle invasion (SMI) is still unclear.Methods: A retrospective cohort study was conducted in clinical N0 (cN0) PTC patients with SMI who underwent thyroid surgery from 2009 to 2017. A total of 152 patients were included, and predictive factors of central-compartment lymph node metastasis (CLNM) were determined.Results: Among the 281 PTCs patients with SMI, 152 (51.1%) did not clinically present with lymph node metastasis. Microscopic CLNM was identified in 77 (50.7%) cN0 PTC patients with SMI. According to the univariate and multivariate analyses, male patients and those aged <40 years were more likely to be diagnosed with CLNM than female patients and those aged >40 years (odds ratio [OR] = 6.22 [95% confidence interval (CI), 1.43–27.10], p = 0.02 vs. OR = 9.94 [95% CI, 2.79–35.44], p = 0.00). The CLNM positive rate of male patients aged <40 years was 87.5%, while that for female patients aged ≥55 years was 23.8%. However, risk factors associated with large-volume CLNM were not identified because of the small number of patients.Conclusions: Taken together, nearly half of PTC patients with SMI did not clinically present with lymph node metastasis. Male sex and patients aged <40 years were identified as the predictive factors of CLNM in cN0 PTCs with SMI. Hence, the results of this single-center study raise the possibility that prophylactic CLND may be more often considered for younger male PTC patients with SMI.

Morphology, ultrastructure, and molecular phylogeny of the unarmoured dinoflagellate Kirithra sigma sp. nov. (Ceratoperidiniaceae, Dinophyceae)

ABSTRACT A Gymnodinium-like dinoflagellate, Kirithra sigma sp. nov., was isolated from Jiaozhou Bay, China, and the southern coast of Korea, and examined by light, scanning, and transmission electron microscopy. Pigment composition and nuclear-encoded partial large subunit ribosomal RNA (LSU rRNA) gene were determined. Cells were oval-shaped (26.4‒36.4 μm long and 17.7‒27.2 μm wide), with a conical epicone and hemispherical hypocone. Its cingulum and sulcus were deep and wide. The cingulum encircled the cell completely, its ends slightly overlapping and displaced one to two cingular widths; the sulcus and sulcal extension formed a sigmoid curve. The anterior sulcal extension contacted the apical structure complex (ASC). The ASC formed a complete circle, consisting of three parallel series of vesicles, and the amphiesmal vesicles within ASC were arranged with one central vesicle (sometimes two) encircled by approximately three rows of polygonal amphiesmal vesicles. Polygonal amphiesmal vesicles of different sizes covered the whole cell surface. The subspherical nucleus was located in the hypocone. Pigment analysis showed that peridinin was the main accessory pigment. The present species is morphologically similar to Kirithra asteri but differs in numbers and rows of amphiesmal vesicles within the ASC, absence of ventral pore, and a sigmoid curve formed by the sulcus and sulcal extension. The partial LSU rRNA gene sequence (c. 1400 bases) of K. sigma differed by c. 5.3% from that of K. asteri. Molecular phylogeny revealed that K. sigma formed an independent sister clade to K. asteri, indicating they are congeneric but different species.

Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

Background: It is unclear which structural parameters determine the development or the absence of chronic pseudoparalysis (PP) in patients with massive rotator cuff tears (mRCTs). Purpose: To determine whether scapular morphologic characteristics and extent of rotator cuff tearing are independent factors associated with chronic PP. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective case-control study, 50 patients with chronic mRCT (≥2 fully detached tendons) and active scapular plane abduction less than 90° (PP group) were age- and sex-matched with a cohort of 50 patients with chronic mRCT and an active scapular plane abduction greater than 90° (non-PP; NPP group). Analysis of standardized, plain radiographs included measurement of the critical shoulder angle (CSA) and the acromiohumeral distance (ACHD) on anteroposterior views and measurement of posterior acromial tilt, anterior and posterior acromial coverage, and posterior acromial height on standardized outlet views. Measurements on magnetic resonance imaging included fatty muscle infiltration, anterior (subscapularis) and posterior (infraspinatus/teres minor) tear extension, and global tear extension (anterior + posterior tear extension) in the parasagittal plane. Results: Overall, no significant difference was found in patients’ demographic characteristics (P > .05). Univariate analyses confirmed significant differences between the PP and NPP groups in active scapular plane abduction (51°± 22° vs 135°± 29°; P < .001). Multivariate analyses revealed independent factors associated with PP compared with the NPP group: CSA (38.2°± 4.6° vs 35.2°± 3.7°; P = .001); ACHD (4.7 ± 2.2 vs 7.3 ± 2.6 mm; P < .001); posterior acromial height (22 ± 10 vs 17 ± 7 mm; P = .005); and anterior (–9°± 21° vs 25°± 12°; P < .001) and posterior (–18°± 14° vs 2°± 14°; P < .001) tear extension. The NPP group had significantly less involvement and fatty infiltration of the subscapularis (1.4 ± 0.6) compared with the PP group (2.2 ± 0.9) (P < .001). Conclusion: This study confirms that global RCT extension and the quality of the inferior half of the subscapularis are significantly associated with chronic pseudoparalysis. The study further shows that acromial morphologic characteristics are relevant in the development of pseudoparalysis. Patients with pseudoparalysis have a larger CSA, less ACHD, and a higher positioned acromion in the sagittal plane.

Post-traumatic arachnoid cyst without neurological sequels

An eight-year-old male patient was admitted to the hospital with a history of left median paramedian frontal craniectomy due to car trauma at six months of age. Axial computed tomography of the skull with reconstruction in three dimensions revealed an arachnoid cyst with slight herniation of the brain in the frontal lobe, leading to protrusion against the skullcap, causing dilation of the ex-vacuum of the anterior extension of the homolateral lateral ventricle. He presented asymmetrical lateral ventricles, a reduced base cistern, and a slightly ectatic IV centred ventricle. After the physical examination, no neurological deficit was found, despite the changes identified in the images. It is believed that such conditions may progressively worsen with the development and maturation of nervous tissue over the age of the assessed child. To confirm this, specialized monitoring is of fundamental importance.

Trends in Posterior Cervical Fusion for Deformity in the United States from 2000 to 2017

ABSTRACT BACKGROUND Posterior cervical decompression and fusion (PCF) is a common treatment for cervical spondylotic myelopathy. Treatment paradigms are shifting from simple decompression and fusion to correcting cervical deformities. OBJECTIVE To identify trends in PCF with an emphasis on cervical deformity and surgical complexity. METHODS Adults who underwent PCF from 2000 to 2017 were retrospectively identified in the Premier Healthcare Database (PHD) using International Classification of Disease Codes (ICD) 9 and 10. Patients were dichotomized into those with or without deformity diagnosis. PCF complexity was defined by adjunct surgical codes, including anterior cervical fusion, extension to thoracic levels, and osteotomy. Patient characteristics, including demographics, functional comorbidity index (FCI), and hospital characteristics, were extracted and annual procedures were projected to the US population. RESULTS A total of 68 415 discharges for PCF were identified. Compound annual growth rate (CAGR) of PCF from 2000 to 2017 for nondeformity cases was 9.7% and 16.5% for deformity. The demographics with the greatest growth were deformity patients aged 65 to 74 yr (15.1%). The CAGR of anterior cervical fusion and extension to thoracic levels was higher for deformity patients compared to nondeformity patients, 13.6% versus 3.9% and 20.4% versus 16.6%, respectively. CONCLUSION Rates of PCF for deformity are increasing at a greater rate than nondeformity PCF. The most growth was seen among deformity patients aged 65 to 74 yr. Surgical complexity is also changing with increasing use of anterior cervical fusion and extension of PCF to include thoracic levels.

Latissimus Dorsi Muscle Flap with a Distally Based Serratus Anterior Extension for Salvaging Aortic Graft Infection.

Supplemental Digital Content is available in the text.

New specimen of Dinodontosaurus (Therapsida, Anomodontia) from west-central Argentina (Chañares Formation) and a reassessment of the Triassic Dinodontosaurus Assemblage Zone of southern South America

The Chañares Formation is known worldwide for its diverse tetrapod assemblage, including representatives of proterochampsid archosauromorphs, early offshoots of the crocodilian lineage, precursors of the dinosaurian lineage, and dicynodont and cynodont therapsids. The dicynodont Dinodontosaurus, originally described nearly 80 years ago, is the most common dicynodont therapsid in the assemblage. Here we present a new specimen of this taxon, focusing on the basicranium structure using 3D modeling and digital segmentation of the individual bones to provide a novel description of this region of the skull. Among the newly-recognized anatomical structures are a rod-like pila antotica in the prootic, the presence of a dorsal conical projection of the parasphenoid, and the anterior extension of the supraoccipital between the prootic and the parietal. The Chañares tetrapod assemblage was historically correlated with the Dinodontosaurus Assemblage Zone of Southern Brazil, originally due to the presence of this large dicynodont, as well as the cynodont Massetognathus, and more recently by absolute dates of the fossil-bearing strata. Both assemblages are similar in diversity and taxonomy, particularly in their non-mammalian therapsids; however their body-size distributions are very different. These differences in body-size are likely not reflecting a taphonomic bias but local variations in climate that promoted more open landscapes in southern Brazil in contrast to western Argentina, where more humid conditions prevailed during the early Late Triassic.

Does conjunctive tissue massage increase range of motion in muscles with plastic hypertonia due to Parkinson's disease?

BACKGROUND:Plastic hypertonia (rigidity), presented by individuals with Parkinson's disease (PD), leads to reduced range of motion (ROM), impairing daily activities and balance reactions. Connective tissue massage (CTM) promotes increased ROM in normotonic muscles, however its effects on hypertonic muscles are not yet known.&#x0D; AIM: To verify the immediate and acute (1h after) effects of CTM on cervical ROM in individuals with PD.&#x0D; METHOD: Cervical ROM during anterior flexion, extension, lateral flexion, and rotation was evaluated using a fleximeter at three moments: before (M1), immediately after (M2), and one hour after (M3) CTM in 14 older people with PD (PDG) and 13 neurologically healthy older people (CG).&#x0D; RESULTS: The CG presented a higher ROM than the PDG for the cervical rotation movement. In addition, there was interaction between group*intervention time. The cervical rotation movement was higher for the CG than PDG at M2 and M3. On the other hand, there was no main effect of intervention time.&#x0D; CONCLUSION: It was concluded that a single session of CTM was not sufficient to promote an increase in ROM in either normotonic or hypertonic muscles in older people, but the higher ROM for cervical rotation in the CG versus PDG was evident after CTM.

Morphometric Analysis of Efnb1 Dependent Palate Growth

Congenital craniofacial anomalies represent one of the most prevalent types of structural birth defects and include common dysmorphology such as cleft palate. While morphometric analysis of surfaces generated from micro computed tomography (micro‐CT) and magnetic resonance imaging (MRI) is a well‐established method, it has not yet been applied to understanding the three‐dimensional changes in palatal shelf morphology that result in a cleft palate phenotype. EFNB1 mutations result in craniofrontonasal syndrome, an X linked condition, consisting of a variety of craniofacial anomalies, including cleft palate. Mouse models for loss of Efnb1, have demonstrated its importance during normal development of the anterior secondary palate, with loss of Efnb1 resulting in changes in secondary palatal shelf shape including apparently reduced anterior palatal shelf extension, leading to a cleft secondary palate. Palatal shelf shape appears more disrupted in Efnb1+/− embryos, which are mosaic for EPHRIN‐B1 expression, but how this mosaicism contributes to palate dysmorphology has been difficult to understand in two dimensions. This study aims to establish a method of quantifying secondary palatal shelf outgrowth and shape that is coupled with an ability to quantify gene expression changes through the use of morphometrics. We performed whole‐mount immunofluorescent staining of E‐CADHERIN, EPHRIN‐B1, and DAPI followed by confocal microscopy to generate 3D renderings that we quantify using landmark based morphometrics. This method allows a deeper understanding of changes in tissue shape as they relate to gene expression.Support or Funding InformationThis study was supported by NIH grant R01DE023337 from NIDCR

838 An Economical Alternative to Static Progressive Splinting of the Elbow

Abstract Introduction A common musculoskeletal complication of burn trauma are elbow extension contractures which can have disabling effects on both daily living skills and leisure activities. One intervention which is used by Therapists to maximize active range of motion in these cases are static progressive splints. The benefit of static progressive is providing a continued gentle stretch, which is adjustable, to maximize length of connective tissues and improve joint pliability. These types of splint can be custom made or purchased commercially to the cost of the patient. Commercially provided static progressive splint are costly for the patient and are not efficient in capturing end range extension. Traditional static progressive splint patterns do not allow for the patient to provide the adjustable force rather, the therapist remodels the splint as range of motion gains are achieved. The “I” splint was created to allow for the patient to provide a static progressive low load adjustable force and range of motion while using the splint over the course of thirty minutes. Methods The splint is fabricated from therma plastic material. The standard anterior elbow extension splint pattern is made thought with a midline window. (Photo 1). When modeling the splint, the therapist positions the boarders of the splint higher than the upper extremity as this will act as the level arm for the adjustable force. Three straps are attached (photo 2). Distal at the wrist, proximal at the elbow and midline at the elbow. The elbow strap attached to the medial board, cups the posterior elbow and is fed inside the lateral board, then pulled up and over th boarder. This positioning transmits the upward force to gain extension. As the stretch decreases, the strap is pulled more tightly, allowing for increased elbow extension. The elbow comes up and through the window. Goal is for the patient to use 3 times per day for 30 minutes each session followed by exercise or functional activities which engage improved connective tissue length. Results There are many benefits from the use of the “I” splint pattern. The splint is able to be fabricated during 1 therapy session and be used immediately. The therapist only bills one orthotic charge and splint charge vs a costly rental and purchase price for the patient. The window design allows for greater adjustability of force able to capture fluctuations with stiffness and pain without fabricating another splint. The splint is lighter weight and easily portable. Conclusions The “I” splint design is a effective, efficient and economic intervention to treat elbow extension contractures. Applicability of Research to Practice Further research needs to be done to investigate range of motion gains and time to makes gains, effects on functional outcomes, cost benefits analysis with the “I” splint design for the patient and Health Care Systems.

The last Palaeoproteus (Urodela: Batrachosauroididae) of Europe

The Batrachosauroididae are an enigmatic group of salamanders known from the Cretaceous and Tertiary of North America and Europe. In Europe, the family is known only by two species of the genus Palaeoproteus. The genus has limited distribution in Western and Central Europe. In the present paper, we describe a new species, Palaeoproteus miocenicus, from the early late Miocene (11–9 Ma) of Austria and Ukraine, representing the youngest record of the family Batrachosauroididae from the Neogene of Europe. The new species differs from the Paleogene representatives of the genus by 12 characters, including large body size, the long anterior extension of the Meckelian groove and the size and shape of the odontoid process on the dentary. The µCT scanning of bones of the new species revealed novel features (e.g. anterior extension of Meckelian groove, interconnected network of canals and small cavities in atlas) observable only in this species. P. miocenicus inhabited aquatic environments, which existed under wet climatic conditions with mean annual precipitation higher than 900 mm. The new species expands the temporal range of the genus by at least 30 million years and enlarges the palaeogeographic distribution of the genus into Eastern Europe.