Anteroposterior Movement Research Articles

Analysis of anticipatory and compensatory postural adjustment in women of different age groups using surface electromyography.

Postural balance is crucial for daily activities, relying on the coordination of sensory systems. Balance impairment, common in the elderly, is a leading cause of mortality in this population. To analyze balance, methods like postural adjustment analysis using electromyography (EMG) have been developed. With age, women tend to experience reduced mobility and greater muscle loss compared to men. However, few studies have focused on postural adjustments in women of different ages using EMG of the lower limbs during laterolateral and anteroposterior movements. This gap could reveal a decrease in muscle activation time with aging, as activation time is vital for postural adjustments. This study aimed to analyze muscle activation times in women of different ages during postural adjustments. Thirty women were divided into two groups: young and older women. A controlled biaxial force platform was used for static and dynamic balance tests while recording lower limb muscle activity using EMG. Data analysis focused on identifying muscle activation points and analyzing postural adjustment times. Results showed significant differences in muscle activation times between the two groups across various muscles and platform tilt conditions. Younger women had longer muscle activation times than older women, particularly during laterolateral platform inclinations. In anteroposterior movements, older women exhibited longer activation times compared to their laterolateral performance, with fewer differences between the groups. Overall, older women had shorter muscle activation times than younger women, suggesting a potential indicator of imbalance and increased fall risk.

Mitral annular dynamics after transcatheter edge-to-edge repair for functional mitral regurgitation: comparison with surgical annuloplasty

Abstract Background Transcatheter edge-to-edge repair (TEER) is a recently emerged therapeutic option for functional mitral regurgitation (FMR). Although the mitral annular shape and function may play an important role in the pathophysiology of FMR, few reports have evaluated the impact of TEER. We sought to investigate the impact of TEER on the mitral annulus and its motion in FMR compared with that of mitral annuloplasty (MAP). Methods Using three-dimensional transesophageal echocardiography, we evaluated the mitral annular morphology and dynamic motion in patients who underwent TEER or MAP before and after the procedures. Mitral annulus analysis was performed by a semi-automatic program to create a dynamic model of the three-dimensional structure, where the end-systolic annular structure was semi-automatically annotated and manually corrected, followed by automatic tracking of the annulus throughout the cardiac cycle . The mitral annular parameters such as mitral annular diameters, area, circumference, and height at all frames were automatically calculated from the model. In order to align the cardiac phase in each patient (i.e. to set the start and the end of diastole and systole at the same time for all patient), data were spline-interpolated to 100 systolic and 200 diastolic frames and then statistically analyzed. The dynamic changes of the parameters during the cardiac cycle were calculated as (maximum – minimum value) / maximum value after the interpolation. Results Patients who underwent TEER (n=20, 69±15 years, 40% female) and those who underwent MAP (n=16, 64±11 years, 6% female) had similar echocardiographic characteristics before the procedures. The maximum anteroposterior diameter and annulus area decreased after both TEER and MAP, while the intercommissural diameter decreased only after MAP but not after TEER. After TEER, the dynamic change in anteroposterior diameter throughout the cardiac cycle tended to decrease (p=0.055), while intercommissural change rather increased (p=0.049), resulting in preserved change in annulus area (p=0.74). After MAP, changes in both diameters and area decreased significantly (all p<0.05). MAP was associated with postoperative mitral annulus area immobility after adjustment (p=0.030). Conclusions The dynamic motion of the mitral annulus in patients with FMR was better preserved after TEER than after MAP. There was a decreasing trend in anteroposterior motion, which was compensated for by intercommissural motion after TEER. Future studies are needed to determine the association of these results with cardiac function and prognosis.

Different right ventricular mechanics in atrial and ventricular secondary tricuspid regurgitation and their prognostic role. A multicentric three-dimensional echocardiography study

Abstract Background/Introduction Secondary tricuspid regurgitation (STR) can develop from markedly different etiologies. Both progressive dilation and dysfunction of the right atrium (atrial phenotype, ASTR), and adverse right ventricular (RV) remodeling (ventricular phenotype, VSTR) may result in STR. RV function is a major determinant of outcome in patients with STR. However, data about how RV function adapts to ASTR and VSTR are scarce, and the prognostic implications of RV mechanics in ASTR and VSTR remain to be clarified. Purpose Accordingly, we aimed to investigate the RV mechanical patterns in ASTR and VSTR and to examine their prognostic role using three-dimensional (3D) echocardiography. Methods We enrolled 192 patients with STR (60% women) who underwent clinically indicated transthoracic echocardiography in a multicentric prospective observational study. The primary outcome was defined as a composite of heart failure hospitalization or cardiac death. STR etiology was assessed based on the TVARC criteria (ventricular STR n=134, atrial STR n=58). STR severity was categorized using STR effective regurgitant orifice area according to current guidelines. We assessed RV function by measuring the tricuspid annular plane systolic excursion (TAPSE) by M-mode echocardiography and RV ejection fraction (EF) by 3D echocardiography. In addition, we imported the 3D RV meshes into the ReVISION software package (Argus Cognitive, Inc, Lebanon, USA) to quantify the relative contribution of the longitudinal (LEFi), radial (REFi), and anteroposterior motion components (AEFi) to total RV EF. Results ASTR and VSTR patients had comparable TAPSE (17±5 mm vs. 18±5 mm, p=0.10), while RV EF was significantly higher in ASTR (54±7% vs. 47±10% p<0.001). Although LEFi (0.37±0.08 vs. 0.38±0.10, p=0.95) and AEFi (0.45±0.08 vs. 0.44±0.11, p=0.53) were comparable between ASTR and VSTR, REFi was significantly lower in VSTR (0.52±0.09 vs. 0.47±0.12, p<0.01). RF EF was comparable among STR severity grades (mild vs. moderate vs. severe: 50±11 vs. 49±9 vs. 50±10%, respectively, p=0.85). Conversely, LEFi was significantly higher in mild and moderate STR vs severe STR (0.39±0.08 vs. 0.39±0.09 vs. 0.35±0.10, respectively, p=0.04). Using multivariable Cox regression based on variables significant in the univariate analysis, REFi was a significant independent predictor of outcome in the entire cohort (hazard ratio: 0.978 [CI, 0.959-0.999], p= 0.037). Conclusions Using 3D echocardiographic assessment, ASTR and VSTR patients demonstrated significant differences in the RV mechanical pattern, with a lower contribution of the radial contraction in the case of ventricular STR etiology. While RV EF was comparable between STR severity grades, the relative importance of the longitudinal motion significantly differed. Notably, the relative contribution of radial motion to RV function demonstrated independent prognostic value in patients with STR.RV mechanics in STR severity stages

The geometry of interpersonal synchrony in human dance

Collective synchronized behavior has powerful social-communicative functions observed across several animal taxa.1,2,3,4,5,6,7 Operationally, synchronized behavior can be explained by individuals responding to shared external cues (e.g., light, sound, or food) as well as by inter-individual adaptation.3,8,9,10,11 We contrasted these accounts in the context of a universal human practice-collective dance-by recording full-body kinematics from dyads of laypersons freely dancing to music in a "silent disco" setting. We orthogonally manipulated musical input (whether participants were dancing to the same, synchronous music) and visual contact (whether participants could see their dancing partner). Using a data-driven method, we decomposed full-body kinematics of 70 participants into 15 principal movement patterns, reminiscent of common dance moves, explaining over 95% of kinematic variance. We find that both music and partners drive synchrony, but through distinct dance moves. This leads to distinct kinds of synchrony that occur in parallel by virtue of a geometric organization: anteroposterior movements such as head bobs synchronize through music, while hand gestures and full-body lateral movements synchronize through visual contact. One specific dance move-vertical bounce-emerged as a supramodal pacesetter of coordination, synchronizing through both music and visual contact, and at the pace of the musical beat. These findings reveal that synchrony in human dance is independently supported by shared musical input and inter-individual adaptation. The independence between these drivers of synchrony hinges on a geometric organization, enabling dancers to synchronize to music and partners simultaneously by allocating distinct synchronies to distinct spatial axes and body parts.

The Effect of Gracilis Tendon Preservation on Postoperative Knee Joint Stability and Muscle Strength in Arthroscopic Anterior Cruciate Ligament Reconstruction Surgery.

The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively (p = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements.

Effect of laser corticotomy on canine retraction rate: a split-mouth randomized clinical trial

BackgroundThis study assessed the effect of corticotomy with Er: YAG (erbium-doped yttrium aluminium garnet) laser on the rate of canine retraction.MethodsThis randomized split-mouth controlled clinical trial was conducted on 12 patients undergoing orthodontic treatment with extraction of maxillary first premolars. Following initial leveling and alignment, an alginate impression was made from the maxillary arch, and Er: YAG laser corticotomy was performed in one of the maxillary quadrants of each patient. Canine retraction was started immediately after corticotomy by placement of nickel-titanium (NiTi) closed coil springs at both sides. At the end of each month, alginate records were repeated for 4 months. Study models were scanned, and the anteroposterior movement of canine was quantified bilaterally. Pain was also measured by a visual analog scale (VAS). Probing depth (PPD) of canines and two adjacent teeth was also evaluated and pulp vitality was assessed by performing the cold test. Data were analyzed by paired and independent t-test and one-way ANOVA (alpha = 0.05).ResultsThe rate of canine retraction was significantly greater in the laser-assisted corticotomy quadrant than the control (P < 0.05). No significant difference existed in posterior anchorage loss, canine rotation angle, PPD, pulp vitality, or pain score between two groups (P > 0.05).ConclusionsFlapless Er: YAG laser corticotomy significantly enhanced canine retraction rate with no adverse effect on other parameters.

F-Chin/Feminizing the Chin: A Genioplasty Technique with Virtual Planning for Male-to-Female Transgender Patients.

The chin is an essential structure in facial harmony and an important gender marker. Advancing a receding chin is fundamental to improve the facial appearance, particularly in male-to-female transgender patients. However, in patients with microgenia and/or retrognathia, desiring a more feminine appearance, a chinadvancement can result in a wider, square shape; an undesirable effect. Genioplasty is a versatile procedure used in facial feminization surgery that allows modifying the natural anatomy of the chin in all three spatial dimensions. The technique herein described proposes a simple genioplasty procedure for feminizing the chin (F-chin genioplasty) in transgender patients where anteroposterior advance is required. Virtual planning was used to establish the landmarks for an anteroposterior advancement with transverse reduction in the chin. A perpendicularline to the Frankfurt plane passing through the incisal edge of the upper central incisor was used to plan the anteroposterior movement, and two vertical lines on the outer wall of the nasal cavity for thechin transverse measurement. The authors presentthree case reportswith the F-chin genioplasty transgender technique with satisfactory results, ensuring a more feminine facial appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Variability of gross and fine motor control in different tasks in fibromyalgia patients

Fibromyalgia (FM) is normally defined as a widespread pain syndrome or disease that presents disturbances in gross and fine motor control. As a gross motor control skill, gait requires coordination, balance, and muscle strength, and it could be an essential factor for FM patients to perform daily activities. Measuring the spatial and temporal gait parameters or gait variability has been used to assess motor pathologies and identify gait disorders. The Lyapunov exponent is a non-linear measure of variability, which quantifies the ability that the system has to attenuate small perturbances, indicating that there might be a relationship between balance and spatiotemporal gait parameters. This technique has already been used for gait analysis and could be used in fine and gross daily tasks, such as the finger tapping test (FTT) or the sit-and-stand test. Inertial Measurement Units have also been used to analyze gross motor control, namely in gait variability. So, the aim of this study is to analyze and compare the variability of gross and fine motor movements between patients with FM and a control group. The sample included 20 female participants, 10 with FM and 10 without (46.150 ± 12.835 years old). To analyze gross motricity, participants were asked to perform the gait task for two minutes and the 30-second chair sit-and-stand test; and to analyze fine motor control, they were asked to perform six trials of FTT test with both hands. To collect the data, an inertial sensor (IMU) was used. FM patients showed a more irregular pattern of linear acceleration peaks than controls in both tasks. Lyapunov values in FM patients show greater instability and variability in the anteroposterior and vertical movements for gait analysis and present significantly higher variability in the anteroposterior movements when performing the sit and stand task and the finger tapping test. Keywords: Fibromyalgia; Gross Motor Control; Gait; Sit and Stand; Variability; Lyapunov; IMU

To identify anatomic relationship between central incisor roots and alveolar bone thickness in individuals with variable sagittal malocclusions

The predisposition of central-incisors and its association with alveolar bone in surrounding area required assessment before any decision for treatment which involves anteroposterior (AP) movement of incisor inside the jaws. To identify anatomic relationship between central incisor roots and alveolar bone thickness in individuals with variable sagittal malocclusions and to also correlate if any sexual dimorphism among samples. The present study was conducted on 100 pre-treatment lateral cephalograms of young adult patients aged 15 to 30 years. They were divided into 2 groups on the basis of Angle’s system of classification as Class I and Class II with 50 subjects each group. patients were selected from the pool of patients who reported to All the lateral cephalograms were hand traced by same operator and tracings included mandibular symphysis, 1 molar central incisors, the OP, incisal edges, root apices, incisor long axes, upper incisor CEJ and upper incisor root midpoint. Various parameters were then measured for both the groups. All data were analysed using the Statistical Package for the Social Sciences software (SPSS version 24.0 Inc, Chicago, IL, USA. Independent sample t-test was used to determine possible statistically significant differences between the Class I and Class II for various parameters. U1-lab was statistically significant increased value in Class I sample, Where as L1-ling was statistically significant increased value in Class II sample. A very small but significant difference was found for the mandibular alveolar bone thickness in males and females in both Class I and Class II samples. A significant variance between alveolar (AV) process of class II and Class I occlusion. There was also a significant variation in males and females of the sample group.

Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension

The right ventricle has a complex contraction pattern of uncertain clinical relevance. We aimed to assess the relationship between right ventricular (RV) contraction pattern and RV-pulmonary arterial (PA) coupling defined by the gold-standard pressure-volume loop-derived ratio of end-systolic/arterial elastance (Ees/Ea). Prospectively enrolled patients with suspected or confirmed pulmonary hypertension underwent three-dimensional echocardiography, standard right heart catheterization, and RV conductance catheterization. RV-PA uncoupling was categorized as severe (Ees/Ea < 0.8), moderate (Ees/Ea 0.8-1.29), and none/mild (Ees/Ea ≥ 1.3). Clinical severity was determined from hemodynamics using a truncated version of the 2022 European Society of Cardiology/European Respiratory Society risk stratification scheme. Fifty-three patients were included, 23 with no/mild, 24 with moderate, and 6 with severe uncoupling. Longitudinal shortening was decreased in patients with moderate vs no/mild uncoupling (p<0.001) and intermediate vs low hemodynamic risk (p<0.001), discriminating low risk from intermediate/high risk with an optimal threshold of 18% (sensitivity 80%, specificity 87%). Anteroposterior shortening was impaired in patients with severe vs moderate uncoupling (p=0.033), low vs intermediate risk (p=0.018), and high vs intermediate risk (p=0.010), discriminating high risk from intermediate/low risk with an optimal threshold of 15% (sensitivity 100%, specificity 83%). Left ventricular (LV) end-diastolic volume was decreased in patients with severe uncoupling (p=0.035 vs no/mild uncoupling). Early RV-PA uncoupling is associated with reduced longitudinal function, whereas advanced RV-PA uncoupling is associated with reduced anteroposterior movement and LV preload, all in a risk-related fashion. GOV: NCT04663217.

Association of right ventricular mechanics with the severity of tricuspid regurgitation and mortality in patients with left-sided cardiac diseases: a propensity score-matched 3D echocardiography study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by the ÚNKP-22-3-II New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund. Introduction The development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with left-sided cardiac diseases. Data are scarce concerning the right ventricular (RV) morphological and functional remodeling in patients with left-sided heart diseases in relation to the severity of TR. Purpose Accordingly, we aimed to characterize RV remodeling in patients with left-sided cardiac diseases with and without significant TR using three-dimensional (3D) echocardiography. Methods We retrospectively identified 357 patients with a wide variety of left-sided cardiac diseases and we graded TR severity according to current guidelines. To account for the heterogeneity of our cohort, we performed propensity-score matching using relevant clinical variables (age, sex, etiology of left-sided cardiac disease, left [LV] and right ventricular [RV] ejection fraction [EF]), and then we compared 134 patients with significant TR (sTR) with a matched cohort of 134 patients without significant TR (nsTR) (Figure 1). All patients underwent clinically indicated 3D transthoracic echocardiography, and 3D EFs were measured. To characterize RV mechanical patterns, the ReVISION method was used to quantify the contribution of the longitudinal (LEF), radial (REF), and anteroposterior (AEF) motion components to total RV EF. The primary endpoint was all-cause mortality, and patients were followed up for a median of 39 months. Results During the follow-up period, 48 patients (17.9%) met the primary endpoint. The propensity-matched groups did not differ in terms of LV and RV EFs. In patients with significant TR, values of AEF were significantly lower (sTR vs. nsTR; 17±7 vs.19±7 %, p&amp;lt;0.05), whereas LEF and REF did not show a difference in the two matched groups. Using univariable Cox regression analysis, both AEF (HR, 0.93 [95% CI 0.89–0.97], p = 0.001) and the presence of significant TR (HR, 2.75 [95% CI 1.48–5.14], p = 0.001) were found to be significant predictors of all-cause mortality. By receiver operating characteristics analysis, we defined an optimal cut-off value of 20.9% for AEF, which was then used to dichotomize our patient population (Figure 2A). Patients with AEF values below the 20.9% cut-off had more than a three-fold risk of all-cause mortality (HR, 3.03 [95% CI 1.42–6.47], p = 0.004) compared to patients with AEF values above the cut-off (Figure 2B). Furthermore, we assessed the relationship between regurgitant volume describing the extent of TR, and AEF, which showed a significant inverse correlation (r=-0.37; p&amp;lt;0.001). Conclusions Three-dimensional echocardiography enabled a more precise assessment of RV mechanics. In patients with left-sided heart diseases with TR, the deterioration of the RV anteroposterior motion component was significantly associated with both the severity of TR and all-cause mortality.

Mechanical adaptation of the right ventricle to increased volume overload associated with secondary tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) function is strongly associated with the prognosis of patients with secondary tricuspid regurgitation (STR). However, the mechanical adaptations (contraction pattern) of the RV to volume overload associated with STR remain to be clarified. Purpose To investigate the changes in RV contraction pattern associated with the increase in severity of STR and to analyse whether the assessment of each RV motion component of RV ejection fraction (RVEF) (longitudinal, radial, and anteroposterior) adds prognostic value in patients with STR. Methods Consecutive patients with STR who underwent clinically indicated transthoracic echocardiography were enrolled in a multi-center prospective observational study. The primary outcome was defined as heart failure hospitalization or cardiac death. 3-dimensional echocardiography studies were performed at baseline and the ReVISION software package (Argus Cognitive, Inc, Lebanon, NH) was used to quantify the contribution of the longitudinal, radial, and anteroposterior motion components to total RVEF (Figure). Results We enrolled 172 patients (43% men, age: 75±15 years), followed for a median of 9 months. The patients were divided in two groups by STR severity (non-severe n=125, severe n=47). The characteristics of patients with massive/torrential STR (n=12) vs. "only" severe STR (n=35) were also assessed. RV end-diastolic volume index (r=0.33, p&amp;lt;0.001) and the longitudinal component of RVEF demonstrated significant correlation with STR severity (r=-0.22, p&amp;lt;0.01), while total RVEF did not (r=0.14; p = NS). The anteroposterior component of RVEF was the only parameter showing relatively strong correlation with left ventricular ejection fraction (r=0.39; p&amp;lt;0.001). RVEF was comparable between non-severe and severe patients (49±10 vs. 49±11%, p = NS). In patients with severe STR, the radial and also anteroposterior component of RVEF were comparable to non-severe STR patients, while the longitudinal component was significantly lower in severe STR (19±6 vs.17±7%, p&amp;lt;0.05; shown on Figure). Notably, in patients with massive/torrential STR, the radial contribution markedly decreased (27±8 vs. 20±9%, p&amp;lt;0.05), with consequently reduced global RVEF (52±9 vs. 41±12%, p&amp;lt;0.01) (Figure). In a multivariable Cox regression, using parameters proved to be significant in the univariable analysis, longitudinal component of total RVEF was a significant and independent predictor of outcome (hazard ratio, 0.947 [CI, 0.903–0.992], P= 0.022). Conclusions Patients with severe STR demonstrate significant morphological and functional RV remodeling with chamber enlargement and maintained RVEF, but a significant decrease in the longitudinal component of RVEF. In patients with massive/torrential STR, the radial mechanism markedly deteriorates, leading to decreased global RVEF. The longitudinal component of RV motion demonstrated independent prognostic value in patients with STR.

Quantification of pharyngeal airway space changes after two-jaw orthognathic surgery in skeletal class III patients

BackgroundSkeletal class III malocclusion is a common dentofacial deformity. Orthognathic treatment changes the position of the jaws and affects the shape of the upper airway to some extent. The aim of this study was to use multislice spiral computer tomography data and orthognathic knowledge to quantify the relationship between the amount of surgical movement of the maxilla or mandible in all three spatial planes and the changes in airway volume that occurred.MethodsA retrospective study of 50 patients was conducted. Preoperative and postoperative linear changes related to skeletal movements of the maxilla and mandible were measured and compared to changes in the most constricted axial level (MCA) and its anteroposterior (MCA-AP) and transverse diameters (MCA-TV). Correlation tests and linear regression analysis were performed.ResultsSignificant interactions were observed between the anterior vertical movement of the maxilla and the MCA-AP. The anteroposterior movement distance of the mandible was significantly correlated with changes in the oropharyngeal, velopharyngeal, total airway volume, MCA, MCA-AP, and MCA-TV. The change in the mandibular plane angle was significantly correlated with the change in velopharyngeal volume, total airway volume (nasopharynx, oropharynx, velopharynx), and MCA.The linear regression model showed that oropharyngeal volume decreased by 350.04 mm3, velopharyngeal volume decreased by 311.50 mm3, total airway volume decreased by 790.46 mm3, MCA decreased by 10.96 mm2 and MCA-AP decreased by 0.73 mm2 when point B was setback by 1 mm.ConclusionsAnteroposterior mandibular control is the key to successful airway management in all patients. This study provides estimates of volume change per millimeter of setback to guide surgeons in treatment planning.

NOVEL DYNAMIC STABILIZATION SYSTEM PROVIDES BETTER AP TRANSLATION AND AXIAL TIBIOFIBULAR JOINT STABILITY

The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization of length-unstable syndesmotic injuries. Recently, a novel screw-suture repair system was developed to address such issues. The aim of this study was to investigate the performance of the novel screw-suture repair system in comparison to a suture-button stabilization of unstable syndesmotic injuries.Eight pairs of human cadaveric lower legs were CT scanned under 700 N single-leg axial loading in five foot positions – neutral, 15° external/internal rotation and 20° dorsi-/plantarflexion – in 3 different states: (1) pre-injured (intact); (2) injured, characterized by complete syndesmosis and deltoid ligaments cuts simulating pronation-eversion injury types III and IV as well as supination-eversion injury type IV according to Lauge-Hansen; (3) reconstructed, using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implants for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond. Following, all specimens were: (1) biomechanically tested over 5000 cycles under combined 1400 N axial and ±15° torsional loading; (2) rescanned. Clear space (diastasis), anterior tibiofibular distance, talar dome angle and fibular shortening were measured radiologically from CT scans. Anteroposterior (AP), axial, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via motion tracking.In each group clear space increased significantly after injury (p ≤ 0.004) and became significantly smaller in reconstructed compared with both pre-injured and injured states (p ≤ 0.041). In addition, after reconstruction it was significantly smaller in Group 1 compared to Group 2 (p &lt; 0.001). AP and axial movements were significantly smaller in Group 1 compared with Group 2 (p &lt; 0.001). No further significant differences were identified/detected between the groups (p ≥ 0.113).Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw-suture reconstruction provides better anteroposterior translation and axial stability of the tibiofibular joint and maintains it over time under dynamic loading. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions.

Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion.

The purpose of this study was to investigate the position of the femur relative to the tibia throughout range of motion in the osteoarthritic knee to evaluate knee kinematics and assess its relationship with the degree of varus deformity. In this study, 116 preoperative knees with varus deformity were evaluated using a navigation system. The internal-external, anteroposterior, and mediolateral positions of the femur relative to the tibia were measured at maximum extension, 15°, 30°, 45°, 60°, 90°, 105°, and 120°, and maximum flexion angles. From these parameters, two-dimensional translation of the surgical epicondylar axis was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia. In addition, the knees were retrospectively classified into three groups according to their degrees of preoperative hip-knee-ankle angle: mild (< 10°), moderate (10°-20°), and severe (> 20°). Then, the differences in each parameter between these groups were investigated. The Steel-Dwass test was performed to identify the difference among three groups. Statistical significance was set at p values < 0.05. There was a significant difference in the anteroposterior position of the femur relative to the tibia among the three groups, especially from extension to early flexion (p < 0.05). The anteroposterior position at knee extension deviated posteriorly according to the progression of varus deformity. Rotational and mediolateral translation were not significantly different among the groups. Normal knee kinematics were diminished in almost all cases in each group. In addition, anterior paradoxical motion of the femur during early knee flexion was observed in 45.6% (n = 26), 57.1% (n = 28), and 80.0% (n = 8) of cases in the mild, moderate, and severe groups, respectively. The anteroposterior position of the femur relative to the tibia at knee extension was significantly more posterior in patients with than in those without anterior paradoxical motion (p < 0.0001). The anteroposterior position of the femur relative to the tibia changed according to the progression of varus deformity in osteoarthritic knees, especially from knee extension to early flexion. Posterior deviation of the femur at knee extension induced its anteroposterior movement relative to the tibia, resulting in anterior paradoxical motion. III.

Maxillary molar distalization with a 2-week clear aligner protocol in patients with Class II malocclusion: A retrospective study

This study aimed to investigate the efficacy of molar distalization with or without anterior teeth retraction. Forty-three patients who received maxillary molar distalization with clear aligners were retrospectively enrolled and further divided into 2 groups: a retraction group (with maxillary incisor retraction ≥2 mm in ClinCheck) and a nonretraction group (without anteroposterior movement or with the labial movement of the maxillary incisor in ClinCheck). Pretreatment and posttreatment models were collected and laser-scanned to obtain the virtual models. Three-dimensional digital assessments of molar movement, anterior retraction and arch width were analyzed in the reverse engineering software Rapidform 2006. To calculate the efficacy of tooth movement, the achieved tooth movement assessed on the virtual model was compared with the predicted tooth movement in ClinCheck. The achieved efficacy rates of molar distalization for the maxillary first and second molars were 36.48% and 41.94%, respectively. There was a significant difference in molar distalization efficacy between the retraction group (31.50% at the first molar and 35.63% at the second molar) and the nonretraction group (48.14% at the first molar and 52.51% at the second molar). In the retraction group, the efficacy of incisor retraction was 56.10%. The efficacy of dental arch expansion was more than 100% at the first molar levels in the retraction group and at the second premolar and first molar levels in the nonretraction group. There is a discrepancy between the outcome and the predicted maxillary molar distalization with clear aligners. The efficacy of molar distalization with clear aligners was significantly affected by anterior teeth retraction, and the arch width significantly increased at the premolar and molar levels.

Practical, Stereotactic, Low-Profile Technique for Transcortical/Transventricular Colloid Cyst Removal Independent of Ventricular Size: Technical Note and Analysis of Approaches.

In the presence of a dilated foramen of Monro, a transcortical, transforaminal approach is considered the safest and simplest approach for resection of colloid cysts. However, in the presence of small or normal frontal horns, numerous microsurgical approaches and, often complicated, variations have been described, invariably employing forms of stereotactic navigation. To report an alternative, accurate, microsurgical stereotactic low-profile technique. The small frontal horn is stereotactically targeted as previously described. Routine equipment is used to accurately create a novel, rigid, atraumatic surgical corridor. After a 7-mm corticotomy, a peel-away catheter carrying the AxiEM stylet engages the target set as the frontal horn. All joints of the endoscope holder are locked, allowing only catheter advancement (y axis) while lateral (x axis) or anteroposterior (z axis) movements are secure. Two, 7-mm retractor blades are inserted. The extremely consistent anatomy of the foramen of Monro allows en bloc microsurgical removal without unnecessary coagulation of cyst wall or choroid plexus. Despite a plethora of approaches to the rostral third ventricle, in the presence of normal or small frontal horns, including creation of transcallosal/interforniceal, suprachoroidal (or transchoroidal), and sub-choroidal, colloid cyst resection does not necessarily need to be convoluted. Technical nuances of an accurate, practical, minimally invasive technique are described.

An experimental characterization of ventilation motions in healthy subjects.

Existing devices detect main breathing data and none is aimed to monitor biomechanics of ventilation motions with small wearable device. The used device has been designed for noninvasive wearing to detect main motion parameters of a rib during ventilation in an experimental campaign with 218 subjects. Experimental activity is carried out by testing in vivo with human volunteers for an experimental characterization of ventilation motions as related to normal breathing, maximal breathing and coughing. Findings can be summarized from a numerical analysis of experimental results in terms of statistical values of ventilation motion parameters in rotation and acceleration as function of age and sex of the tested subjects. The discussed campaign reporting results on healthy patients was carried out with the aim to build a reference database of normal conditions against which the status of patients with both thoracic and ventilation problems can then be judged. Females showed significantly larger lateral-to-lateral movements during basal breathing and lateral-to-lateral Z-axis movements during maximal breathing and cough. Males demonstrated wider antero-posterior Y-axis and cranio-caudal X-axis movements during maximal breathing, while antero-posterior movements prevailed during cough. Older participants demonstrated larger lateral-to-lateral Z-axis and antero-posterior Y-axis movements during basal breathing. Young participants showed more significant increments along antero-posterior Y-axis from basal to maximal breathing and basal to cough, demonstrating a more efficient muscular activity. The ventilation motion during ventilation act is useful to detect the status of ventilation and can give indications for diagnostics and medical solutions even in thoracic surgery.

Effects of occlusal splint and exercise therapy, respectively, for the painful temporomandibular disorder in patients seeking for orthodontic treatment: a retrospective study

ObjectiveTo evaluate the effect of hard stabilization splints (HSS), counselling and exercise therapies, respectively, for the painful temporomandibular disorder (TMD) in patients seeking for orthodontic treatment through magnetic resonance imaging (MRI) and clinical examination.Materials and methodsEighty-seven TMD patients were divided into two groups according to their therapies: the HSS group (n = 43) comprising of patients treated with HSS, counselling and masticatory muscle exercises; the control group (n = 44) comprising of patients treated with counselling and masticatory muscle exercises alone. All patients had orthodontic therapies after the first treatment phase. The joint pain and clicking of all patients were recorded via clinical examination. MRIs of HSS groups were taken before (T0), after the first phase (T1), and after the orthodontic treatment (T2). Parameters indicating the condyles and articular discs were evaluated. Clinical symptom (pain and clicking) changes among T0, T1 and T2 time point were detected in the two groups respectively. The significant differences between HSS and control groups, as well as between male and female were tested at T1 and T2. Position changes of condyles and discs in HSS group among T0, T1 and T2 were detected in male and female respectively.ResultsAfter the first treatment phase, there was no difference in the decrease of facial pain between the two group, as well as between male and female in the two groups (P > 0.05). Clicking decreasing was not statistically significant. After the whole orthodontic periods, the TMJ pain relapsed in female of the control group, and the number of female’s pain joints was more than male’s (P < 0.05). In the HSS group, the posterosuperior movements of discs and the anteroposterior movements of condyles were recorded in closing position (P < 0.05). After the whole orthodontic periods, female’s disc-condyle angles increased, the discs to HRP distance decreased and condyles to VRP distance increased when compared with the data of T1 (P < 0.05).ConclusionsFor the orthodontic patients with painful TMD, HSS combined with counselling and exercise therapies before orthodontic treatment could provide pain relief. HSS is helpful to improve the position and relation of discs and condyles. In addition, male's prognosis is better than female's in terms of stability.

Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position : Aretrospective cohort study.

To assess changes in pharyngeal airway dimensions, head posture and hyoid position after maxillary expansion and face mask (FM) treatment compared to untreated classIII patients. This study examined 24classIII patients (10girls, 14boys, mean age: 10.97 ± 0.88years) treated with expansion and apetit-type FM appliance and 24untreated classIII patients (16girls, 8boys, mean age: 10.50 ± 1.06years). Pre- and posttreatment cephalometric radiographs were digitally analysed. Parametric data were analysed with paired and independent-samples t‑tests, nonparametric data were analysed with Wilcoxon signed-rank and Mann-WhitneyU tests. Spearman's correlation analysis was used to examine the relationship between dental/skeletal treatment changes and those of craniocervical postural position, pharyngeal airway dimension and hyoid position. With respect to the hypopharyngeal airway dimension, the hypopharyngeal sagittal length (CV3'-LPW), velar angle (HRL/U-PNS) and velar length (U-PNS) significantly increased in the treatment group. All the parameters describing head posture and those describing the distances of the hyoid bone to the HRL changed significantly after treatment, but these changes were not significantly different from the control group. In the treatment group, there also occurred asignificant increase in the sagittal growth of the maxilla (SNA, Co‑A, Na-PerpA, Wits), vertical growth of the maxillomandibular complex (SN-GoGN, N‑ANS, N‑Me), counterclockwise rotation of the maxilla (SN-PP) and overjet, while aclockwise rotation (y-axis) and anonsignificant inhibition of the sagittal growth (Co-Gn) of the mandible were observed. The treatment induced increases of hypopharyngeal sagittal length (CV3'-LPW), soft palate thickness and anteroposterior movement of hyoid bone (H-CV3) demonstrated apositive correlation with changes of craniocervical angles (NSL/OPT, NSL/CVT) and anegative correlation with craniohorizontal angles (OPT/HOR, CVT/HOR). The change of the anteroposterior movement of hyoid bone (H-CV3) was also positively correlated with oropharyngeal sagittal length (CV2'-MPW), the hypopharyngeal sagittal length (CV3'-LPW) and the minimal dimension of the pharyngeal airway space (PASmin). While expansion and FM treatment did not affect the head posture and hyoid bone position, positive effects were observed in the hypopharyngeal airway region.