Changes In Head Position Research Articles

Đặc điểm lâm sàng và hiệu quả điều trị của liệu pháp oxy cao áp ở bệnh nhân chóng mặt ngoại biên

This paper presents “Clinical characteristics and therapeutic efficacy of hyperbaric oxygen therapy in patients with peripheral vertigo” to determine the clinical features of peripheral vertigo and its therapeutic efficacy. The study was carried out at Hyperbaric Oxygen Center (Southern Branch of Joint Vietnam-Russia Tropical Science and Technology Research Center) from October 2021 to December 2022, with 60 patients, divided into 2 groups. Group 1 consisted of 30 patients was treated with hyperbaric oxygen therapy (HBOT) and group 2 consisted of 30 patients was treated with HBOT and drugs (vestibular inhibitors, antiemetics and brain tonics). The results showed that: vertigo often occured when changing head position, vertigo accompanied by nausea, loss of balance. After the treatment, the group treated with HBOT and drugs, the patient's condition improved better, the level gradually increased with HBOT. In the group treated with HBOT and drugs, the mean score before treatment was 12.5 points, after 10 days of treatment was 4.37 points, after 20 days of treatment decreased to 0.63 points and after 30 days of treatment to 0.27 points. Particularly, in the group treated with HBOT, this rate was 12.33 points, respectively; 6.37 points; 2.1 points and 0.97 points (p < 0.05).

Behavioral measures of psychotic disorders: Using automatic facial coding to detect nonverbal expressions in video

Emotional deficits in psychosis are prevalent and difficult to treat. In particular, much remains unknown about facial expression abnormalities, and a key reason is that expressions are very labor-intensive to code. Automatic facial coding (AFC) can remove this barrier. The current study sought to both provide evidence for the utility of AFC in psychosis for research purposes and to provide evidence that AFC are valid measures of clinical constructs. Changes of facial expressions and head position of participants—39 with schizophrenia/schizoaffective disorder (SZ), 46 with other psychotic disorders (OP), and 108 never psychotic individuals (NP)—were assessed via FaceReader, a commercially available automated facial expression analysis software, using video recorded during a clinical interview. We first examined the behavioral measures of the psychotic disorder groups and tested if they can discriminate between the groups. Next, we evaluated links of behavioral measures with clinical symptoms, controlling for group membership. We found the SZ group was characterized by significantly less variation in neutral expressions, happy expressions, arousal, and head movements compared to NP. These measures discriminated SZ from NP well (AUC = 0.79, sensitivity = 0.79, specificity = 0.67) but discriminated SZ from OP less well (AUC = 0.66, sensitivity = 0.77, specificity = 0.46). We also found significant correlations between clinician-rated symptoms and most behavioral measures (particularly happy expressions, arousal, and head movements). Taken together, these results suggest that AFC can provide useful behavioral measures of psychosis, which could improve research on non-verbal expressions in psychosis and, ultimately, enhance treatment.

Novel Extension Control Instrument for Power Wheelchair Based on Kalman Filter Head Motion Detection

People with upper limb disabilities or high quadriplegia have extremely high requirements for the maneuverability and functionality of power wheelchairs. Normal wheelchairs cannot meet travel tasks, while smart customized wheelchairs are expensive and cannot be popularized. Therefore, a novel extension control instrument for power wheelchairs with low cost, strong scalability, and convenient usage is proposed, which can realize the control of the wheelchair by sensing a change of head posture. The device is divided into a head motion sensing unit (HMSU) and a wheelchair assistance control unit (WACU). The mapping relationship between the head attitude and the subject’s motion intention is established. The inertial measurement module in the HMSU collects the head attitude data and uses the Kalman filtering method to obtain the accurate Euler angle. The WACU is fixed on the original controller of the wheelchair. The joystick is inserted into the extended control mechanism and controlled, instead of the hand, through a 2-degree-of-freedom servo system combined with the pinion and rack push rod structure, thus controlling the movement of the wheelchair. In proceeding, the system can also detect the distance of objects in the environment in real time through the three-direction (front, left, right) ultrasonic ranging sensors installed on the WACU, with a certain obstacle avoidance function. The prototype experiments prove that the extension control instrument developed in this paper based on the Kalman filter can quickly and accurately identify head motion and accurately control the movement of the wheelchair. It is easy to operate and has strong universality, which presents a new low-cost solution for the travel of patients with disabilities.

Pediatric Benign Paroxysmal Positional Vertigo: Degree of Nystagmus and Concurrent Dizziness Differs from Adult BPPV.

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease's characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.

Stay Alert: Drowsiness Detection with IoT Technology

The "Drowsiness Detection using IoT with Eye Blink Sensor and Buzzer" project aims to address the critical issue of driver fatigue and drowsiness, a major cause of road accidents. Leveraging Internet of Things (IoT) technologies and a combination of eye blink sensors and a buzzer, this system provides a real-time solution for monitoring and alerting drivers when signs of drowsiness are detected. The project focuses on enhancing road safety by preventing accidents caused by driver fatigue Drowsiness detection is a critical aspect of ensuring safety, particularly in domains such as transportation where fatigue-related accidents pose significant risks. In recent years, the proliferation of Internet of Things (IoT) devices has enabled innovative approaches to drowsiness detection systems. This abstract outlines a novel framework for drowsiness detection utilizing IoT technologies. Our proposed system integrates various sensors, including facial recognition cameras, heart rate monitors, and accelerometers, into a networked IoT infrastructure. These sensors continuously monitor key physiological and behavioral indicators associated with drowsiness, such as eye movement patterns, blink frequency, heart rate variability, and head position changes.

A More Comfortable Method for Hydrostatic Weighing: Head above Water at Total Lung Capacity.

Hydrostatic weighing (HW) requires full submersion with the lungs at residual volume (RV) which is uncomfortable. Therefore, the purpose of this study was to find a more comfortable way to complete HW. A HW system was used to complete three comparisons: comparison 1: change in head position (head above water vs. head below water (HAW vs. HBW)), comparison 2: change in lung volume (total lung capacity (TLC) vs. RV), and comparison 3: change in head and lung volume changes. Participants were separated by males (n = 64) and females (n = 58). Comparison 1: HAW resulted in higher mean percent body fat (PBF) than HBW (4.5% overall, 3.8% in males, 5.4% in females, p < 0.05). Comparison 2: TLC resulted in lower mean PBF than RV (5.1% overall, 5.3% in males, 4.8% in females, p < 0.05). Comparison 3: HAW@TLC resulted in significantly lower (1.5% lower, p = 0.003) mean PBF for males but was not significantly lower for females or overall (0.6% higher, p = 0.39, 0.6% lower, p = 0.18, respectively) compared to HBW@RV. In conclusion, keeping the head above water and taking a deep inhale makes HW a more enjoyable, and accessible experience for everyone while still producing accurate PBF results.

Enhancing tube feeding method for neurosurgery: the application of improved PICC technique

Background and purposePeripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method.MethodIn a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients’ body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients’ body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients’ body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement.ResultThe study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group.ConclusionIn patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.

New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment.

Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and whether those variables are correlated with neurological prognosis. This is a prospective cohort with 30 patients who were submitted to cranioplasty and followed for 6 months. Patients underwent simple head CT before and after cranioplasty for morphometric and cerebral radiodensity assessment. A complete neurological exam with Mini-Mental State Examination (MMSE), modified Rankin Scale, and the Barthel Index was performed to assess neurological prognosis. There was an improvement in all symptoms of the syndrome of the trephined, specifically for headache (p = 0.004) and intolerance changing head position (p = 0.016). Muscle strength contralateral to bone defect side also improved (p = 0.02). Midline shift of intracranial structures decreased after surgery (p = 0.004). The Anterior Distance Difference (ADif) and Posterior Distance Difference (PDif) were used to assess morphometric changes and varied significantly after surgery. PDif was weakly correlated with MMSE (p = 0.03; r = -0.4) and Barthel index (p = 0.035; r = -0.39). The ratio between the radiodensities of gray matter and white matter (GWR) was used to assess cerebral radiodensity and was also correlated with MMSE (p = 0.041; r = -0.37). Morphological anatomy and radiodensity of the cerebral cortex can be used as a tool to assess neurological prognosis after DC.

Positional nystagmus is observed in the vast majority of healthy individuals

IntroductionBenign paroxysmal positional vertigo (BPPV) is a vestibular disease characterized by brief positional vertigo. When examined, characteristic patterns of positional nystagmus (PN) are found with specific head position changes. Previous studies have shown a high prevalence of PN among vestibular healthy subjects. Considering the current diagnostic criteria of BPPV and the potentially high prevalence of PN in healthy individuals, this raises the question of potential over diagnosing BPPV, if diagnostics are based exclusively upon objective findings. This study aims to determine the prevalence of PN within a healthy, adult population and furthermore include a characterization of the PN observed.MethodsThis is a prospective cross-sectional study. 78 subjects were included. The subjects underwent four standardized positional tests for BPPV in a mechanical rotational chair while using a VNG-goggle to monitor and record eye movements.ResultsPositional nystagmus was recorded in 70.5% (55/78) of the subjects. Of the 55 subjects, who presented with PN, 81.8% (45/55) had upbeating PN. The 95th percentile of the maximum a-SPV was found to be 10.4 degrees per second, with a median of 4. Five subjects (6.4%) in total presented with PN mimicking BPPV.ConclusionThis study found PN to be a common finding within a healthy, adult population based on the high prevalence of PN in the study population. Upbeating PN mimicking posterior canalolithiasis was found in numerous subjects. The authors recommend a cautious approach when diagnosing BPPV, especially in cases of purely vertical PN (without a torsional component) and if no vertiginous symptoms are present during Dix-Hallpike and Supine Roll Test examinations.

Analysis of the effect of motion on highly accelerated 3D FatNavs in 3D brain images acquired at 3T.

3D FatNavs are rapid acquisitions of MRI fat-volumes within the head that can be used for retrospective motion correction for brain MRI. 3D FatNavs typically use very high acceleration factors and are reconstructed with the GRAPPA parallel imaging technique. However, the GRAPPA reconstruction is not expected to perform well on 3D FatNavs volumes in the presence of strong motion due to the mismatched calibration data acquired once at the start of the scan, leading to motion-parameter misestimation. This study aims to assess the accuracy and precision of 3D FatNav-derived motion-estimates in the presence of large changes in head position. Rigid motion parameters were simulated and applied retrospectively to the 3D FatNav volumes from MPRAGE datasets acquired at 3T. The transformed images were then re-reconstructed using GRAPPA to simulate real motion deterioration of the fat-navigator, and used to estimate the motion applied and evaluate the tracking inaccuracy. This information was then used to estimate the residual motion after 3D FatNav-based motion correction and applied to the original MPRAGE volumes. The effect of the misestimation was assessed using an image quality metric and the evaluation scores from two observers. Quality boundaries were then estimated to assess the motion tolerance when 3D FatNavs are used. The GRAPPA reconstruction was shown to deteriorate for large changes in the head position, affecting the quality of 3D FatNav volumes and consequently degrading the accuracy of the motion-estimates. Based on our simulations, the estimated threshold of motion that led to a noticeable degradation in the MPRAGE image quality was up to RMS values of 3.7° and 3 mm for rotations and translations respectively. 3D FatNavs were shown to be able to correct for a wide range of motion levels and types. Boundaries of acceptable motion magnitudes for different levels of acceptable loss of image quality were determined.

Influence of Different Head and Neck Positions on Oropharyngeal Leak Pressure with the LMA Protector Airway: A Cross-over Study

Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient’s head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in oropharyngeal leak pressure (OLP) with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H2O, SD 5.080 cm H2O vs. 34.49 cm H2O, SD 4.804 cm H2O, p&lt;0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position.

An evaluation of inter-relationship between cervical posture and skeletal malocclusions

Introduction: The growth pattern of the cervical spine and the craniocervical structure are interconnected, inflencing one another both morphologically and functionally. As a result, stretching the head in relation to the cervical spine leads to notable changes, including greater anterior facial height, a shorter sagittal dimension, and a posterior rotation of the jaw. This study was conducted to determine the correlation between cervical curvature in different sagittal skeletal malocclusions and association between cervical lordosis and maxillary and mandibular base. Materials and Method: One hundred fity adults presenting with skeletal Class I, II, and III malocclusion were investigated, irrespective of growth pattern. Three groups were delineated based on the lateral cephalograms of the selected participants: Group 1 (50 skeletal Class I), Group 2 (50 skeletal Class II), and Group 3 (50 skeletal Class III). A comprehensive assessment of cervical posture was conducted through the measurement of manually traced 15 specifi angles, which were carefully chosen to provide a detailed characterization of cervical variations across all three groups. Validity was assessed using Wilk and Kolmogorov-Smirnov tests, and analysis was done using One way Analysis of variance and Post hoc Turkey’s test. Result: Statistically signifiant correlations (P&lt;.05) were found between angles OPT/HOR and CVT/HOR (representing cervical inclination with reference to the true horizontal plane),NSL/CVT, and FH/CVT (indicating middle craniocervical posture), NSL/RL, FH/RL, and NL/RL(reflcting rotation of mandibular ramus). Conclusion: It was proven that changes in head posture and craniofacial development are strongly correlated. The rotation of the mandibular ramus in relation to the cranium was compared between groups, and was found that skeletal Class II malocclusion subjects had more posterior rotation of the ramus in relation to the cranium and extended head compared to those with skeletal Class III and skeletal Class I malocclusion subjects.

Evaluation of natural head position changes in the treatment of class II malocclusions with functional appliance

Objectives: The position of the head to the neck is affected by various factors, including respiratory tract features, temporomandibular joint disorders, type of occlusion, and physical aspects. In addition, malocclusion can negatively affect the head-neck position. The present study aimed to evaluate changes in natural head position following treatment of Class II malocclusions with Farmand II functional appliance. Material and Methods: The present study was implemented as a historical cohort with the before and after design. Pre- and post-treatment lateral cephalometric radiographs of 33 skeletal Class II patients treated with the Farmand II functional appliance were included in the present study. The cephalometric analysis was done by tracing the related lines and landmarks. Facial angles and angles determining the natural head and neck position including craniohorizontal, craniocervical, craniovertical (CCV), and cervical curvature (CCI) were measured. Collected data were entered in Statistical Package for the Social Sciences (SPSS)-version 17 software. Paired t-test was used to evaluate the changes in cephalometric indices before and after treatment. P &lt; 0.05 was defined to be statistically significant for all the tests. Results: The results of the present study, showed a significant reduction in the mean values of A point, nasion, B point (ANB) angle and angle of convexity following treatment (P &lt; 0.001); also, Sella-nasion/Odontoid process tangent (SN/OPT) angle showed a substantial decrease in treated patients (P = 0.033), which is indicative of head flexion following treatment. Moreover, the decrease in the mean values of the craniocervical angles, including True vertical line (NL/VER) and Sella-nasion/true vertical line (SN/VER), suggests downward bending of the head in patients treated with this appliance (P-values of 0.029 and 0.012, respectively). The odontoid process tangent/cervical vertebra tangent (OPT/CVT) angle showed an insignificant increase (P = 0.260). Conclusion: The present study showed that patients treated with the Farmand II functional appliance tend to flex their heads and maintain their cervical vertebra in a more upright and straight position.

Simulation and experimental study on the stability and comfortability of the wheelchair human system under uneven pavement.

With the improvement in the level of science and technology and the improvement of people's living standards, the functions of traditional manual wheelchairs have been unable to meet people's living needs. Therefore, traditional wheelchairs have been gradually replaced by smart wheelchairs. Compared with traditional wheelchairs, smart wheelchairs have the characteristics of light operation and faster speed. However, when driving on some complex road surfaces, the vibration generated by the bumps of the motorcycle will cause damage to the human body, so wheelchairs with good electric power and stability can better meet the needs of people and make up for their travel needs. Based on the traditional vehicle stability analysis method, the mathematical theory of roll stability and pitch stability of the wheelchair-human system was established. We built a multi-body dynamics model with human skeleton and joint stiffness based on the multi-body dynamics method. The functioning of the wheelchair-human system was simulated and analyzed on the ditch, step, and combined road. The acceleration and Euler angle changes of the human head, chest, and wheelchair truss position were obtained, and the data results were analyzed to evaluate the stability and comfort of the system. Finally, a wheelchair test platform was built, and the road driving test was carried out according to the simulation conditions to obtain the system acceleration and angle data during the driving process. The simulation analysis was compared to verify the accuracy of the multi-body dynamics method, and the stability and comfort of the system were evaluated.

Diagnostic Criteria of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix-Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.

Two-Stream Spatial–Temporal Transformer Networks For Driver Drowsiness Detection

&lt;p&gt;For driver drowsiness detection in the real world, the existing methods have good performance in general. However, when the face is blocked, the light is dim, and the driver’s head posture changes, the performance will deteriorate significantly. In this paper, a two-stream Spatial-Temporal transformer network intended to perform diver drowsiness detection task is proposed to solve the above problems. The spatial-temporal graph is extracted from the video and then the results are obtained from 2s-STTN. The model is a two-stream transformer network model. In our model, the Spatial Self-Attention module is used to learn the embedding of different facial landmarks, and the Temporal Self-Attention module is used to learn the correlation between the frames of facial feature points. Different activated facial landmarks are separated and recognized by class activation mapping technology. Each flow recognizes different activated facial features, extracts spatial or temporal features, and integrates the information about facial features, so as to improve the performance of the system. 2s-STTN can not only mine the long-term dependence of driver behavior from video, but also mine the driver drowsiness information provided by the unobstructed facial signs when the face is blocked. By conducting experiments and comparing our model with other models, it is demonstrated that the proposed model has good performance in driver drowsiness detection.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

The effect of humeral head positioning and incomplete backside contact on bone stresses following total shoulder arthroplasty with a short humeral stem.

The use of uncemented humeral stems in total shoulder arthroplasty (TSA) is known to be associated with stress shielding. This may be decreased with smaller stems that are well-aligned and do not fill the intramedullary canal; however, the effect of humeral head positioning and incomplete head backside contact has not yet been investigated. The purpose of this study was to quantify the effect of changes in humeral head position and incomplete head backside contact on bone stresses and expected bone response following reconstruction. Three-dimensional finite element models of 8 cadaveric humeri were generated, which were then virtually reconstructed with a short-stem implant. An optimally sized humeral head was then positioned in both a superolateral and inferomedial position for each specimen that was in full contact with the humeral resection plane. Additionally, for the inferomedial position, 2 incomplete humeral head backside contact conditions were simulated whereby contact was defined between only the superior or inferior half of the backside of the humeral head and the resection plane. Trabecular properties were assigned based on computed tomography attenuation and cortical bone was applied uniform properties. Loads representing 45° and 75° of abduction were then applied, and the resulting differentials in bone stress versus the corresponding intact state and the expected time-zero bone response were determined and compared. The superolateral position reduced resorbing potential in the lateral cortex and increased resorbing potential in the lateral trabecular bone, while the inferomedial position produced the same effects but in the medial quadrant. For the inferomedial position, full backside contact with the resection plane was best in terms of changes in bone stress and expected bone response, although a small region of the medial cortex did experience no load transfer. The implant-bone load transfer of the inferior contact condition was concentrated at the midline of the backside of the humeral head, leaving the medial aspect largely unloaded as a result of the lack of lateral backside support. This study shows that inferomedial humeral head positioning loads the medial cortex at the cost of unloading the medial trabecular bone, with the same occurring for the superolateral position except that the lateral cortex is loaded at the cost of unloading the lateral trabecular bone. Inferomedial positioned heads also were predisposed to humeral head lift-off from the medial cortex, which may increase the risk of calcar stress shielding. For the inferomedial head position, full contact between the implant and resection plane was preferable.

Effectiveness of Epley-Canalith Repositioning Procedure versus Vestibular Rehabilitation Therapy in Diabetic Patients with Posterior Benign Paroxysmal Positional Vertigo: A Randomized Trial.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder, characterized by brief episodes of vertigo caused by changes in head position. The condition can cause significant functional impairment and reduced quality of life. BPPV is especially common among diabetic patients. The Epley-canalith repositioning procedure (CRP) and vestibular rehabilitation therapy (VRT) are two commonly used interventions for the treatment of BPPV. The objective of this study is to compare the effectiveness of Epley-canalith repositioning procedure (ECRP) and Vestibular Rehabilitation (VR) therapy in the management of vertigo among Type 2 Diabetes Mellitus patients. A total of 30 subjects with Type 2 diabetes mellitus, aged between 40 and 65 years, were randomly allocated to either the ECRP or VR therapy groups using a lottery method, and then underwent Epley-canalith repositioning procedure or vestibular rehabilitation therapy, respectively. The outcomes measured by the study were Vertigo Symptom Scale-Short Form (VSS-sf) score and Berg Balance Scale (BBS) score, assessed pre-treatment (pre) and 4 weeks post-treatment (post). The results demonstrated that both ECRP and VR therapy led to improvements in VSS-sf and BBS scores. However, VR therapy was found to be more effective, resulting in a 13.6% higher improvement in VSS-sf scores (p = 0.03) and a 5.1% higher improvement in BBS scores (p = 0.51) compared to ECRP. Both Epley-canalith repositioning procedure and vestibular rehabilitation therapy are effective in managing BPPV in diabetic patients. Although the differences in BBS scores are not statistically significant, VRT demonstrated a trend towards greater improvement. Vestibular rehabilitation therapy can be used by clinicians as another rehabilitation technique for improving vertigo, postural stability, and activity of daily living in diabetic patients with BPPV.

Case Study: A Heart Transplant Recipient with New, Severe Headache (P3-12.011)

<h3>Objective:</h3> To describe a case and raise awareness of tick-borne disease as an important cause of secondary headache in transplant recipients. <h3>Background:</h3> Tick-borne illness is an uncommon but important cause of secondary headache, especially within the transplant population. Organ transplant recipients have a 2.3-fold relative risk of death and of severe, systemic infection. Identification of risk factors for tick-borne disease is essential to reduce morbidity and mortality in this patient population. <h3>Design/Methods:</h3> Case Study <h3>Results:</h3> A middle-aged patient with history of a prior heart transplant was admitted with headache for four days. The pain was mild initially but soon worsened and was exacerbated by bright lights, coughing, and changes in head position. He had never experienced similar pain or migraine. Medications included daily sirolimus, tacrolimus, and prednisone. The patient lived in the rural Midwest. The patient was afebrile and other vital signs were stable. Exam was notable for positive Jolt accentuation and negative Kernig/Brudzinski signs and no noticeable rashes. He was oriented but was unable to spell the word “world” backwards. Otherwise, exam was normal. Lumbar puncture revealed clear CSF with 0 RBC/cumm, 0 Nucleated cells/cumm, Protein 57 mg/dL (H), Glucose 62 mg/dL (serum glucose 100 mg/dL). Bacterial/fungal cultures demonstrated no organisms on Cytospin gram staining. VZV, CMV, WNV, and HSV PCR analyses were sent. Other labs were significant for hyponatremia (132 mmol/L), leukopenia (1.9 K/cumm), microcytic anemia (Hgb 10.9 g/dL, MCV 74 fL), and thrombocytopenia (81 K/cumm). CT Head and MRI brain were normal. This patient’s CSF viral PCR studies returned negative. A qualitative blood PCR assay for <i>Ehrlichia chaffeensis, E. ewingii</i>, and <i>E. canis</i> returned positive. The patient received doxycycline for a 10-day course with improvement. <h3>Conclusions:</h3> Identification of tick-borne disease in patients with a history of chronic immune suppression is necessary to avoid complications related to this relatively uncommon cause of infection. <b>Disclosure:</b> Dr. Anderson has nothing to disclose. Mary Petrulis has nothing to disclose. Dr. Wu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Progentec. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Wu has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neuroimmunology. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Department of Justice.

Revisiting pathophysiology of benign paroxysmal positional vertigo: a review

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. There are several possible underlying causes of BPPV, although the idiopathic form is the most common. BPPV is characterized by brief recurrent episodes of vertigo that are triggered by changes in head position. Although BPPV is a benign vestibular disorder, it can be a severe and disabling problem for some of patients. The pathophysiology of BPPV is still unclear. The pathophysiology for BPPV is complex and the underlying mechanism is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These otolith/debris are originally accumulated after detachment from the neuroepithelium of the utricular macula secondary to degeneration. BPPV can occur following other vestibular disorders. In the majority of cases, the triggering factors are unknown. Some patients of BPPV have a history of previous inner ear diseases such as Meniere’s disease or acute unilateral peripheral vestibulopathy. This clinical entity is well-defined in medical literature and usually effectively treated by certain physical maneuvers. However, the pathophysiology is still obscure and is being critically discussed in this article, which reviews the details pathological mechanism for BPPV. This review article will discuss that aging, trauma, migraine, Meniere’s disease, vestibular neuronitis, and vitamin-D deficiency are the most commonly investigated etiopathological factors resulting in BPPV.