Overlap Research Articles

Exploring Trans Effect Concept in Pt(II) Complexes through the Quantum Theory of Atoms in Molecules and Chemical Bond Overlap Model Perspectives

AbstractThis study utilizes Density Functional Theory (DFT) alongside the Chemical Bond Overlap (OP) Model and Quantum Theory of Atoms in Molecules (QTAIM) to reinterpret the well‐established trans effect in square‐planar Pt(II) complexes. Investigating ligand exchange mechanisms in trans‐[()T] (T = , , , , CO, ) via transition state localization and intrinsic reaction coordinate calculations, overlap descriptors (OP/TOP) such as density, repulsion, and polarizability are computed for Pt−T and Pt−L bonds for reactants and transition states. Through OP/TOP and QTAIM, key descriptors correlating are identified with the trans‐directing effectiveness of ligands, revealing higher electron density donation and more electron‐rich bonds in stronger trans‐directing ligands. This combined methodology offers insights into ligand trans‐directing character, enhancing understanding of their reactivity and bonding behavior.

Intensive sampling of the umbra and penumbra improves clinically significant prostate cancer detection and reduces risk of grade group upgrading at radical prostatectomy.

Our objective is to evaluate the clinically significant prostate cancer detection rate of overlapping and perilesional systematic biopsy cores and its impact on grade group (GG) concordance at prostatectomy. Biopsy maps of those undergoing MRI-targeted (TB) and systematic biopsy (SB) were reviewed to reclassify systematic cores. Perilesional (PL) cores were defined as adjacent cores within 10mm of the target lesion ("penumbra") whilst overlap (OL) cores were defined as cores within the ROI itself ("umbra"). All other cores were designated as distant cores (DC). The incremental csPCa detection rate (GG ≥ 2) and the rate of GG upgrading on prostatectomy as OL, PL and DC sequentially added to TB were determined. Out of the 398 patients included, the median number of OL and PL cores was 5 (IQR 4-7) and 5 (IQR 3-6) respectively. OL cores detected more csPCa than PL cores (31 vs 16%, p < 0.001). OL and PL cores improved the csPCa detection rate of TB from 34 to 39% (p < 0.001) and 37% (p = 0.001) respectively. TB+OL+PL had greater csPCa detection compared to just TB+OL (41 vs 39%, p = 0.016) and TB+PL (41 vs 37%, p < 0.001). Of the 104 patients who underwent prostatectomy, GG upgrading rate for TB+OL+PL was lower compared to TB (21 vs 36%, p < 0.001) and was not significantly different compared to TB+OL+PL+DC (21 vs 19%, p = 0.500). A biopsy strategy incorporating both intensive sampling of the umbra and penumbra improved csPCa detection and reduced risk of GG upgrading at prostatectomy.

Pixel-Wise Warping for Deep Image Stitching

Existing image stitching approaches based on global or local homography estimation are not free from the parallax problem and suffer from undesired artifacts. In this paper, instead of relying on the homography-based warp, we propose a novel deep image stitching framework exploiting the pixel-wise warp field to handle the large-parallax problem. The proposed deep image stitching framework consists of a Pixel-wise Warping Module (PWM) and a Stitched Image Generating Module (SIGMo). For PWM, we obtain pixel-wise warp in a similar manner as estimating an optical flow (OF). In the stitching scenario, the input images usually include non-overlap (NOV) regions of which warp cannot be directly estimated, unlike the overlap (OV) regions. To help the PWM predict a reasonable warp on the NOV region, we impose two geometrical constraints: an epipolar loss and a line-preservation loss. With the obtained warp field, we relocate the pixels of the target image using forward warping. Finally, the SIGMo is trained by the proposed multi-branch training framework to generate a stitched image from a reference image and a warped target image. For training and evaluating the proposed framework, we build and publish a novel dataset including image pairs with corresponding pixel-wise ground truth warp and stitched result images. We show that the results of the proposed framework are quantitatively and qualitatively superior to those of the conventional methods.

Continuous extraction of coronary artery centerline from cardiac CTA images using a regression-based method.

Coronary artery centerline extraction in cardiac computed tomography angiography (CTA) is an effectively non-invasive method to diagnose and evaluate coronary artery disease (CAD). The traditional method of manual centerline extraction is time-consuming and tedious. In this study, we propose a deep learning algorithm that continuously extracts coronary artery centerlines from CTA images using a regression method. In the proposed method, a CNN module is trained to extract the features of CTA images, and then the branch classifier and direction predictor are designed to predict the most possible direction and lumen radius at the given centerline point. Besides, a new loss function is developed for associating the direction vector with the lumen radius. The whole process starts from a point manually placed at the coronary artery ostia, and terminates until tracking the vessel endpoint. The network was trained using a training set consisting of 12 CTA images and the evaluation was performed using a testing set consisting of 6 CTA images. The extracted centerlines had an average overlap (OV) of 89.19%, overlap until first error (OF) of 82.30%, and overlap with clinically relevant vessel (OT) of 91.42% with manually annotated reference. Our proposed method can efficiently deal with multi-branch problems and accurately detect distal coronary arteries, thereby providing potential help in assisting CAD diagnosis.

Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography–based Lymph Node Atlas for Salvage Radiotherapy in Patients with Recurrent Prostate Cancer: A Validation of the New NRG Oncology 2020 guideline

BackgroundApproximately 20–40% of patients with prostate cancer (PC) who undergo radical prostatectomy (RP) experience relapse, with the majority of these cases developing pelvic lymph node (LN) metastases. Taking new data from the prostate-specific membrane antigen (PSMA) positron emission tomography (PET) era into account, the Radiation Therapy Oncology Group (RTOG) 2009 contouring guideline for the pelvic LNs from 2009 was updated by the NRG Oncology group in 2020 (NRG 2020). ObjectiveTo evaluate and validate the updated NRG 2020 guideline with our established LN atlas. Design, setting, and participantsWe screened 1653 PSMA PET/computed tomography (CT) data sets for patients with biochemical relapse who underwent a PET scan between November 2012 and November 2017. After screening, we developed an LN atlas using data from 233 patients. Outcome measurements and statistical analysisWe evaluated LN overlap (OL) with the RTOG 2009 and NRG 2020 contouring guidelines. OL was defined as within (>90%), partly within (10–90%), or outside (<10%). Results and limitationsIn comparison to the RTOG 2009 guideline, 403 (52%), 134 (17%), and 241 (31%) of the LNs were not, were partly, or were fully covered within the overall group, respectively. By contrast, using the NRG 2020 guideline, 302 (39%), 190 (24%), and 286 (37%) of the LNs were not, were partly, or were fully covered, respectively (p < 0.001). Limitations include the retrospective design with missing data and no histopathological confirmation of the PET results. ConclusionsThe updated NRG 2020 contouring guideline improves coverage of the pelvic LNs in patients undergoing salvage radiation therapy. However, PET/CT should be considered whenever possible to ensure coverage of untypical LN spread. Patient summaryWe compared the 2009 and 2020 guidelines on the radiation area for the pelvis for patients with recurrent prostate cancer that has spread to lymph nodes. The newer guideline provides better coverage of pelvic lymph nodes than the older one and is useful in planning radiation therapy. However, a scan of the pelvis using the newest technique should be considered for individual patients to ensure coverage of untypical lymph nodes.

Calculating Self-concept Structure Indices, Including Linville’s H: Toward Standardization and Replication

The structure of the self and its relationship with wellbeing are of interest to researchers in many areas of psychology, including social, clinical and differential. Psychologists seeking to calculate the self-concept structure indices associated with the self-complexity framework have long been faced with a computation bottleneck. The complex formulae, variable approaches and lack of availability of ready-to-use programs that allow streamlined calculation of dimensionality (Linville’s H), complexity (Sakaki’s SC), overlap (OL) and compartmentalisation (Shower’s Phi) means that the research area has been limited in both research speed and participation. The low volume of studies and the computational disincentive for replications have led to a situation where the evidence on self-complexity and related constructs is equivocal. In this article, we discuss approaches to calculating self-concept structure, providing a practical guide for researchers who would like to implement the published formulas or use existing computational tools, made available by the authors. This tutorial will allow both efficiency and broader access for researchers seeking to examine constructs related to self-concept structure. We hope that these contributions might foster a new wave of data collection in this area, allowing for clarity on the utility and implications of dimensionality and complexity in the self-concept.

Syndesmosis Changes before and after Syndesmotic Screw Removal: A Retrospective Radiographic Study.

Background and Objectives: In patients with ankle fractures complicated by syndesmotic injuries, no consensus has been reached on the best method of syndesmosis fixation using syndesmotic screws. One previous study revealed no difference in the tibiofibular overlap between two groups with or without syndesmotic screw removal. Other studies have indicated that distal tibiofibular diastasis exists after the removal of syndesmotic screws. In this study, we aimed to confirm the effect of syndesmotic screw removal on diastasis occurrence. We further analyzed the risk factors that may contribute to the widening of the tibiofibular syndesmosis. Materials and Methods: This retrospective study involved a review of the records of 63 patients with ankle fractures accompanied by syndesmosis injuries that required syndesmotic screw fixation. Anteroposterior radiographs were analyzed for each patient at various time points, from syndesmotic screw fixation to outpatient department follow-ups after screw removal. The changes in tibia–fibula overlap (OL), tibia–fibula clear space (CS), and medial clear space (MCS) were analyzed. Further analysis was performed to reveal potential factors that may have contributed to radiographic differences. Results: Compared with the postoperation radiographs following syndesmotic screw fixation, OL decreased (2.0 mm) and CS increased (0.8 mm) in the anteroposterior radiographs from outpatient department follow-ups. No significant changes were noted in OL or CS after syndesmotic screw removal. However, OL decreased (1.8 mm) and CS increased (0.5 mm) before syndesmotic screw removal. No significant change in MCS occurred during the whole observation period. Linear regression analysis did not reveal any significant correlations between potentially related factors and radiographic changes. Conclusions: Marked diastasis had occurred at final follow-up. Notably, the diastasis occurred before rather than after screw removal. This implies that screw removal does not significantly influence the radiographic outcomes of rotational ankle fractures.

Automatic construction of coronary artery tree structure based on vessel blood flow tracking.

We sought to propose an innovative vessel blood flow tracking (VBFT) method to extract coronary artery tree (CAT) and to assess the effectiveness of this VBFT versus the single-frame method. Construction of a CAT from a segmented artery is the basis of artificial intelligence-aided angiographic diagnosis. However, construction of a CAT using a single frame remains challenging, due to bifurcations and overlaps in two-dimensional angiograms. Overall, 13,222 angiograms, including 28,539 vessels, were retrospectively collected from 3275 patients and were then annotated. Coronary arteries were automatically segmented by a previously established deep neural networks (DNNs), and the skeleton lines were then extracted from segmentation images to construct CAT using the single-frame method and the VBFT method. Additionally, 1322 angiograms with 2201 vessels were used to test these two methods. Compared to the single-frame method, the VBFT method can significantly improve the accuracy of CAT as (84.3% vs. 72.3%; p < 0.001). Overlap (OV) was higher in the VBFT group than that in the Single-Frame group (91.1% vs. 87.5%; p < 0.001). The VBFT method significantly reduced the incidence of the lack of branching (7.30% vs. 13.9%, p < 0.001), insufficient length (6.70% vs. 11.0%, p < 0.001), and redundant branches (1.60% vs. 3.10%, p < 0.001). The VBFT method improved the extraction of a CAT structure, which will facilitate the development of artificial intelligence-aided angiographic diagnosis. Cardiologists can efficiently diagnose CAD using this method.

Experimental assessment of a micro-pulse lidar system in comparison with reference lidar measurements for aerosol optical properties retrieval

Abstract. Simultaneous observations of a polarized micro-pulse lidar (P-MPL) system and two reference European Aerosol Research Lidar Network lidars running at the Leipzig site Germany, 51.4∘ N, 12.4∘ E; 125 m a.s.l.) were performed during a comprehensive 2-month field intercomparison campaign in summer 2019. An experimental assessment regarding both the overlap (OVP) correction of the P-MPL signal profiles and the volume linear depolarization ratio (VLDR) analysis, together with its impact on the retrieval of the aerosol optical properties, is achieved; the experimental procedure used is also described. The optimal lidar-specific OVP function is experimentally determined, highlighting that the one delivered by the P-MPL manufacturer cannot be used long. Among the OVP functions examined, the averaged function between those obtained from the comparison of the P-MPL observations with those of the other two reference lidars seems to be the best proxy at both near- and far-field ranges. In addition, the impact of the OVP function on the accuracy of the retrieved profiles of the total particle backscatter coefficient (PBC) and the particle linear depolarization ratio (PLDR) is examined. The VLDR profile is obtained and compared with that derived from the reference lidar, showing that it needs to be corrected by a small offset value with good accuracy. Once P-MPL measurements are optimally (OVP, VLDR) corrected, both the PBC and PLDR profiles can be accurately derived and are in good agreement with reference aerosol retrievals. Overall, as a systematic requirement for lidar systems, an adequate OVP function determination and VLDR testing analysis needs to be performed on a regular basis to correct the P-MPL measurements in order to derive suitable aerosol products. A dust event observed in Leipzig in June 2019 is used for illustration.

Types and frequency of fingerprint minutiae in individuals of Igbo and Yoruba ethnic groups of Nigeria

The population distribution of fingerprint minutiae is necessary to improve efficiency of fingerprints in identifying individuals in a population-specific manner. The objective of the study was to determine the distribution of different types of minutiae fingerprint feature in two Nigerian ethnic populations. Fingerprints from forty-four (44) Igbo individuals and forty-four (44) Yoruba individuals, both of Nigeria were collected using a manual impression method that uses ink pad and paper. Of all the minutiae types considered, bifurcations and convergences accounted for 54.85% of the study’s total minutiae counts (TMC). This study shows that the Igbo ethnic group consistently have higher count of all minutiae types and higher total minutiae counts for both hands statistically significant at P<0.001. We found association between gender and minutiae distribution in some minutiae types including fragment/point or dot (FP), overlap (OL) and break (BR). This work revealed important variations among individuals from the two ethnic groups on the distribution and variability of minutiae in Nigeria populations. Keywords: Dermatoglyphics, fingerprints, forensic, Igbo, minutiae, Nigeria, Yoruba.

Clinical effects of intravenous to oral amiodarone transition strategies in critically ill adult patients.

There is limited guidance on how to transition critically ill patients from intravenous (IV) to oral (PO) amiodarone. The objective of this study was to assess the impact of IV and PO amiodarone overlap on short-term tachyarrhythmia recurrence and adverse hemodynamic outcomes in the intensive care unit. This is a retrospective, single-center analysis of critically ill adults who were treated with IV amiodarone for a supraventricular arrhythmia with rapid ventricular rate (RVR) and transitioned to PO amiodarone while inpatient. Patients were excluded if rate control was not achieved prior to the PO transition. Receipt of concomitant IV and PO therapy for ≤2hours was considered no overlap (NOV) and >2hours was considered overlap (OV). Tachyarrhythmia recurrence and adverse hemodynamic events were compared between groups. A total of 90 patients (45 NOV, 45 OV) were included in the analysis. The median overlap duration was 0.1 (-1.3 to 1.2) hours in the NOV arm and 4 (2.6-6.1) hours in the OV arm. Recurrence of RVR occurred in 9 (20%) patients in each arm (P=1.0). The median time from IV discontinuation to return of tachyarrhythmia was 10.5hours. There were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Hypotension occurred in 13% and 20% (P=0.369) and bradycardia in 9% and 13% (P=0.502) of patients in the NOV and OV arms, respectively. Providing IV and PO overlap of amiodarone for a median of 4hours did not decrease the rate of early tachyarrhythmia recurrence. Future studies are warranted to evaluate the impact of alternative amiodarone dosing strategies on breakthrough tachyarrhythmia.

Directional fast-marching and multi-model strategy to extract coronary artery centerlines

BackgroundComputed tomography angiography (CTA) is a non-invasive technique to image coronary arteries and evaluate coronary artery diseases (CAD). The diagnosis of CAD requires modeling anatomical structures and analyzing the function and pathology of the coronary arteries. Therefore, a robust and automated method for extracting reliable coronary artery centerlines is valuable in clinical practice. MethodWe extracted coronary centerlines using the directional fast marching (DFM) method and improved DFM with a multi-model strategy. The method comprises model guidance, the application of vessel direction, and a multi-model strategy: (1) coronary models are constructed using registration techniques and then used as prior knowledge of the vessels; (2) the vessel direction, modified from the eigenvectors of the Hessian matrix and vesselness, is used to guide the search for the vessel points during fast marching; and (3) the multi-model strategy is applied to identify suboptimal results from the overall outcome as in multi-atlas segmentation. Overlap and accuracy metrics are used to assess the segmentation. The authors evaluated the performance of the proposed method on 32 CT cardiac angiography datasets from the Rotterdam Coronary Artery Algorithm Evaluation Framework (RCAAEF). The authors also studied the effect of models on DFM. ResultsFor the quantitative evaluation, DFM improved the average overlap (OV) from 43.6% of a method without model information to 77.8%. In addition, with the ground truth delineated by experts, multi-model DFM (MM-DFM) obtained 83.5% average overlap (OV) in the training datasets and 86.6% in the test datasets. ConclusionThe authors propose a novel approach to extract coronary centerlines from CTA using DFM and further extend DFM to a multi-model strategy. DFM effectively applies the prior shape of the coronary vessels and vascular features within the target image and has the potential to achieve clinically relevant results.

Assessing the GRIP of Ventral Hernia Repair: How to Securely Fasten DIS Classified Meshes.

Recurrences are frequently observed after ventral hernia repair. Based on clinical data, the mesh–defect area ratio (MDAR) can lead to lower recurrence rates. Using dynamic intermittent strain (DIS) in a pig tissue model, MDAR can be modified to give a measure called grip to better assess the mechanical stability of ventral hernia repair. The focus of this experimental study is to assess the different aspects of mesh overlap (OL) and fixation only in bridging repair of ventral hernias. DIS mimics coughing actions in an ex vivo model with the repetition of submaximal impacts delivered via a hydraulically driven plastic containment. Tissue derived from pig bellies simulates a ventral hernia with varying defect sizes. MDAR is calculated from the hernia orifice and the mesh OL. Commercially available meshes were strengthened with glue, tacks, and sutures to bridge the defects. The reconstructions are strained with up to 425 dynamic impacts. The grip of each repair is assessed using MDAR modified by the strength of the fixation. The DIS classification is based on bridging of a 5 cm ventral hernia orifice with an OL of 5 cm in a sublay position. The classification discriminates meshes properties upon DIS strain. MDAR is calculated to be 9 under these conditions. Decreasing the OL or increasing the hernia orifice reduces MDAR to numbers below 9. MDAR is modified to reach GRIP. Closure of the peritoneum adds about 4 to the grip given by MDAR. The multiplying factor of a transmural suture or one tack of Securestrap® or Protack® is 0.5 times the number of tacks applied. The multiplier given by a bonding spot of Glubran® is similar to that of an Absorbatack® being 0.33. Plotting the likelihood of a bridging repair to survive more than 400 DIS impacts versus the grip estimated from the factors given above, the grip to be passed for a durable repair is 10 for Parietex Progrip®, and Dynamesh Cicat® and 25 for Dynamesh IPOM®. Clinical data previously published can be reculculated to assess MDAR and permit an estimation of the grip of the reconstruction. In these recalculations, a correlation between MDAR and long-term recurrence rates is found. A dimensionless number called grip can be calculated. The grip can be modified by fixation in a reproducible way. A higher grip can improve the durability of ventral hernia repair. We believe that a higher grip leads to lower recurrence rates in the clinical setting.

TCT-171 Optical Coherence Tomography evaluation of the Absorb bioresorbable scaffold performance for overlap versus non-overlap segments in patients with coronary chronic total occlusion: insights from the GHOST-CTO registry

The Absorb®(Abbott Vascular, Santa Clara, CA) Bioresorbable Vascular Scaffold (BVS) has advantages over its predecessors, but has a drawback due to its large thickness, especially in regions of overlap. In this study we compared healing and performance between overlap (OL) and non-overlap regions (

Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p&gt;0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p&gt;0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

THE FINANCIAL CAPACITY INSTRUMENT–SHORT FORM IS A NOVEL, PERFORMANCE-BASED MEASURE THAT MAY HELP DIFFERENTIATE MILD COGNITIVE IMPAIRMENT AND MILD DEMENTIA DUE TO ALZHEIMER’S DISEASE POPULATIONS IN CLINICAL TRIALS

Mild cognitive impairment (MCI) represents a pre-dementia stage of Alzheimer's disease (AD) that immediately precedes mild AD dementia (mAD) on the disease continuum. As both MCI and mAD populations are now commonly included in AD clinical trials, effective differentiation of these two clinical subgroups has key relevance to defining clinical trial populations. We have previously shown that MCI and mAD subgroups at baseline share substantial overlap on traditional clinical measures, suggesting no clear subgroup boundary when using measures such as the Mini Mental State Examination (MMSE). Thus, new measures are needed to better differentiate these subgroups based on clinical score. The Financial Capacity Instrument—Short Form (FCI-SF) is a novel, performance-based measure of clinically relevant financial skills shown to be sensitive to preclinical, prodromal (MCI), and mild dementia stages of AD. In this study, we assessed the ability of FCI-SF performance and processing speed variables to distinguish MCI and mAD groups at baseline. Baseline clinical scores were summarized using descriptive statistics for baseline MCI (n=65) and mAD (n=51) participants from the NIH-funded Cognitive Observations in Seniors Study 2 (COINS2; co-author Marson, PI). The SAS KDE procedure was used to quantify the degree of overlap (OVR) between the two populations on FCI-SF Total Performance, FCI-SF Total Time, and MMSE scores. MCI and mAD populations in COINS2 showed low overlap on baseline FCI-SF total performance scores (OVR=0.41), and high overlap on FCI-SF time to completion scores (OVR=0.78). Consistent with previous work, MMSE overlap was low and similar to FCI-SF performance score overlap when MMSE was used to define clinical subgroup diagnosis (OVR=0.431). The FCI-SF is a novel, performance-based measure that effectively distinguishes MCI and mAD clinical subgroups using baseline performance scores, and in this regard, appears to outperform traditional clinical measures. Previous findings indicate that MMSE overlap is dependent on the use of MMSE at inclusion, where overlap is substantially higher when it is not used to define the clinical subpopulations (OVR=0.72). The FCI-SF represents an emerging new generation of clinically relevant functional performance instruments that may better differentiate early AD populations in clinical trials.

Early Weight Bearing on a Fixed Syndesmosis. Does it Matter?

Category: Trauma Introduction/Purpose: Introduction: There is no consensus about when to allow weight bearing in ankle fractures in which a screw was used to maintain reduction of the syndesmosis. There has been no evaluation, of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged. The aim of this study was to evaluate the radiographic parameters of the syndesmosis over time in patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Methods: We analyzed 42 patients with ankle fractures treated in our institution, with at least one syndesmotic screw in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). We measure medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS) and talar shift (TS). Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p&gt;0,05). Also no difference was found in measurements within patients with intact versus broken screws (p&gt;0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable consequences on plain X rays regarding ankle joint parameters. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We believe aggressive functional rehabilitation after ankle fractures including early weight bearing is beneficial for our patients and may lead to improved functional results.

Determination of contact maps in proteins: A combination of structural and chemical approaches.

Contact map selection is a crucial step in structure-based molecular dynamics modelling of proteins. The map can be determined in many different ways. We focus on the methods in which residues are represented as clusters of effective spheres. One contact map, denoted as overlap (OV), is based on the overlap of such spheres. Another contact map, named Contacts of Structural Units (CSU), involves the geometry in a different way and, in addition, brings chemical considerations into account. We develop a variant of the CSU approach in which we also incorporate Coulombic effects such as formation of the ionic bridges and destabilization of possible links through repulsion. In this way, the most essential and well defined contacts are identified. The resulting residue-residue contact map, dubbed repulsive CSU (rCSU), is more sound in its physico-chemical justification than CSU. It also provides a clear prescription for validity of an inter-residual contact: the number of attractive atomic contacts should be larger than the number of repulsive ones - a feature that is not present in CSU. However, both of these maps do not correlate well with the experimental data on protein stretching. Thus, we propose to use rCSU together with the OV map. We find that the combined map, denoted as OV+rCSU, performs better than OV. In most situations, OV and OV+rCSU yield comparable folding properties but for some proteins rCSU provides contacts which improve folding in a substantial way. We discuss the likely residue-specificity of the rCSU contacts. Finally, we make comparisons to the recently proposed shadow contact map, which is derived from different principles.

Modulação da Dor na Síndrome Fibromiálgica: Um Distúrbio Termorregulatório?

Several characteristics from Fibromyalgia Syndrome (FMS) suggest alterations in the thermoregulatory activity. There is an overl ap between thermoregulation and nociceptive modulation, consistent with the symptoms of the syndrome. Several studies, addressed in this review , describe common aspects between the regulation of pain and temperature, what may contribute to the generalized and persistent pain of FMS. Several findings, evidenced in the literature, support this idea: the distribution of Brown Fat (BAT) resembles the tender points; stress and cold cause sympathetic hyperactivity stimulating afferent fibers C, innervating BAT and adjacent tissues. They stimulate thermogenesis of BAT, which exacerbates hyperalgesia of FMS in regions corresponding to the tender points; physical activi ty acts in an antagonistic way, avoiding the BAT recruitment and alleviating the symptoms; women may be more susceptible to FMS, because they are less capable of initiating adaptive thermogenesis than men. The activation of the BAT has a peripheral vasoconstriction action, but it increase s the supraclavicular temperature. Infrared thermography may record the activation of BAT in the FMS through the mantle signal. Hands or feet immersion in water at 20oC test evaluates the aforementioned activation. Although not a definitive diagnosis, the phenomenon of the mantle and peripheral vasoconstriction may support the clinical diagnosis, having an important role in monitoring patients with FMS, as markers of autonomic dysfunction, present in this disease.

Impact of stent overlap on long-term clinical outcomes in patients treated with newer-generation drug-eluting stents

Early-generation drug-eluting stent (DES) overlap (OL) is associated with impaired long-term clinical outcomes whereas the impact of OL with newer-generation DES is unknown. Our aim was to assess the impact of OL on long-term clinical outcomes among patients treated with newer-generation DES. We analysed the three-year clinical outcomes of 3,133 patients included in a prospective DES registry according to stent type (sirolimus-eluting stents [SES; N=1,532] versus everolimus-eluting stents [EES; N=1,601]), and the presence or absence of OL. The primary outcome was a composite of death, myocardial infarction (MI), and target vessel revascularisation (TVR). The primary endpoint was more common in patients with OL (25.1%) than in those with multiple DES without OL (20.8%, adj HR=1.46, 95% CI: 1.03-2.09) and patients with a single DES (18.8%, adj HR=1.74, 95% CI: 1.34-2.25, p<0.001) at three years. A stratified analysis by stent type showed a higher risk of the primary outcome in SES with OL (28.7%) compared to other SES groups (without OL: 22.6%, p=0.04; single DES: 17.6%, p<0.001), but not between EES with OL (22.3%) and other EES groups (without OL: 18.5%, p=0.30; single DES: 20.4%, p=0.20). DES overlap is associated with impaired clinical outcomes during long-term follow-up. Compared with SES, EES provide similar clinical outcomes irrespective of DES overlap status.