Posterior Portion Research Articles

Autologous Fat Injection for the Treatment of Patulous Eustachian Tube.

Patulous eustachian tube is a disorder that leads to disturbing symptoms such as autophony, respiratory noise, and aural fullness. There has not been an established treatment found for this disorder. This study aims to assess the efficacy of autologous fat injection for a novel treatment of patients with patulous eustachian tube. Twenty-eight patients with refractory patulous eustachian tube were recruited for the study. Endoscopic autologous fat injection was performed submucosally into the anterior and posterior portion of the pharyngeal orifice of the eustachian tube. The outcomes were quantitatively assessed by comparing the difference between pre- and postoperative scores with the visual analog scale on 4 criteria: aural fullness, respiratory noise, tinnitus, and autophony. Autologous fat injection was performed successfully in all patients without major complications. According to the combined visual analog scale scores, after the treatments, 20 patients showed significant improvement and 6 showed moderate improvement. The overall success rate of the treatment was 92.9%. Autologous fat injection is an effective and safe procedure for the treatment of patulous eustachian tube.

The tetrapod fauna of the upper Permian Naobaogou Formation of China: 10. Jimusaria monanensis sp. nov. (Dicynodontia) shows a unique epipterygoid.

Jimusaria is the first reported Chinese dicynodont, previously only known from Xinjiang. Here we refer two specimens from the Naobaogou Formation, Nei Mongol, China to Jimusaria based on the following features: squamosal separated from supraoccipital by tabular, tabular contacting opisthotic, sharp and thin lateral dentary shelf expanding anteriorly into a thick swelling, nasals fused as single element, rod-like medial bar formed by footplate of epipterygoid connecting to the parabasisphenoid and periotic medially. A new species, J. monanensis, is named based on the diagnostic characters on these two specimens such as distinct caniniform buttress lacking posteroventral furrow, naso-frontal suture forming an anterior directed sharp angle, and converging ventral ridges on posterior portion of anterior pterygoid rami. In Jimusaria, the epipterygoid posteromedially contacts the parabasisphenoid and the periotic as a rod-like bar, a unique morphology unknown in any other dicynodonts. This structure probably increases the stability of the palatal complex. A similar structure might also appear in other dicynodonts as a cartilage connection. The new occurrence of Jimusaria increases the diversity of the tetrapod assemblage from the Naobaogou Formation, and further strengthens the connection between the tetrapod faunas from Nei Mongol and Xinjiang. Based on the current record, Jimusaria is one of the few tetrapod genera which survived in the end-Permian mass extinction.

The effect of intervertebral disc damage on the mechanical strength of the annulus fibrosus in the adjacent segment

BACKGROUND CONTEXTA herniated intervertebral disc (IVD) is a common injury in the human population. Despite the injury being isolated to a singular IVD in the spine, it is important to look at the biomechanical effects that a damaged IVD has on the entire spine, specifically the IVD adjacent to the injury. PURPOSEThis study examined the effects of a damaged IVD on the mechanical properties of the annulus fibrosus (AF) in the adjacent cranial IVD. STUDY DESIGNBasic science study using an in-vitro porcine model. METHODSSixteen porcine cervical spines were used; specifically spinal levels C3/4/5 were assigned to one of two experimental groups: 1) a control group that was not subjected any injuries (n=8); 2) an experimental group that experienced an injury to the anterolateral part of the disc, reaching the nucleus pulposus but without affecting the posterior portion of the AF in the C4/5 functional spine unit (FSU) (n=8). Each specimen underwent a previously published precondition compression protocol of 300 N of compression for 15 minutes followed by a cyclical compression protocol of compression protocol of 0.5 Hz sinusoidal waveform at 300 to 1200 N for 2 hours (3600 cycles). Post compression, the C3/4 AF was dissected to obtain two multilayer samples (one anterior and one posterior) as well as a peel sample (from the posterolateral region). A tensile strength test was conducted to examine the strength of the interlamellar matrix (peel sample) and the overall strength of the AF (multilayer samples). RESULTSSignificant results were found in the peel test samples. Specifically, experimental specimens were less stiff compared than control specimens (p<.01). In addition, experimental specimens also had a lower average strength then control specimens (p<.01). This reduction in both interlamellar strength and stiffness increases the risk of delamination in the experimental samples. In contrast, there were no differences found between the two groups when examining the AF as a whole through the multilayer tests (p>.05). CONCLUSIONSIt appears that a damaged IVD impacts the biomechanics of the spine and specifically the mechanical properties of the adjacent IVD. Specifically, the observed weakening of the interlamellar matrix in these adjacent IVDs may predispose it to delamination and subsequently degeneration or herniation. CLINICAL SIGNIFICANCEThese findings may help clinicians when treating patients who have experienced a disc herniation or severe degeneration, as they may potentially experience accelerated adjacent disc degeneration.

PH sensitive in-situ gel for ophthalmic delivery of ofloxacin and dexamethasone sodium phosphate: Formulation, development, and evaluation

Ofloxacin and dexamethasone sodium phosphate will be used to create a gel-forming ocular medicine delivery system and examine its efficacy. Conventional dose forms have a number of drawbacks, including inadequate routes for drug transport to the posterior portion of ocular tissue, poor ocular drug bioavailability, and pulse-drug entry following topical administration and systemic exposure due to nasolacrimal duct outflow. Ofloxacin and Dexamethasone were obtained from Trimed Life Science Pvt. Ltd. Mumbai India. HPMC E50, Carbopol 930 was obtained from MET’s Institute of Pharmacy, Nashik. The developed formulation showed sustained drug release for 480 Minutes. While compared with marketed eye drop which shows drug release within 80 Minutes. The formulations were evaluated for different parameters like Clarity, pH of Sol, Gelling pH, Viscosity of Sol, Viscosity of gel, drug content, and Percentage Cumulative Drug Release. From these studies, formulation gives good clarity and satisfactory gelling pH along with good gelling capacity. The in situ gelling systems of Ofloxacin and Dexamethasone Sodium Phosphate were successfully developed. It also showed increased residence time with good gelling capacity at physiological pH and sustained drug release.

Therapeutic effects of melatonin in long-term exposure to 2100 MHz radiofrequency radiation on rat sperm characteristics

IntroductionRadiofrequency electromagnetic fields (RF-EMFs) are one of the risk factors for male reproductive health and melatonin can be an ideal candidate for therapeutic development against RF-induced male fertility problems due to its antioxidant properties. The possible therapeutic role of melatonin in the destructive effects of 2100MHz RF radiation on rat sperm characteristics is investigated in the present study. MethodsWistar albino rats were divided into four groups and the experiment continued for ninety consecutive days; Control, Melatonin (10mg/kg, subcutaneously), RF (2100MHz, thirty minutes per day, whole-body), and RF+Melatonin groups. Left caudal epididymis and ductus deferens tissues were placed in sperm wash solution (at 37°C) and dissected. The sperms were counted and stained. Measurements of the perinuclear ring of the manchette and posterior portion of the nucleus (ARC) were performed and the sperms were examined at an ultrastructural level. All of the parameters were evaluated statistically. ResultsThe percentages of abnormal sperm morphology were significantly increased with RF exposure, while the total sperm count was significantly decreased. RF exposure also showed harmful effects on acrosome, axoneme, mitochondrial sheath, and outer dense fibers at the ultrastructural level. The number of total sperms, sperms with normal morphology increased, and ultrastructural appearance returned to normal by melatonin administration. DiscussionThe data showed that melatonin may be a beneficial therapeutic agent for long-term exposure of 2100MHz RF radiation-related reproductive impairments.

Expressive Prosody in Patients With Focal Anterior Temporal Neurodegeneration.

Progressive focal anterior temporal lobe (ATL) neurodegeneration has been historically called semantic dementia. More recently, semantic variant primary progressive aphasia (svPPA) and semantic behavioral variant frontotemporal dementia (sbvFTD) have been linked with predominant left and right ATL neurodegeneration, respectively. Nonetheless, clinical tools for an accurate diagnosis of sbvFTD are still lacking. Expressive prosody refers to the modulation of pitch, loudness, tempo, and quality of voice used to convey emotional and linguistic information and has been linked to bilateral but right-predominant frontotemporal functioning. Changes in expressive prosody can be detected with semiautomated methods and could represent a useful diagnostic marker of socioemotional functioning in sbvFTD. Participants underwent a comprehensive neuropsychological and language evaluation and a 3T MRI at the University of California San Francisco. Each participant provided a verbal description of the picnic scene from the Western Aphasia Battery. The fundamental frequency (f0) range, an acoustic measure of pitch variability, was extracted for each participant. We compared the f0 range between groups and investigated associations with an informant-rated measure of empathy, a facial emotion labeling task, and gray matter (GM) volumes using voxel-based morphometry. Twenty-eight patients with svPPA, 18 with sbvFTD, and 18 healthy controls (HCs) were included. f0 range was significantly different across groups: patients with sbvFTD showed reduced f0 range in comparison with both patients with svPPA (mean difference of -1.4 ± 2.4 semitones; 95% CI -2.4 to -0.4]; p < 0.005) and HCs (mean difference of -1.9 ± 3.0 semitones; 95% CI -3.0 to -0.7]; p < 0.001). A higher f0 range was correlated with a greater informant-rated empathy (r = 0.355; p ≤ 0.05), but not facial emotion labeling. Finally, the lower f0 range was correlated with lower GM volume in the right superior temporal gyrus, encompassing anterior and posterior portions (p < 0.05 FWE cluster corrected). Expressive prosody may be a useful clinical marker of sbvFTD. Reduced empathy is a core symptom in sbvFTD; the present results extend this to prosody, a core component of social interaction, at the intersection of speech and emotion. They also inform the long-standing debate on the lateralization of expressive prosody in the brain, highlighting the critical role of the right superior temporal lobe.

In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction.

Superior capsular reconstruction (SCR) is a procedure purported to restore stability of the glenohumeral joint after an irreparable rotator cuff tear, but the in vivo behavior of the graft is unknown. Previous work has not evaluated the relationship between graft deformation, kinematics, and healing. To (1) determine regional graft elongation after SCR, (2) determine if graft elongation is related to graft healing, and (3) identify associations between graft elongation and changes in kinematics from presurgery to postsurgery. Case series; Level of evidence, 4. Ten patients who underwent SCR performed abduction and shoulder rotation with the arm at 90° of humerothoracic abduction before and 1 year after surgery while biplane radiographs were collected at 50 images per second. Kinematics was determined with submillimeter accuracy by matching patient-specific digitally reconstructed radiographs of the humerus and scapula to the biplane radiographs using a validated volumetric tracking technique. Graft elongation was calculated using motion of the graft anchors that were identified on postoperative magnetic resonance imaging. Differences in elongation between anterior and posterior regions of the graft, as well as associations between graft elongation, graft healing, and kinematics, were analyzed. Peak graft elongation ranged from a 3% decrease in the anterior region during rotation to up to a 171% increase in the anterior region during abduction and the posterior region during rotation. Grafts that were healed at both anterior anchors reached the intraoperative length at lower abduction angles (60°) than grafts that were not healed at 1 or both of the anterior anchors (87°) (P = .005). The posterior anchor graft origin to insertion distances were 2.1 mm farther apart after surgery compared with before surgery during both abduction and rotation. SCR dermal allografts are stretched well beyond their intraoperative length in vivo. Graft healing appears to be associated with less graft elongation. The posterior portion of the SCR graft does not appear to improve glenohumeral joint stability 1 year after surgery. Improved clinical outcomes after dermal allograft SCR may be because of the spacer effect of the graft rather than improved glenohumeral joint stability 1 year after surgery.

Integration failure of regenerated limb tissue is associated with incongruencies in positional information in the Mexican axolotl.

Introduction: Little is known about how the newly regenerated limb tissues in the Mexican axolotl seamlessly integrate with the remaining stump tissues to form a functional structure, and why this doesn't occur in some regenerative scenarios. In this study, we evaluate the phenomenological and transcriptional characteristics associated with integration failure in ectopic limb structures generated by treating anterior-located ectopic blastemas with Retinoic Acid (RA) and focusing on the "bulbus mass" tissue that forms between the ectopic limb and the host site. We additionally test the hypothesis that the posterior portion of the limb base contains anterior positional identities. Methods: The positional identity of the bulbus mass was evaluated by assaying regenerative competency, the ability to induce new pattern in the Accessory Limb Model (ALM) assay, and by using qRTPCR to quantify the relative expression of patterning genes as the bulbus mass deintegrates from the host site. We additionally use the ALM and qRTPCR to analyze the distribution of anterior and posterior positional identities along the proximal/distal limb axis of uninjured and regenerating limbs. Results: The bulbus mass regenerates limb structures with decreased complexity when amputated and is able to induce complex ectopic limb structure only when grafted into posterior-located ALMs. Expressional analysis shows significant differences in FGF8, BMP2, TBX5, Chrdl1, HoxA9, and HoxA11 expression between the bulbus mass and the host site when deintegration is occuring. Grafts of posterior skin from the distal limb regions into posterior ALMs at the base of the limb induce ectopic limb structures. Proximally-located blastemas express significantly less HoxA13 and Ptch1, and significantly more Alx4 and Grem1 than distally located blastemas. Discussion: These findings show that the bulbus mass has an anterior-limb identity and that the expression of limb patterning genes is mismatched between the bulbus mass and the host limb. Our findings additionally show that anterior positional information is more abundant at the limb base, and that anterior patterning genes are more abundantly expressed in proximally located blastemas compared to blastemas in the more distal regions of the limb. These experiments provide valuable insight into the underlying causes of integration failure and further map the distribution of positional identities in the mature limb.

Autonomous robotic surgery for zygomatic implant placement and immediately loaded implant-supported full-arch prosthesis: a preliminary research

ObjectivesA patient with extensive atrophy of the alveolar ridge in the posterior portion of the maxilla was selected to complete an experimental and clinical case of the robotic zygomatic implant to investigate the viability of an implant robotic system in clinical use.MethodsThe preoperative digital information was collected, and the implantation position and personalized optimization marks needed for robot surgery were designed in advance in a repair-oriented way. The resin models and marks of the patient’s maxilla and mandible are all printed in 3D. Custom-made special precision drills and handpiece holders for robotic zygomatic implants were used to perform model experiments and compare the accuracy of the robotic zygomatic implant group (implant length = 52.5 mm, n = 10) with the alveolar implant group (implant length = 18 mm, n = 20). Based on the results of extraoral experiments, a clinical case of robotic surgery for zygomatic implant placement and immediate loading of implant-supported full arch prosthesis was carried out.ResultsIn the model experiment, the zygomatic implant group reported an entry point error of 0.78 ± 0.34 mm, an exit point error of 0.80 ± 0.25 mm, and an angle error of 1.33 ± 0.41degrees. In comparison, the alveolar implant group (control group) reported an entry point error of 0.81 ± 0.24 mm, an exit point error of 0.86 ± 0.32 mm, and an angle error of 1.71 ± 0.71 degrees. There was no significant difference between the two groups (p > 0.05). In clinical cases, the average entry point error of two zygomatic implants is 0.83 mm, the average exit point error is 1.10 mm and the angle error is 1.46 degrees.ConclusionsThe preoperative planning and surgical procedures developed in this study provide enough accuracy for robotic zygomatic implant surgery, and the overall deviation is small, which is not affected by the lateral wall deviation of maxillary sinus.

Prevalence of Accessory Sacroiliac Joint and Its Clinical Significance

Objective: To determine the prevalence of the accessory sacroiliac joint (ASIJ) on both computed tomography (CT) images and dry bones and ultimately, to contribute to the literature.&#x0D; Materials and Methods: CT images archived in the Radiology department of Gaziantep University Medical Faculty obtained from 145 individuals (104 males and 41 females) as well as 92 sacral bones were examined. &#x0D; Results: The prevalence of ASIJ among 92 sacral bones was 15.2%. The ASIJ was more commonly (52%) located at the posterior portion of the SIJ at the level of the second dorsal sacral foramen. In 48% of the bones, ASIJ was identified just above the first dorsal sacral foramen. Unilateral ASIJ was observed in 10.8% and bilateral ASIJ in 4.4% of the sacral bones. On CT images, ASIJ was found in 7.8% of the males and 7.2% of the females. The total prevalence of sacroiliac joint variations was 28.9%, and 6.8% of them were ASIJs.&#x0D; Conclusion: It should be kept in mind that ASIJ may be a source of arthritis and chronic hip pain. The presence of ASIJ should be sought through imaging studies for early diagnosis of ASIJ.

Double Opposing U Suture For Septal Multiple Axis Deviations: A Multi-Vectoral Approach.

Septal cartilage deviations comprise the majority of deformities related to revision rhinoplasty operations. Therefore, the primary operation should be as eventless and durable as possible. Many techniques have been suggested, but most present with a monoplanar correction and fixation of the septum. This study aims to demonstrate a suture method that fixates and broadens the deviated septum. This method employs a single-stranded suture passing below the spinal periosteum, pulling the posterior and anterior portions of the septal base separately. It was utilized in 1578 patients, of which only 36 necessitated a revision of septoplasty in the past 11 years (2010-2021). With a revision rate of 2.29%, this method should be considered a preferable choice over many techniques described in the literature.

Function and form of the shoulder in congenital and untreated growth hormone deficiency.

The shoulder is the most mobile joint in the entire human body. During arm elevation, it requires the integrity of a set of muscles, bones, and tendons. Individuals with short stature often need to raise their arms above the shoulder girdle and may have functional restriction or shoulder injuries. The impact of isolated GH deficiency (IGHD) on joints remains not well defined. The purpose of this work is to evaluate the function and structure of the shoulder in short-statured adult individuals with untreated IGHD due to the same homozygous mutation in the GHRH receptor gene. A cross-sectional study (evidence 3) was carried out in 20 GH-naive IGHD subjects and 20 age-matched controls. They completed the disabilities of the arm, shoulder, and hand (DASH) questionnaire and shoulder ultrasound (US). Thickness of the anterior, medial, and posterior portions of the supraspinatus tendon and of subacromial space was measured, and the number of individuals with tendinosis or tearing of the supraspinatus tendon was registered. DASH score was similar between IGHD and controls, but IGHD subjects complained less of symptoms (p = 0.002). The number of individual with tears was higher in the controls (p = 0.02). As expected, the absolute US measurements were lower in IGHD, but the magnitude of the reduction was most pronounced in the thickness of the anterior portion of the supraspinatus tendon. Adults with lifetime IGHD do not have functional shoulder restrictions, complain less of problems in performing upper extremity activities, and have fewer tendinous injuries than controls.

The effect of type 2 diabetes mellitus on the prognosis of osteoporotic vertebral compression fracture with osteoporotic fracture classification after vertebroplasty

BackgroundTo analyze the clinical and radiological effects of type 2 diabetes mellitus on the prognosis of osteoporotic vertebral compression fracture after percutaneous vertebroplasty, and explore the prognostic value of osteoporotic fracture classification.MethodsOsteoporotic vertebral compression fracture patients who received vertebroplasty from January 1, 2016 to June 30, 2021 were divided into type 2 diabetes mellitus group and control group in this retrospective cohort study. Visual analogue scale, Oswestry Disability Index, bone cement leakage, new compression fracture, anterior, middle, and posterior portion heights of vertebral body and local Cobb angle on X-ray before surgery, 2 days after surgery, 6 months, and 12 months after surgery were recorded, and the osteoporotic fracture classification was performed. P < 0.05 was set as statistical significance.ResultsA total of 261 vertebral bodies were included, containing 68 in the type 2 diabetes mellitus group and 193 in the control group. There were no differences in baseline characteristics between the two groups. At 6 months after vertebroplasty, the local Cobb angle of the type 2 diabetes mellitus group was 8.29 ± 4.90° greater than that of the control group 6.05 ± 5.18° (P = 0.002). At 12 months, compared with pre-operation, the anterior portion height recovered 8.13 ± 12.90%, which was less than 12.51 ± 14.92% of the control group (P = 0.032), and 19.07 ± 16.47% of the middle portion height recovery was less than the control group’s 24.63 ± 17.67% (P = 0.024). Compared with the control group, osteoporotic fracture 2 vertebral bodies of the type 2 diabetes mellitus group at 12 months postoperatively in middle portion height (14.82 ± 14.71% vs 24.78 ± 18.16%, P = 0.023) and local Cobb angle (5.65 ± 4.06° vs 3.26 ± 4.86°, P = 0.043) restored significantly worse. Besides, osteoporotic fracture 3 with type 2 diabetes mellitus restored worse in anterior portion height (5.40 ± 11.02% vs 13.57 ± 12.79%, P = 0.008), middle portion height (11.22 ± 15.53% vs 17.84 ± 12.36%, P = 0.041) and local Cobb angle (10.85 ± 3.79 vs 7.97 ± 3.83°, P = 0.002) at 12 months postoperatively. There was no difference in radiological outcomes of osteoporotic fracture 4 between the two groups.ConclusionsThe degree of fractured vertebral compression, the recovery of the height and angle obtained immediately after surgery and the clinical symptoms in type 2 diabetes mellitus patients were not different from those in the control. However, vertebral body morphology of type 2 diabetes mellitus patients was worse since the sixth month after surgery. Osteoporotic fracture classification has a good prognostic reference value for both the control and the type 2 diabetes mellitus population.

Comparison between Platelet-rich Fibrin and Saline Filling after Sinus Elevation without Adjunctive Bone Graft in Dental Implants Insertion Using CBCT.

The goal of this research was to compare radiographically the outcomes of hydraulic transcrestal sinus lifting with platelet-rich fibrin (PRF) or normal saline filling on implant survival rates, negative outcomes, and variations in the height of residual alveolar ridge (HARB). There were 80 study participants included and 90 dental implants were placed. The study participants were divided into two categories: Category A and Category B. Each category consists of 40 study participants. Category A: Normal saline was placed in the maxillary sinus. Category B: PRF was placed in the maxillary sinus. Implant survival, complications, and HARB alterations were the outcome metrics. Radiographic images through Cone-beam computed tomography (CBCT) were retrieved and compared prior to surgery (T0), immediately following surgery (T1), three months later (T2), 6 months later (T3), and 12 months later (T4). There are 90 implants having an average length of 10.5 ± 0.7 mm were inserted into the posterior portion of the maxilla of 80 patients with an average HARB of 6.9 ± 1.2 mm. At T1, elevation in HARB peaked, and the sinus membrane continued to droop but steadied while observed at T3. The steady increment of areas of radiopacities was noticed below the elevated membrane of the maxillary antrum. A radiographic intrasinus bone increase of 2.9 ± 1.4 mm was caused by the PRF filling, compared to 1.8 ± 1.1 mm by the saline filling at T4 (p < 0.05). Over the course of the one-year follow-up period, all of the implants were operating normally with no major issues. Platelet-rich fibrin when used as a filling medium alone without bone graft can cause significant ascend in height of the residual alveolar bone (HRAB). The degradation of the alveolar bone under the maxillary sinus following tooth loss frequently restricts the placement of the implant in the edentulous region of posterior maxilla. Numerous sinus-lifting surgery procedures and tools have been developed to address these problems. It has been a topic of debate regarding the benefits of bone grafts placed at the apical region of the implant. The sharp protrusions of the granules of bone graft may also provide a danger of membrane puncture. Recently, it was shown that regular bone gain might occur inside the maxillary antrum without the use of any bone transplant material. Additionally, if there were substances that filled the gap between the floor of the sinus and the raised sinus membrane, then the membrane of the maxillary sinus could be raised greater and for a longer period of time during the phase of formation of new bone formation.

Unique dentition of rhynchosaurs and their two‐phase success as herbivores in the Triassic

AbstractRhynchosaurs were key herbivores over much of the world in the Middle and Late Triassic, often dominating their faunas ecologically, and much of their success may relate to their dentition. They show the unique ankylothecodont mode of tooth implantation, with deep roots embedded in the bone of the jaw and low crowns that were rapidly worn down in use. During growth, the main area of oral food processing, located in the middle and posterior portions of the occlusal surfaces of the jaws, moved posteriorly relative to the anterior tips of the jaws, which curved up. As the maxilla and dentary grew by addition of new bone posteriorly, the dental lamina fed in new teeth at the back of the tooth rows. CT scanning of the holotype skull of Bentonyx sidensis from the Middle Triassic of England reveals previously concealed details of the dentition. Together with new dentary material from the same location, this has enabled us to examine the tooth replacement process and elucidate ontogenetic changes in dentition and jaw morphology as the animals aged. There were major changes in rhynchosaur anatomy and function through their evolutionary history, with the early forms of the Middle Triassic dying out before or during the Carnian Pluvial Episode (233–232 Ma), and the subclade Hyperodapedontinae, with broad skulls and adaptations to chop tough vegetation, subsequently diversifying worldwide in a successful ecological expansion until their global extinction 227–225 Ma.

Musculoskeletal Modeling of the Compensatory Role of the Shoulder Muscles in Ensuring the Stability of the Shoulder Joint in the Conditions of Partial Traumatic Tear of the Supraspinatus Muscle Caused by Calcific Tendinitis

Relevance. The presence of calcium deposits in the rotator cuff tendons usually leads to a restriction of the biomechanics of the shoulder joint and, in particular, to a failure of the scapulohumeral rhythm. The question of the compensatory participation of the muscles of the shoulder girdle in ensuring the stability of the shoulder joint in conditions of partial-thickness damage to the tendon of the supraspinatus muscle caused by calcific tendinitis remains interesting and understudied.&#x0D; Objective: to carry out skeletal and muscular modeling with the study of the compensatory participation of the rotator cuff muscles in ensuring the stability of the shoulder joint during the elementary movement of elevation of the upper limb in conditions of partial-thickness damage to the supraspinatus tendon caused by the presence of calcification in it.&#x0D; Materials and Methods. For the analysis we used simulation modeling in the software package AnyBody Modeling System™ (AnyBody Technology A / S, Denmark) for Windows. The calculation was carried out using the software component Mannequin, selected from the AnyBody Managed Model Repository™ model collection. The parameters of joint forces acting in the direction of three axes – X, Y, Z – were calculated, where the X axis corresponded to the anterior-posterior force direction (antero-posterior force), the Y axis – to the inferior-superior force direction, the Z axis – compression-distraction force direction (medio-lateral force) on the shoulder joint. The object of the study was muscle activity (Activity) and muscle strength (Fm) of m. deltiodus clavicular, m. deltiodus scapularis, m. infrapsinatus, m. subscapularis, m. teres major, and m. teres minor while simulating a decrease in the strength of m. supraspinatus by 50% caused by the presence of calcification in the thickness of its tendon.&#x0D; Results. With complex movement of the upper limb, associated with the elevation of the upper limb, in conditions of partial-thickness tear to the m. supraspinatus, with a decrease in its strength by 50%, there is a compensatory increase in the strength of the muscles of the shoulder joint – the posterior portion of the m. deltoidus scapularis, m. infraspinatus and m. subscapularis, to ensure the stability of the shoulder joint. Taking into account minor changes in joint reactions along three axes, with a decrease in the strength of m. supraspinatus caused by the presence of calcification in its thickness, the compensatory mechanism of including additional muscle activity and muscle efforts of other muscles of the shoulder girdle provides the necessary stability of the shoulder joint in these conditions.&#x0D; Conclusions. The study confirms the possibility of successful application of programs of conservative treatment of calcifications of the m. supraspinatus tendon, aimed at developing the compensatory capabilities of the muscles of the shoulder girdle.

Posterior Spinal Cord Infarct: To Make the Diagnosis, Think of the Unthinkable! (P12-5.004)

<h3>Objective:</h3> We report a case of posterior spinal artery (PSA) infarct initially misdiagnosed as transverse myelitis (TM) and highlight some of the differentiating features of this exceedingly rare entity. <h3>Background:</h3> Spinal cord infarcts (SCIs) represent 1% of strokes and 5–8% of acute myelopathy. In a systematic review of 133 cases of SCI collected over two decades, PSAs presented 11% of the total pool. Redundancy in the vascular supply of the posterior portion of the spinal cord accounts for PSA rarity. <h3>Design/Methods:</h3> A single case report. <h3>Results:</h3> A 62-year-old woman with a history of recurrent nephrolithiasis, vitamin B12 deficiency, hypertension, and hyperlipidemia presented painless and rapidly progressive severe numbness and weakness of the legs. Sphincter symptoms were absent. Enhanced Magnetic Resonance Imaging (MRI) of the brain and spinal cord were unremarkable. Cerebral spinal fluid (CSF) was unremarkable. She was diagnosed with TM, given a five-day course of intravenous (IV) steroids, and discharged to a rehabilitation facility with a protracted and incomplete recovery. She presented two years later with fluctuating sensory and motor symptoms in the context of ureteral stent removal. Repeat CSF was unremarkable. However, on repeat thoracic spine MRI, there was interval development of a T2 hyperintensity along the dorsal columns and myelomalacia from T3–T4 disc to T12. She received IV steroids with minimal improvement. She had recurrent myelopathy pseudoexacerbations in the context of concurrent illnesses subsequently. Spinal magnetic resonance angiography, computerized chest, abdomen, pelvis tomography, positron emission tomography scan, and cardiovascular investigations were unremarkable. <h3>Conclusions:</h3> Given its scarcity, PSA infarct can often go misdiagnosed. A high index of suspicion for PSA should be kept in mind, particularly in the case of 1) acute, severe, and rapidly progressive myelopathic symptoms, 2) an extensively normal CSF analysis, and 3) an initially normal MRI of the spinal cord that eventually shows some T2 hyperintensity and cord atrophy. <b>Disclosure:</b> Dr. Solis has nothing to disclose. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene/BMS. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Neurosciences. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. The institution of Dr. Zabad has received research support from Adamas. The institution of Dr. Zabad has received research support from Biogen. The institution of Dr. Zabad has received research support from Novartis. The institution of Dr. Zabad has received research support from Sun Pharma. The institution of Dr. Zabad has received research support from Parexel &amp; MedDay Pharmaceuticals.

Localized White Matter Tract Integrity Measured by Diffusion Tensor Imaging Is Altered in People with Mild Cognitive Impairment and Associated with Dual-Task and Single-Task Gait Speed.

Altered white matter (WM) tract integrity may contribute to mild cognitive impairment (MCI) and gait abnormalities. The purpose of this study was to determine whether diffusion tensor imaging (DTI) metrics were altered in specific portions of WM tracts in people with MCI and to determine whether gait speed variations were associated with the specific DTI metric changes. DTI was acquired in 44 people with MCI and 40 cognitively normal elderly controls (CNCs). Fractional anisotropy (FA) and radial diffusivity (RD) were measured along 18 major brain WM tracts using probabilistic tractography. The average FA and RD along the tracts were compared between the groups using MANCOVA and post-hoc tests. The tracts with FA or RD differences between the groups were examined using an along-tract exploratory analysis to identify locations that differed between the groups. Associations between FA and RD in whole tracts and in the segments of the tracts that differed between the groups and usual/dual-task gait velocities and gross cognition were examined. Lower FA and higher RD was observed in right cingulum-cingulate gyrus endings (rh.ccg) of the MCI group compared to the CNC group. These changes were localized to the posterior portions of the rh.ccg and correlated with gait velocities. Lower FA and higher RD in the posterior portion of the rh.ccg adjacent to the posterior cingulate suggests decreased microstructural integrity in the MCI group. The correlation of these metrics with gait velocities suggests an important role for this tract in maintaining normal cognitive-motor function.

Brain Areas Critical for Picture Naming: A Systematic Review and Meta-Analysis of Lesion-Symptom Mapping Studies.

Lesion-symptom mapping (LSM) studies have revealed brain areas critical for naming, typically finding significant associations between damage to left temporal, inferior parietal, and inferior fontal regions and impoverished naming performance. However, specific subregions found in the available literature vary. Hence, the aim of this study was to perform a systematic review and meta-analysis of published lesion-based findings, obtained from studies with unique cohorts investigating brain areas critical for accuracy in naming in stroke patients at least 1 month post-onset. An anatomic likelihood estimation (ALE) meta-analysis of these LSM studies was performed. Ten papers entered the ALE meta-analysis, with similar lesion coverage over left temporal and left inferior frontal areas. This small number is a major limitation of the present study. Clusters were found in left anterior temporal lobe, posterior temporal lobe extending into inferior parietal areas, in line with the arcuate fasciculus, and in pre- and postcentral gyri and middle frontal gyrus. No clusters were found in left inferior frontal gyrus. These results were further substantiated by examining five naming studies that investigated performance beyond global accuracy, corroborating the ALE meta-analysis results. The present review and meta-analysis highlight the involvement of left temporal and inferior parietal cortices in naming, and of mid to posterior portions of the temporal lobe in particular in conceptual-lexical retrieval for speaking.

Surtos de infecção por Neoechinorhynchus buttnerae (Acanthocephala) em Colossoma macropomum cultivado semi-intensivamente em Theobroma, estado de Rondônia, Amazônia Ocidental

The aim of this study was to describe two outbreaks of Neoechinorhynchus buttnerae parasitizing Colossoma macropomum raised semi-intensively in the Theobroma municipality, Rondônia state, Brazil. It was reported by owner that the animals had a history of poor weight gain and decreased food intake. C. macropomum that weighed around 1.5 kg were clinically evaluated where the body surface, fins, buccal and brachial cavity were carefully analyzed and no changes were found. N. buttnerae was the only intestinal parasite found in the specimens studied, and its distribution pattern showes a preference for the posterior portion of the intestine of C. macropomum. All 50 fish examined were parasitized by at least one N. buttnerae. This parasite was found in the digestive system of the examined fish. 100% of prevalence, 430 of intensity, 8.6 of average intensity and average abundance were found. Although there was no record of mortalities due to acanthocephalosis, damage that compromised the feed conversion of the fish was recorded. C. macropomum were infected by ingesting a crustacean containing cystacanth, the infective larval form of the parasite. Damage, such as presence of nodules, hypertrophy of goblet cells, thickening of the muscle layer, metaplasia in muscle tissue, severe edema from leukocyte infiltration in blood vessels and necrotic foci, were found in the intestine due to high infection rates of N. buttnerae. That said, inspection activities are essential for the preservation of consumer and animal health.