Site Of Compression Research Articles

Carpal tunnel sonography.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45 and 60years of age, and it is more frequent in women than in men. The main cause of CTS is chronic compression of the median nerve and ischemic suffering secondary to increased pressure in the carpal tunnel. There are many possible causes of CTS, which can be differentiated into idiopathic causes, which include most cases, and secondary causes. Classical CTS diagnosis is based on the patient's clinical examination and electrophysiological tests, such as electromyography and nerve conduction studies. The latter are helpful for determining the site of nerve compression, assessing its severity, monitoring the course of the disease after therapy, and excluding other causes of median nerve pain, such as cervical radiculopathies, brachial plexopathies, polyneuropathy, or other forms of mononeuropathies. However, clinical examination and electrophysiological tests are not able to differentiate idiopathic forms from secondary forms of CTS, and discrepancies are possible between clinical examination and electrophysiological tests (false negatives). Ultrasound examination is able to recognize most of the secondary forms of CTS. It can evaluate the morphological alterations of the nerve and correlate them with the severity of nerve suffering in all cases, even idiopathic ones, with a sensitivity and specificity equal to those of electrophysiological tests. It can also highlight some anatomical predisposing variants or conditions that may represent contraindications to minimally invasive treatments. Ultrasound examination also plays a fundamental role in evaluating patients with an unfavorable outcome after surgical treatment.

Optimum chest compression point might be located rightwards to the maximum diameter of the right ventricle: A preliminary, retrospective observational study.

Some researchers have reported that applying compression closer to the maximum diameter of the left ventricle (Point_max.LV) is associated with worse clinical outcomes, challenging its traditional position as optimum compression point (Point_optimum). By locating the mid-sternum (the actual compression site) in terms of Point_max.LV and its right ventricular equivalent (Point_max.RV), we aimed to determine its optimum horizontal position associated with increased chances of return of spontaneous circulation (ROSC). A retrospective, cross-sectional study was performed at a university hospital from 2014 to 2019 on non-traumatic out-of-hospital cardiac arrest (OHCA) victims who underwent chest computed tomography. On absolute x-axis, we designated the x-coordinate of the mid-sternum (x_mid-sternum) as 0 and leftward direction as positive. Re-defining the x-coordinate of Point_max.RV and Point_max.LV as 0 and 1 interventricular unit (IVU), respectively, we could convert x_mid-sternum to "-x_max.RV/(x_max.LV-x_max.RV) (IVU)." Using multiple logistic regression analysis, we investigated whether this converted x_mid-sternum was associated with clinical outcomes, adjusting core elements of the Utstein template. Among 887 non-traumatic OHCA victims, 124 [64.4±16.7years, 43 women (34.7%)] were enrolled. Of these, 80 (64.5%) exhibited ROSC. X_mid-sternum ranging from-1.71 to 0.58 (-0.36±0.38) IVU was categorised into quintiles: <-0.60, -0.60 to-0.37, -0.37 to-0.22, -0.22 to-0.07 and ≥-0.07 (reference) IVU. The first quintile was positively associated with ROSC (odds ratio [95% confidence interval], 9.43 [1.44, 63.3]). Point_optimum might be located far rightwards to Point_max.RV, challenging the traditional assumption identifying Point_optimum as Point_max.LV.

Muscone suppresses inflammatory responses and neuronal damage in a rat model of cervical spondylotic myelopathy by regulating Drp1‐dependent mitochondrial fission

Cervical spondylotic myelopathy (CSM) is a common cause of disability with few treatments. Aberrant mitochondrial dynamics play a crucial role in the pathogenesis of various neurodegenerative diseases. Thus, regulation of mitochondrial dynamics may offer therapeutic benefit for the treatment of CSM. Muscone, the active ingredient of an odoriferous animal product, exhibits anti-inflammatory and neuroprotective effects for which the underlying mechanisms remain obscure. We hypothesized that muscone might ameliorate inflammatory responses and neuronal damage by regulating mitochondrial dynamics. To this end, the effects of muscone on a rat model of chronic cervical cord compression, as well as activated BV2 cells and injured neurons, were assessed. The results showed that muscone intervention improved motor function compared with vehicle-treated rats. Indeed, muscone attenuated pro-inflammatory cytokine expression, neuronal-apoptosis indicators in the lesion area, and activation of the nod-like receptor family pyrin domain-containing 3 inflammasome, nuclear transcription factor-κB, and dynamin-related protein 1 in Iba1- and βIII-tubulin-labeled cells. Compared with vehicle-treated rats, compression sites of muscone-treated animals exhibited elongated mitochondrial morphologies in individual cell types and reduced reactive oxygen species. In vitro results indicated that muscone suppressed microglial activation and neuronal damage by regulating related-inflammatory or apoptotic molecules. Moreover, muscone inhibited dynamin-related protein 1 activation in activated BV2 cells and injured neurons, whereby it rescued mitochondrial fragmentation and reactive oxygen species production, which regulate a wide range of inflammatory and apoptotic molecules. Our findings reveal that muscone attenuates neuroinflammation and neuronal damage in rats with chronic cervical cord compression by regulating mitochondrial fission events, suggesting its promise for CSM therapy.

Surgical Outcome of Intradural-extra-medullarySpinal Tumour: 205 Our Experience in Dhaka Medical College & Hospital

Introduction: Surgical outcome of spinal tumours varies depending on a number of factors such as: site of tumour compression within the spinal canal, the histological characteristics of tumours, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighbor structures and organs etc.&#x0D; Materials &amp; Methods: The 46 patients with intradural extramedullary (IDEM) spinal tumour underwent surgery by our team in 7 years (2010-2017) were reviewed retrospectively.&#x0D; Discussion: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuro imaging, comorbidities etc. The aim of surgery was decompression of the spinal cord and total removal of the tumour.&#x0D; Conclusion: The aim of this study is to analyze the data to make conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish an effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumor can be radically resected with no mortality and minimal peri-operative morbidity&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 205-208

Anterior Cervical Idiopathic Hyperostosis and Dysphagia: The Impact of Surgical Management—Study of a Series of 11 Cases

To assess the efficacy and safety of surgery for dysphagia in anterior cervical idiopathic hyperostosis. This retrospective study included 11 consecutive patients presenting with dysphagia and anterior cervical idiopathic hyperostosis. Computed tomography scans and dynamic swallowing fluoroscopies were performed. The site of compression and the size and position of osteophytes were measured. The clinical outcomes and complications were recorded. Two patients with anterior esophageal compression were found to have dysphagia caused by lower esophageal sphincter dysfunction. In the remaining 9patients, the level of maximal compression was between C3 and C5 with the size of the osteophytes ranging from 8 to 17 mm. Intubation was challenging in 7 patients. Postoperative transient worsening of dysphagia was encountered in 3 patients. Two patients experienced severe complications including aphagia and respiratory compromise. Within 2 months of the operation, all patients reported satisfactory improvement of symptoms and a considerable gain in quality of life. No recurrence had occurred at final follow-up. Anterior cervical hyperostosis causing dysphagia typically affects older men and results from compression between C3 and C5 from osteophytes of variable sizes. Operative intervention can provide long-lasting resolution of symptoms but is complicated by difficulty in endotracheal intubation, postoperative dysphagia, and rarely respiratory compromise. A systematic preoperative ear, nose, and throat consultation is recommended to reduce these complications.

Echinacoside attenuates inflammatory response in a rat model of cervical spondylotic myelopathy via inhibition of excessive mitochondrial fission

Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction with few treatment options. Although mitochondrial dynamics are linked to a wide range of pathological changes in neurodegenerative diseases, a connection between aberrant mitochondrial dynamics and CSM remains to be illuminated. In addition, mechanisms underlying the emerging anti-inflammatory and neuroprotective effects of echinacoside (ECH), the main active ingredient of Cistanche salsa, are poorly understood. We hypothesized that excessive mitochondrial fission plays a critical role in regulating inflammatory responses in CSM, and ECH might alleviate such responses by regulating mitochondrial dynamics. To this end, we assessed the effects of ECH and Mdivi-1, a selective inhibitor of dynamin-related protein (Drp1), in a rat model of chronic cervical cord compression and activated BV2 cells. Our results showed that rats with Mdivi-1 intervention had improved motor function compared with vehicle-treated rats. Indeed, Mdivi-1 treatment attenuated pro-inflammatory cytokine expression, as well as activation of the nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, nuclear transcription factor-κB (NF-κB), and Drp1 in lesions. Compared with vehicle-treated rats, compression sites of Mdivi-1-treated animals exhibited elongated mitochondrial morphologies and reduced reactive oxygen species (ROS). Similarly, ECH-treated rats exhibited neurological recovery and suppression of inflammatory response or related signals in the lesion area after treatment. Interestingly, ECH treatment partly reversed aberrant mitochondrial fragmentation and oxidative stress within the lesion area. In vitro data suggested that ECH suppressed activated microglia by modulating activation of the NLRP3 inflammasome and NF-κB signaling. Furthermore, we observed that ECH markedly inhibited Drp1 translocation onto mitochondria, whereby it regulated mitochondrial dynamics and ROS production, which act as regulators of NLRP3 inflammasome activation and NF-κB signaling. Thus, our findings reveal that mitochondrial dynamics modulate inflammatory responses during CSM. Moreover, ECH may attenuate neuroinflammation in rats subjected to chronic cervical cord compression by regulating Drp1-dependent mitochondrial fission and activation of downstream signaling.

Prevalence of left iliac vein compression on computed tomography scans from a population.

BackgroundMay-Thurner syndrome (MTS) is defined as compression of the left iliac vein between the right iliac artery and the lumbar vertebral body in the presence of signs and symptoms of unilateral left chronic venous insufficiency. However, imaging findings of compression are not manifest in symptoms of the syndrome in all subjects.ObjectivesTo evaluate findings of compression in an asymptomatic population.MethodsComputed tomography angiographies or venous phase computed tomographies were analyzed. Demographic data and reason for the exam were recorded. Vein diameter was measured at the site of greatest compression and distal of the compression and the ratio between the two diameters was calculated.ResultsFrom January to July of 2016, 590 computed tomography scans were analyzed (357 women and 233 men). Left iliac compression was found in 14.74% of patients. Patients with a left iliac diameter below the 5mm threshold had a mean diameter at the site of greatest iliac vein compression of 4.4 mm (range: 2.67 mm-4.97 mm). The ratio between the two measurements was < 0.5 in 30% of patients.ConclusionsOur study suggests that iliac vein compression is common among random patients who have had computed tomography for any other reason. This indicates that compression found on tomography images is not the only finding to consider when treating a patient.

The beneficial role of intravascular ultrasound in the diagnosis and treatment of nonthrombotic iliac venous obstructions as compared with traditional venography in the Chinese population

PURPOSE: The efficacy of intravascular ultrasound (IVUS) in diagnosing obstructive venous lesions has been established in the Western countries; however, its beneficial role in the Asian population is seldom reported. Because IVUS is still not widely used in China, we, therefore, investigated whether the salutary effect of IVUS on the diagnosis and treatment of iliac venous outflow obstructions could also be extended to the Chinese population. MATERIALS AND METHODS: This was a prospective single-center study. Patients with nonthrombotic iliac venous obstructions were consecutively enrolled from September 2017 to September 2019. IVUS and venography were performed for every participant. The anatomic characteristics of the venous lesions were measured by these two imaging modalities and then compared with each other. Venous lesions were divided into the collateral and noncollateral group according to the presence of collaterals on venographic images, and comparison was performed between the two groups. The difference of lesion diameter or area at the most compression site was also observed after the endovascular intervention. RESULTS: A total of 50 patients with 59 limbs were eligible (males, 25; females, 25; mean age 63.46 ± 8.07). The clinical-etiology-anatomy-pathophysiology classification was C4: 43 (72.88%), C5: 6 (10.17%), and C6: 10 (16.95%). Compared with IVUS, the diameter and area stenosis calculated by traditional venography were dramatically lower than that measured by IVUS (diameter stenosis, 38.56% ± 17.76% vs. 64.55% ± 15.96%, P CONCLUSIONS: Compared with IVUS, traditional venography underestimates the degree of stenosis and misses significant iliac venous obstructive lesions. The collaterals presented by venography is not a reliable indicator in distinguishing significant lesions. IVUS is a valuable and effective imaging modality in the diagnosis and treatment of nonthrombotic iliac venous obstructions in the Chinese population.

Consistency of neurovascular relationship between multimodal image fusion 3D reconstruction and intraoperative findings of microvascular decompression for primary trigeminal neuralgia

Objective To explore the consistency of neurovascular relationships between multimodal image fusion 3D reconstruction and intraoperative findings in microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Methods A retrospective analysis was conducted on the clinical data of 50 PTN patients treated with MVD at Department of Neurosurgery, Qingdao University Hospital from January to November 2018. All subjects underwent three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional cyclic phase steady-state acquisition rapid imaging (3D-FIESTA) sequences. Then, the 3D-slicer software was used to reconstruct the multimodal fusion 3D image. Multimodal image fusion 3D reconstruction images and surgical video were analyzed to determine the offending vessels responsible for trigeminal neuralgia. At the same time, the direction of compression, compression site and compression degree of the trigeminal nerve were analyzed. Kappa consistency test method was used to judge the consistency of the two approaches above. Results With MVD set as the standard, the accuracies of multimodal image fusion 3D reconstruction images in determining the offending vessels, direction of compression, compression site and the degree of compression were 92.0% (46/50), 92.0% (46/50), 96.0% (48/50) and 58.0% (29/50), respectively. Multimodal image fusion 3D reconstruction images and MVD showed high consistency in judging offending vessels, compression direction and compression position (Kappa values: 0.729, 0.903 and 0.955 respectively, all P<0.001). However, the consistency was poor in judging the degree of compression of offending vessels to the trigeminal nerve (Kappa value=0.227, P=0.002). The degree of compression was higher in intraoperative findings of MVD than that revealed by multimodal image fusion three-dimensional reconstruction (mean values: 2.57 and 1.58 respectively, Z=-4.499, P<0.001). Conclusions Preoperative multi-modal image fusion 3D reconstruction could help accurately determine the offending vessel, compression direction and compression position of PTN, which seems highly consistent with intraoperative findings of MVD. Preliminary speculation could be used as one of the methods facilitating preoperative diagnosis. Key words: Trigeminal neuralgia; Multimodal image fusion; Microvascular decompression; Neurovascular relationship; Computer-aided diagnosis

Endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound

Objective: To evaluate the clinical efficacy of endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound. Methods: The clinical data of 40 patients with non-thrombotic right iliac vein compression syndromereceiving intravascular ultrasound-assisted balloon dilatation combined with stent implantation from January 2012 to December 2018 were retrospectively analyzed. There were 32 males and 8 females, the average age of whom was 63 (46-81) years old. The patients were classified according to the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) classification: 7 cases as C3, 18 as C4, 10 as C5 and 5 as C6. All patients underwent percutaneous right femoral vein puncture, intravascular ultrasound, and balloon dilatation combined with stentimplantation in the right iliac vein lesion location. Results: The success rate of clinical operations was 100%. There were no serious complications during the perioperative period. All patients were followed up for 4-58 months. During the follow-up period, the relief rate of limb edema was 88.6% (31/35), the pain relief rate was 86.7%(13/15), and the healing rate of ulcers was 100% (6/6). After the stent implantation, the endovascular area of the compression site was significantly enlarged (34.5mm(2)± 11.1mm(2)vs129.8 mm(2)±17.2 mm(2), P<0.001). The follow-up of color Doppler and/or anterograde angiography for deep veins of lower limb with digital subtraction angiography showed that the blood flow in the stentsweres mooth in all patients. Three cases were observed that the intimal hyperplasia led to mild in-stent restenosis, no obvious in stent restenosis (>50%). The abdominal X-ray plain film showed no obvious displacement and fracture of the stents. The venous clinical severity score (VCSS) was statistically significant (13.0±2.4 vs 6.2±2.0, P<0.001). The statistical results of short-form health surver SF-36 showed that the scores of life quality in all dimensions of the affected limb were significantly improved after operation (P=0.000). Conclusion: Intravascular ultrasound-assisted balloon dilatation combined with stent implantation is not only a safe and effective treatment for non-thrombotic right iliac vein compression syndrome, but also has a good mid-term patency rate.

Anatomy of the median nerve and its clinical applications

The median nerve is a mixed sensory and motor nerve. It is classically described as the nerve of pronation, of thumb, index finger, middle finger and wrist flexion, of thumb antepulsion and opposition, as well as the nerve of sensation for the palmar aspect of the first three fingers. It takes its name from its middle position at the end of the brachial plexus and the forearm. During its course from its origin at the brachial plexus to its terminal branches, it runs through various narrow passages where it could be compressed, such as the carpal tunnel or the pronator teres. The objective of this review is to summarize the current knowledge on the median nerve's anatomy: anatomical variations (branches, median-ulnar communicating branches), fascicular microanatomy, vascularization, anatomy of compression sites, embryology, ultrasonographic anatomy. The links between its anatomy and clinical, surgical or diagnostic applications are emphasized throughout this review.

Neurologic and magnetic resonance imaging features of German Shepherd Dogs with cervical spondylomyelopathy: 10 cases (2006-2018).

To describe the neurologic signs and MRI findings for German Shepherd Dogs (GSDs) with cervical spondylomyelopathy (CSM). 10 GSDs with confirmed CSM. Medical records from January 2006 through July 2018 were reviewed to identify dogs with CSM. For each CSM-affected dog, information regarding age, duration of clinical signs, presence of neurologic signs, and treatments administered were obtained; the main site and cause of spinal cord compression and other vertebral and spinal cord changes were identified on MRI images. Data for 9 male and 1 female (mean age, 6.2 years) GSDs with CSM were assessed. Dogs were classified as having chronic (n = 9) or acute (1) CSM. Nine dogs had ataxia; 1 dog had only signs of cervical hyperesthesia. Neurologic examination findings localized the lesion to the cervical portion of the vertebral column in each dog. The main spinal cord compression site was at the C6-7 (n = 5), C5-6 (4), or C4-5 (1) intervertebral spaces; osseous proliferation of the articular processes was the sole or a contributory cause of these compressions for 6 of the 10 dogs. Eight dogs also had dorsal compression of the spinal cord as the result of ligamenta flava hypertrophy. The 10 GSDs of the present retrospective case series had CSM that was often characterized by osseous changes and a ligamentous component and were older than dogs of other breeds (eg, Great Dane and Mastiff) with osseous-associated CSM described in previous reports. Cervical spondylomyelopathy should be a differential diagnosis for GSDs with ataxia, paresis, or signs of cervical hyperesthesia.

Application of different turnover intervals in preventing stress injury to patients in rescue room

Objective To investigate the effect of different turnover intervals in preventing stress injury to patients in emergency room. Methods The 200 eligible patients from July 2016 to July 2017 were divided into 4 groups by random number table method, 50 patients per group, named as the conventional group, test group 1, test group 2 and test group 3. Turning frequency was used for 2.0 h in the conventional group, and 2.5 h, 3.0 h and 3.5 h in the first, second and third groups, respectively. The average body pressure of the shoulder blade, left and right lateral ankle and sacral tail between the four groups at different turning time, the incidence of stress injuries, the comprehensive satisfaction of patients with turn-over nursing were compared. Results There was no statistically significant difference in the body pressure value of the main compression site between the four groups (P>0.05), and the incidence of stress injury was 2.0% (1/50), 2.0% (1/50), 2.0% (1/50), and 4.0% (2/50), respectively (P>0.05). The comprehensive satisfaction degree of the patients in the four groups was 71.0%(71/100), 75.0%(81/108), 79.8% (83/104), and 86.6% (97/112), respectively, with statistically significant differences (χ2=8.517, P< 0.05). For each of the two groups, only the general group and the experimental group showed statistically significant differences in the comprehensive satisfaction degree of the patients in the three groups (χ2=7.824, P< 0.01). Conclusions It shows that the 3.5 h turning-over interval can effectively prevent stress injuries, improve patient satisfaction, and reduce the workload of nursing staff without affecting patient treatment, nursing, and stress injury prevention. Key words: Emergency room; Pressure-induced injury; Average body pressure; Patients′ satisfaction

Functional Results after Intramuscular Ulnar Nerve Anterior Transposition for Young Adults Patients.

Background: This study investigated the functional outcomes of intramuscular ulnar nerve transposition (IMUNT) in young adults with cubital tunnel syndrome (CuTS). Methods: This retrospective study enrolled 37 military soldiers on active duty diagnosed with and treated for CuTS to determine the compression sites, complication rate, and postoperative results. Patient outcomes were analyzed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Bishop-Kleinman rating scales. Results: Patient outcomes were analyzed after a mean follow-up duration of 26.1 (22-29) months for 37 extremities. DASH scores improved from 38.7 (range, 13-63 points) preoperatively to 5.8 (range, 0-18 points) postoperatively. Patient improvement was statistically significant (p < 0.05). Based on the 12-point Bishop-Kleinman rating system, 30 (82.1%) patients were graded as excellent; five (13.5%) as good, and two (5.4%) as failed outcomes. Statistically significant improvements in both key pinch and grip strength were noted. Complications included one case of transient neuroparaxias of the medial antebrachial cutaneous nerve and one case of hematoma formation. Conclusions: We consider intramuscular ulnar nerve transposition to be a satisfactory procedure for CuTS. The procedure enhances upper limb function, thus allowing the patients to resume their physically demanding work with minimal complications.

1921 A Case of Ovarian Varices Bleeding Presenting as an Obscure GI Bleed and Abdominal Pain

INTRODUCTION: Upper GI bleed is one of the most common complications in cirrhotic patients with portal hypertension. However, when GI bleed cannot be found after performing endoscopy, one should consider an ectopic gastrointestinal variceal bleeding. Ectopic varices are portosystemic collaterals in locations other than the gastroesophageal region. We present you a case of 44 year old cirrhotic patient, who was seen for nausea, vomiting and abdominal pain with acute blood loss anemia. She was found to have an ectopic gastrointestinal variceal bleeding after a negative endoscopy. CASE DESCRIPTION/METHODS: 44 years old female with past medical history of cirrhosis secondary to NASH presented to the ER with complaint of abdominal pain associated with nausea and vomiting while she was having sexual intercourse. Patient had CT Abdomen and Pelvis with IV contrast which was consistent with evidence of portal hypertension including large venous collaterals and splenomegaly. There was hyperdense ascitic fluid identified on the CT scan. On the left side of the hemiabdomen the fluid was hyperdense, suggestive of blood. But no site of bleeding could be identified on the study. Patient’s hemoglobin dropped by 2 grams in the ER. GI recommended to place NG tube and evaluate for blood contents. Gastric content via NG tube was non-bloody.IR was consulted who, after reviewing her CT scan images, noticed an unusual large IMV supplying large pelvic varices presumably as portal venous compression sites into systemic venous system. IR performed transhepatic portal access with pelvic variceal embolization. Interestingly, they did not find active bleed at the time of procedure. But, given recent history and CT findings, empiric embolization was performed of these varices. At completion, no residual pelvic varices was seen. Patient has successful sclerotherapy and coil embolization of the 2 pelvic-to-ovarian venous plexus varicosities for treatment of presumed source of variceal intraperitoneal bleeding. Patient was discharged home with stable hemoglobin. DISCUSSION: When GI bleed cannot be found after performing endoscopy, one should consider an ectopic gastrointestinal variceal bleeding. Out of all the variceal bleeding, 5% of them are ectopic variceal bleeds. As GI bleed with acute blood loss anemia can be fatal and outcome being time-sensitive, it is necessary to establish diagnosis early. Multi-slice computed tomography with contrast plays an important role in the early diagnosis of ectopic variceal bleed.

Interleukin 17 (IL-17) and interleukin 23 (IL-23) levels are modulated by compressive orthodontic forces in humans

ObjectiveThe purpose of the investigation was to evaluate whether the application of compression forces exerted on the periodontal ligament during orthodontic movement is reflected at the level of interleukin (IL)-17 and IL-23. Materials and methodsThe gingival crevicular fluid (GCF) samples from the compression sites of 32 molars from 16 patients prescribed with modified Hyrax appliance were collected. The GCF were analyzed for IL-17, IL-23, and IL-1β (Control) at baseline and at 1, 7, and 14 days of active wear of the appliance. ResultsOrthodontic forces resulted in increased levels of IL-17 and IL-23 in the GCF, which were statistically significant at 7 days of force application at compression sites. At day 14, levels decreased to baseline; IL-1β levels (positive control) were more elevated at all times after force application. IL-17 and IL-23 levels were significantly lower than IL-1β, and undetectable in some samples. ConclusionUpregulation of IL-17 and IL-23 occurred in response to the force application in compression sites. Monitoring the levels of inflammatory mediators might be a clinically useful procedure, as they may help to define optimal forces to produce the most rapid tooth movement.

Role of Fused Three-Dimensional Time-of-Flight Magnetic Resonance Angiography and 3-Dimensional T2-Weighted Imaging Sequences in Neurovascular Compression

To evaluate role of fused 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3-dimensional constructive interference in steady state (3D-CISS) in neurovascular compression in trigeminal neuralgia (TN) and hemifacial spasm (HFS). A prospective study was conducted on 30 patients (mean age 47.20 ± 11.69 years), 17(56.7%) male and 13 (43.3%) female, with TN and HFS. 3D-TOF-MRA and 3D-CISS sequences of the cerebellopontine angle were performed, as well as postprocessing with fusion of the images. Two independent readers assessed the degree of neurovascular conflict. The images were evaluated for site, signal, and degree of nerve compression and the offending vessel. The kappa test for interobserver agreement was done. The interobserver agreement of both readers was excellent for degree of compression (k= 0.70, 95% confidence interval [CI] 0.49-0.92, r= 0.856, P= 0.001), excellent for the side affected (k= 1.0, 95% CI= 1.0-1.0, r= 1.000, P= 0.001), excellent for the offending vessel (k= 0.85, 95% CI= 0.66-1.0, P= < 0.001), and excellent for the position of the offending vessel (k= 0.685, 95% CI= 0.489-0.882, r= 0.863, P ≤ 0.001). There was no significant correlation between the degree of compression and signal intensity. Fused 3D-TOF-MRA and 3D-CISS images are a reliable, noninvasive tool for the evaluation of offending vessel and degree of affection in patients with neurovascular compression. MRA-CISS can be used for evaluation and treatment planning of neurovascular compression in TN and HFS.

First application of 7-T ultra-high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia.

Trigeminal neuralgia (TN) is a debilitating neurological disease that commonly results from neurovascular compression of the trigeminal nerve (CN V). Although the CN V has been extensively studied at the site of neurovascular compression, many pathophysiological factors remain obscure. For example, thalamic-somatosensory function is thought to be altered in TN, but the abnormalities are inadequately characterized. Furthermore, there are few studies using 7-T MRI to examine patients with TN. The purpose of the present study was to use 7-T MRI to assess microstructural alteration in the thalamic-somatosensory tracts of patients with TN by using ultra-high field MRI. Ten patients with TN and 10 age- and sex-matched healthy controls underwent scanning using 7-T MRI with diffusion tensor imaging. Structural images were segmented with an automated algorithm to obtain thalamus and primary somatosensory cortex (S1). Probabilistic tractography was performed between the thalamus and S1, and the microstructure of the thalamic-somatosensory tracts was compared between patients with TN and controls. Fractional anisotropy of the thalamic-somatosensory tract ipsilateral to the site of neurovascular compression was reduced in patients (mean 0.43) compared with side-matched controls (mean 0.47, p = 0.01). The mean diffusivity was increased ipsilaterally in patients (mean 6.58 × 10-4 mm2/second) compared with controls (mean 6.15 × 10-4 mm2/second, p = 0.02). Radial diffusivity was increased ipsilaterally in patients (mean 4.91 × 10-4 mm2/second) compared with controls (mean 4.44 × 10-4 mm2/second, p = 0.01). Topographical analysis revealed fractional anisotropy reduction and diffusivity elevation along the entire anatomical S1 arc in patients with TN. The present study is the first to examine microstructural properties of the thalamic-somatosensory anatomy in patients with TN and to evaluate quantitative differences compared with healthy controls. The finding of reduced integrity of these white matter fibers provides evidence of microstructural alteration at the level of the thalamus and S1, and furthers the understanding of TN neurobiology.

Clinical and magnetic resonance imaging characterization of cervical spondylomyelopathy in juvenile dogs.

BackgroundCervical spondylomyelopathy (CSM) occurs because of compression of the cervical spinal cord, nerve roots, or both, usually affecting young adult to older large and giant breed dogs. Juvenile dogs are affected infrequently.ObjectiveTo describe clinical and magnetic resonance imaging (MRI) findings in juvenile dogs (≤ 12 months) with cervical spondylomyelopathy.AnimalsTwenty CSM‐affected juvenile dogs.MethodsMedical and imaging records for juvenile dogs with CSM were reviewed. History and neurologic examination findings were obtained, including follow‐up data. The MRI studies were reviewed for cause and site of spinal cord compression, intervertebral disk protrusion or degeneration, articular process degenerative changes, intervertebral foraminal stenosis, and spinal cord signal changes.ResultsMean (median) age at the time of diagnosis was 9.4 (10) months. There were 16 giant breed dogs. Eighteen dogs had a chronic presentation, 18/20 had proprioceptive ataxia, and 9/20 had cervical pain. On MRI, the principal spinal cord compression occurred at C5‐C6, C6‐C7, or both in most dogs; 12/20 dogs had ≥2 sites of spinal cord compression. The cause of compression was articular process proliferation in 8/20 dogs and disk protrusion in 2/20 dogs. Intervertebral disk degeneration was seen in 9/20 dogs. Follow‐up was obtained for 12/20 dogs: 10/12 were managed medically and 2/12 surgically.Conclusions and Clinical ImportanceCervical spondylomyelopathy in juvenile dogs was characterized mostly by osseous‐associated spinal cord compression and multiple compressive sites. Almost half of the dogs had intervertebral disk degeneration. Intervertebral disk protrusion was seen in both giant and large breed dogs.

Thoracoabdominal Compression Model of Traumatic Asphyxia to Identify Mechanisms of Respiratory Failure in Fatal Crowd Accidents.

Traumatic asphyxia is a major cause of death in fatal crowd disasters, but the relationships between compression site, load magnitude, load time, and medical outcomes are unclear. This study estimated thoracoabdominal compression conditions (load magnitude, load time) that could result in respiratory failure in adults. Eight load patterns-A (chest load: 0 kg, abdominal load: 10 kg), B (0, 20), C (10, 0), D (10, 10), E (10, 20), F (20, 0), G (20, 10), and H (20, 20)-were applied to 14 healthy women. Blood pressure, heart rate, respiratory rate, SpO2, tidal volume, vital capacity, respiratory phase, and modified Borg dyspnea score were measured over time. Breathing Intolerance Index (BITI) was also calculated. Vital capacity decreased in patterns C, D, E, F, G, and H. BITI reached the critical range of ≥0.15 (at which respiratory failure occurs after about 45 min) after 14 min in pattern G and 2 min in pattern H. A vital capacity ≤1.85 L and a modified Borg scale score ≥8.3 corresponded to a BITI of ≥0.15 and were regarded as equivalent to reaching the critical range. Furthermore, change in chest load was positively correlated with BITI when abdominal load remained constant. In women, respiratory failure can occur within 1 h from respiratory muscle fatigue, even when total thoracoabdominal load is only about 60% of body weight. A vital capacity ≤1.85 L and modified Borg scale score ≥8.3 can be regarded as indices for predicting respiratory failure.