Finite element study of controlling factors of anterior intrusion and torque during Temporary Skeletal Anchorage Device (TSAD) dependent en masse retraction without posterior appliances: Biocreative hybrid retractor (CH-retractor)

Objectives:To evaluate, using the finite element method (FEM), the factors that allow control of the anterior teeth during en masse retraction with the Biocreative hybrid retractor (CH-retractor) using different sizes of nickel-titanium (NiTi) archwires and various gable bends on the stainless-steel (SS) archwires.Materials and Methods:Using FEM, the anterior archwire section, engaged on the anterior dentition, was modeled in NiTi, and another assembly, the posterior guiding archwire, was modeled in SS. Two dimensions (0.016 × 0.022- and 0.017 × 0.025-inch NiTi) of the anterior archwires and different degrees (0°, 15°, 30°, 45°, and 60°) of the gable bends on the guiding wire were applied to the CH-retractor on the anterior segment to evaluate torque and intrusion with 100-g retraction force to TSADs. Finite element analysis permitted sophisticated analysis of anterior tooth displacement.Results:With a 0° gable bend all anterior teeth experienced extrusion. The canines showed a larger amount of extrusion than did the central and lateral incisors. With a gable bend of >15°, all anterior teeth exhibited intrusion. Bodily movement of the central incisor required a 30°∼45° gable bend when using anterior segments of 0.016 × 0.022-inch NiTi and 15°∼30° gable bend with the 0.017 × 0.025-inch NiTi.Conclusions:With the CH-retractor, varying the size of the NiTi archwire and/or varying the amount of gable bend on the SS archwire affects control of the anterior teeth during en masse retraction without a posterior appliance.     

Nigrosome 1 Detection at 3T MRI for the Diagnosis of Early-Stage Idiopathic Parkinson Disease: Assessment of Diagnostic Accuracy and Agreement on Imaging Asymmetry and Clinical Laterality

BACKGROUND AND PURPOSE:In the early stages of idiopathic Parkinson disease, motor symptoms are usually asymmetric. We aimed to assess the feasibility of nigrosome 1 detection at 3T MR imaging to analyze the agreement of its asymmetry and clinical laterality.MATERIALS AND METHODS:High-resolution 3D multiecho imaging was performed at 3T MR imaging in 13 healthy subjects and 24 patients with idiopathic Parkinson disease confirmed by N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl) nortropane (¹⁸F-FP-CIT) PET. The nigrosome 1 detection findings by using the MR imaging data were rated as “normal,” “possibly abnormal,” and “abnormal” by 2 independent reviewers. The degree of ¹⁸F-FP-CIT binding was visually assessed in the caudate nucleus and putamen on PET images. Clinical laterality was evaluated by scores of the Unified Parkinson Disease Rating Scale, Part III. Asymmetry of the affected nigrosome 1 and the degree of ¹⁸F-FP-CIT binding were analyzed for agreement with clinical laterality.RESULTS:The diagnostic sensitivity, specificity, and accuracy of the nigrosome 1 detection at 3T MR imaging was 100%, 84.6%, and 94.6%, respectively. Interrater agreements for the abnormality and asymmetry of nigrosome 1 were excellent (κ = 0.863 and 0.835, respectively). In patients with idiopathic Parkinson disease, the agreement of asymmetry between clinical laterality and nigrosome 1 detection was good (κ = 0.724). The degree of the ¹⁸F-FP-CIT PET binding showed fair agreement (κ = 0.235) with clinical laterality.CONCLUSIONS:The abnormality involving nigrosome 1 can be detected at 3T MR imaging with an accuracy of 94.6%. The clinical laterality is in high concordance with the laterality of the nigrosome 1 detection at 3T (κ = 0.724).

Nigrosomes are calbindin-poor zones within the substantia nigra pars compacta.¹ The nigrosomes are primary subregions of the substantia nigra pars compacta where dopaminergic cells are lost in idiopathic Parkinson disease (IPD). Within the nigrosomes, the maximal cell loss occurs in nigrosome 1, which is the largest subgroup of the nigrosomes.²Recently, a few researchers have tried to visualize the nigrosome 1 area with 7T MR imaging and demonstrated its feasibility as an imaging biomarker for the diagnosis of IPD.^3–6 The results, however, had a limited clinical utility because of low availability of 7T MR imaging. Hence, several studies have tried to translate nigrosome 1 detection to 3T MR imaging, which is widely available.^7–9 In the previous studies at 3T, however, patients were confirmed as having IPD by clinical assessment, not by dopamine-transporter (DAT) imaging such as N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl) nortropane (¹⁸F-FP-CIT) PET or SPECT, which is commonly used for an early diagnosis of IPD.In clinical practice, it is more difficult to diagnose an early stage of parkinsonism than an advanced stage. Therefore, a confirmation by an imaging biomarker would be desirable in the diagnosis of a patient in an early stage. If the nigrosome 1 detection at 3T MR imaging is available for the diagnosis of early-stage IPD, it can minimize the need for the DAT PET or SPECT.In early stages of IPD, motor symptoms are usually asymmetric.¹⁰ Unilateral or asymmetric symptoms have been suggested to correspond to nigrostriatal degeneration in the contralateral hemisphere.¹¹ On the basis of this observation, we hypothesized that the asymmetric dopaminergic cell loss in the substantia nigra pars compacta reflects the contralateral symptoms in early-stage IPD, and the cell loss can be visualized by the signal change in the nigrosome 1 area at 3T MR imaging.In this study, we investigated the feasibility of the nigrosome 1 detection at 3T MR imaging for the diagnosis of patients with early-stage IPD with abnormal findings on DAT PET imaging.¹² Additionally, we assessed the agreement of asymmetry between the nigrosome 1 detection and patient symptoms, and the asymmetry between the DAT PET imaging and patient symptoms.     

Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes

IntroductionDissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales.MethodsA 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications.ResultsA total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively.ConclusionsFunnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications.     

Successful Treatment of Occipital Radiating Headache Using Pulsed Radiofrequency Therapy

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.     

Fibrinogen Seoul (FGG Ala341Asp): a novel mutation associated with hypodysfibrinogenemia.

Dysfibrinogenemia is a coagulation disorder caused by a variety of structural abnormalities in the fibrinogen molecule that result in fibrinogen function. The molecular basis of hypodysfibrinogenemia was investigated in a 66-year-old woman with peripheral artery obstructive disease and in her family members. Plasma level of functional fibrinogen determined using the Clauss method was lower (75 mg/dL; normal, 140-460 mg/dL) than that measured with immunologic nephelometric assay (137 mg/dL; normal, 180-400 mg/dL). Similar results were also observed in two family members through two generations. DNA was extracted from whole blood, and the coding regions and intron/exon boundaries of gamma chain gene (FGG) were amplified. A novel (Fibrinogen Seoul) heterozygous FGG mutation (GCT->GAT, Ala341Asp) was identified in all three affected family members. Thrombin-catalyzed polymerization was found to be defective on the analysis of purified fibinogen from the propositus. Molecular modeling also showed a conformational change of fibrinogen structure.     

Effects of body awareness training on mild visuospatial neglect in patients with acute stroke: a pilot randomized controlled trial

[Purpose] This study aimed to investigate the effects of body awareness training (BAT) on mild visuospatial neglect in patients following acute stroke. [Subjects] The subjects were 12 stroke patients randomly assigned to either the experimental group (n₁=6) or control group (n₂=6). [Methods] The experimental group underwent BAT for 15 minutes and then task-oriented training for 30 minutes a day, five times a week for three weeks. The control group underwent task-oriented training for 30 minutes a day, five times a week for three weeks. Assessments were made using the Motor-free Visual Perception Test (MVPT), Line Bisection Test (LBT), and modified Barthel index (MBI). [Results] Following the interventions, the experimental group showed a significant change in MVPT, LBT, and MBI scores. [Conclusion] The results of this study suggest the feasibility and suitability of BAT with task-oriented training for mild visuospatial neglect in patients with acute stroke.Key words: Body awareness training, Neglect, Stroke     

Relationship between the intensity of physical activity and depressive symptoms among Korean adults: analysis of Korea Health Panel data

[Purpose] The aim of this study was to examine the relationship between the intensity of physical activity and symptoms of depression. [Subjects and Methods] We analyzed the influence of different intensities of physical activity on depressive symptoms using the data of 12,350 adults over the age of 20 years who had completed the 2011 Korea Health Panel. After controlling for confounding variables, a multivariable logistic regression analysis was conducted to identify the association between the intensity of physical activity and depressive symptoms. [Results] The results showed that vigorous physical activity had a significant effect on depressive symptoms. The incidence of depressive symptoms was 1.487 (95% CI 1.137, 1.943) OR higher among people who did not participate in regular activity than it was among those who took part in regular intense physical activity. [Conclusion] It appears that physical activity affects depressive symptoms, a result which is in agreement with previous studies. However, we also showed a difference in influence according to activity intensity. Thus, the intensity of physical activity should be considered when developing physical activity programs for improving depressive symptoms.Key words: Intensity of physical activity, Depressive symptoms     

Effect of a muscle strengthening exercise program for pelvic control on gait function of stroke patients

[Purpose] The purpose of this study was to investigate the effects of strengthening exercises for the hip extensors on the gait performance and stability of patients with hemiplegia. [Subjects and Methods] The subjects were fifteen stroke patients (ten males, five females). The experimental subjects performed a hip extensor strengthening exercise (HESE) program for a total of four weeks. [Results] The experimental subjects showed significant improvements after the HESE program. Especially, walking speed and the affected side stance phase time significantly increased after the HESE program. Furthermore, the affected side stride length and symmetry index in the stance phase significantly increased after HESE program. [Conclusion] These results suggest that the HESE program may, in part, help to improve gait performance ability and stabilize physical disability after stroke.Key words: Stroke patients, Hip extensor strengthening exercise (HESE) program, Gait function     

Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke

[Purpose] The purpose of this study was to confirm the effects of both conventional overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS) on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke. [Subjects and Methods] Thirty stroke patients were alternately assigned to one of two treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional ambulation classification on the affected side improved significantly in the CGT and GTBWS groups. Walking speed also improved significantly in both groups. [Conclusion] These results suggest that the GTBWS in company with CGT may be, in part, an effective method of gait training for restoring gait ability in patients after a stroke.Key words: Gait training, Spatiotemporal gait parameters, Stroke patients