bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitro force delivery of nickel-titanium superelastic archwires in vertical displacement
Authors: Stumpf Aisha de Souza Gomes , Mundstock Karina dos Santos , Mundstock Daniel , Mundstock Carlos Alberto
Published: March 2013

OBJECTIVE: The purpose of this study was to evaluate the force delivered by different superlastic nickel-titanium wires during vertical displacement, in order to determine whether their stress release meets the criteria for constant and light forces that are usually accredited to these archwires. METHOD: Ten samples of 6 brands of 0.016-in archwires (Ormco, GAC, Morelli, TP, American Orthodontics e Rocky Mountain) were tested in a complete metal model using Dynalock brackets (3M Unitek™). In the canine position, there was a sliding bracket connected to a pole. This set was related to a load cell of 0.5 kg attached to a universal testing machine (Autograph AG-199kNG, Shimadzu). The crosshead speed was 0.5 mm/min and the maximum displacement was 1.0 mm. The model was submerged in temperature-controlled water. The results were analyzed by ANOVA (p < 0.05), using the software SAS System 8.02, Cry, NC, USA. RESULTS: The TP archwire had the lowest force throughout the test, although the final force was high (277.91 g). The Rocky Mountain archwire had the highest force release (455.41 g). CONCLUSION: The different brands of wires tested in this study failed in delivering low and constant forces as expected from superlastic nickel-titanium wires. The forces were extremely heavy for a vertical tooth movement.
Evaluation of occlusal factors in patients with temporomandibular joint disorder
Authors: Costa Max Dória , Froes Junior Gontran da Rocha Torres , Santos Carlos Neanes
Published: March 2013

OBJECTIVE: The aim of this study was to determine the prevalence and the relation between the main occlusal factors and the temporomandibular disorder (TMD). METHODS: We analyzed 100 patients (50 diagnosed with TMD and 50 asymptomatic volunteers, control group) through a questionnaire that classified TMD as absent, mild, moderate and severe. Then, an evaluation was made of intraoral occlusal factors: Absence of posterior teeth, wear facets, overjet, overbite, open bite, posterior crossbite, sagittal relationship (Class I, II and III), centric relation discrepancy for maximum intercuspation, anterior guidance and balancing occlusal interference. The c² examined the association between TMD and considered occlusal variables. RESULTS: The prevalence of studied occlusal factors was higher in patients with moderate and severe TMD. Statistically significant results were found on: Absence of five or more posterior teeth, overbite and overjet greater than 5 mm, edge-to-edge bite, posterior crossbite, Class II and III, the absence of effective anterior guide and balancing side interferences. CONCLUSIONS: Indeed, it is concluded that there is a relationship between TMD and occlusal factors, however it can not be told to what extent these factors are predisposing, precipitating or perpetuating the disease. Therefore, despite its multifactorial etiology, one can not neglect the occlusal analysis of these patients.
Influence of treatment with and without extractions on the growth pattern of dolichofacial patients
Authors: Porto Vanessa Scherer , Henriques José Fernando Castanha , Janson Guilherme , Freitas Marcos Roberto de , Pinzan Arnaldo
Published: March 2013

OBJECTIVE: The objective of this retrospective study was to compare, by means of lateral cephalograms, the facial growth pattern changes due to the treatment with and without extractions of four first premolars in dolichofacial individuals. METHODS: Groups 1 and 2 were constituted of 23 dolichofacial patients each, with Class II malocclusion, division 1 and initial age average of 12.36 and 12.29 years, respectively. Patients from Group 1 were treated without extractions and Group 2 was treated with extraction of the four first premolars, given that both used occipital headgear. Groups were compatibilized according to age, treatment period, gender and malocclusion severity. The t test was applied for intergroups comparison. RESULTS: Most variables (SN.PP, SN.Ocl and FMA) did not present statistically significant difference between groups. CONCLUSION: Although the treatment with extractions tend to reduce the mandibular plane angle (SN.GoGn) and the facial axis (NS.Gn), the analyzed treatment protocols did not affect in a clinically relevant way the facial growth pattern.
Prevalence assessment of root dilaceration in permanent incisors
Authors: Silva Beatriz Feitosa da , Costa Luciana Ellen Dantas , Beltrão Ricardo Villar , Rodrigues Tânia Lemos , Farias Ricardo Lombardi de , Beltrão Rejane Targino Soares
Published: March 2013

INTRODUCTION: Root dilaceration is a dental anomaly characterized by an abnormal curvature of the dental root, which can cause problems during eruption and complications in the orthodontic and endodontic treatment or extraction. OBJECTIVE: The aim of this study was to determine the prevalence of root dilaceration in permanent incisors in an oral radiology clinic in the city of João Pessoa / PB, Brazil. METHODS: The sample consisted of 548 patients who allowed assessments of their dental radiographs, a total of 3,948 examined teeth. Each tooth was examined according to the occurrence of root dilaceration, regarding type (mild, moderate or severe), root third that it was in and direction of the root. The angle formed by the root deviation in relation to the long tooth axis was obtained by means of a diagram printed on transparent acetate, placed over the radiograph. RESULTS: The results were analyzed with SPSS software (Statistical Package for Social Sciences) version 13.0, performing an exploratory data analysis. The prevalence of root dilaceration in the studied sample was 1.03% (41 cases), with higher incidence in males (65.8%), being the superior lateral incisor the most affected teeth (78%). The most prevalent type of root dilaceration was the mild one (73.1%), occurring more in the apical third (90.2%) and with distal direction of the root (95.1%). CONCLUSION: Considering these results, it is emphasized the importance of performing a diagnostic radiographic examination prior to planning a treatment in permanent anterior teeth.
Conservative compensatory Angle Class III malocclusion treatment
Authors: Sobral Marcio Costa , Habib Fernando Antônio de Lima , Matzenbacher Liz
Published: March 2013

INTRODUCTION: Angle's Class III malocclusion is a dental discrepancy in a sagittal view that may appear or not with an important skeletal discrepancy. Facial esthetics may be affected by this skeletal discrepancy and it is one of the most common complaints of patients who seek orthodontic treatment. Class III treatment, in adults, may be done by compensatory tooth movement, in simple cases, or through an association between orthodontics and orthognathic surgery, in more severe cases. OBJECTIVE: This article describes a non-extraction compensatory Class III treatment case, applying the Tweed-Merrifield mechanical principles with headgear (J-Hook) in the mandibular arch. This case was presented at the V Brazilian Association of Orthodontics and Dentofacial Orthopedics (ABOR) Meeting, it was evaluated by members of Brazilian Board of Orthodontics and obtained third place in the general classification.
Assessment of the mechanical properties of glass ionomer cements for orthodontic cementation
Authors: Farret Marcel M. , Lima Eduardo Martinelli de , Mota Eduardo Gonçalves , Oshima Hugo Mitsuo S. , Maguilnik Gabriela , Scheid Patrícia Alves
Published: March 2013

OBJECTIVE: To evaluate the mechanical properties of three glass ionomers cements (GICs) used for band cementation in Orthodontics. METHODS: Two conventional glass ionomers (Ketac Cem Easy mix/3M-ESPE and Meron/Voco) and one resin modified glass ionomer (Multi-cure Glass ionomer/3M-Unitek) were selected. For the compressive strength and diametral tensile strength tests, 12 specimens were made of each material. For the microhardness test 15 specimens were made of each material and for the shear bond strength tests 45 bovine permanent incisors were used mounted in a self-cure acrylic resin. Then, band segments with a welded bracket were cemented on the buccal surface of the crowns. For the mechanical tests of compressive and diametral tensile strength and shear bond strength a universal testing machine was used with a crosshead speed of 1,0 mm/min and for the Vickers microhardness analysis tests a Microdurometer was used with 200 g of load during 15 seconds. The results were submitted to statistical analysis through ANOVA complemented by Tukey's test at a significance level of 5%. RESULTS: The results shown that the Multi-Cure Glass Ionomer presented higher diametral tensile strength (p < 0.01) and compressive strength greater than conventional GICs (p = 0.08). Moreover, Ketac Cem showed significant less microhardness (p < 0.01). CONCLUSION: The resin-modified glass ionomer cement showed high mechanical properties, compared to the conventional glass ionomer cements, which had few differences between them.
Angle Class II, division 2 malocclusion with pronounced overbite
Authors: Locks Arno
Published: March 2013

Angle Class II, division 2, malocclusion is characterized by a Class II molar relation associated with retroclined or vertical positioning of the upper incisors and in general an overbite. This clinical case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements for becoming a BBO Diplomate .
Sampling environmental acoustic recordings to determine bird species richness
Authors: Wimmer Jason , Towsey Michael , Roe Paul , Williamson Ian
Published: March 2013

Acoustic sensors can be used to estimate species richness for vocal species such as birds. They can continuously and passively record large volumes of data over extended periods. These data must subsequently be analyzed to detect the presence of vocal species. Automated analysis of acoustic data for large numbers of species is complex and can be subject to high levels of false positive and false negative results. Manual analysis by experienced surveyors can produce accurate results; however the time and effort required to process even small volumes of data can make manual analysis prohibitive.

This study examined the use of sampling methods to reduce the cost of analyzing large volumes of acoustic sensor data, while retaining high levels of species detection accuracy. Utilizing five days of manually analyzed acoustic sensor data from four sites, we examined a range of sampling frequencies and methods including random, stratified, and biologically informed.

We found that randomly selecting 120 one‐minute samples from the three hours immediately following dawn over five days of recordings, detected the highest number of species. On average, this method detected 62% of total species from 120 one‐minute samples, compared to 34% of total species detected from traditional area search methods. Our results demonstrate that targeted sampling methods can provide an effective means for analyzing large volumes of acoustic sensor data efficiently and accurately. Development of automated and semi‐automated techniques is required to assist in analyzing large volumes of acoustic sensor data.
Validation ofFhb1andQFhs.nau‐2DLin Several Soft Red Winter Wheat Populations
Authors: Balut Ana L. , Clark Anthony J. , Brown‐Guedira Gina , Souza Edward , Van Sanford David A.
Published: March 2013

Exotic resistance quantitative trait loci (QTL) such asFhb1andQFhs.nau‐2DLprovide one strategy for breeding wheat (Triticum aestivumL.) cultivars resistant to Fusarium head blight (FHB). The first objective of this study was to evaluate the effectiveness of these QTL in reducing FHB in diverse genetic backgrounds and to measure their impact on agronomic and quality traits. Lines from five susceptible × resistant crosses were evaluated in the FHB nursery at Lexington, KY, in 2010 and 2011. The populations were also grown in yield trials at Lexington (2010 and 2011) and Princeton (2011), KY, to measure agronomic and quality traits.Fhb1reducedFusariumdamaged kernels (FDK) by 32% and deoxynivalenol (DON) concentration by 20%.QFhs.nau‐2DLreduced FDK by 29% in two of five populations and DON by 24% in four of five populations. Significant QTL effects (P< 0.05) on agronomic and quality traits were observed although impact was small. One cycle of direct or indirect simulated phenotypic selection was effective at reducing DON levels. The frequency ofFhb1‐homozygous resistant lines among the phenotypically selected lines was higher than the frequency ofQFhs.nau‐2DL‐homozygous resistant lines. The second objective was to assess the effectiveness of near‐infrared reflectance (NIR) to estimate damage from FHB. Near‐infrared reflectance‐based predictions of FDK and DON showed that FDK measured by NIR was at least as good as FDK measured by air separation in predicting DON in four of five populations.
Nitrate Uptake Rates of Kentucky Bluegrass Genotypes and Their Effect on Nitrate Absorption under Competitive Conditions
Authors: Zhang Chenxi , Rufty Thomas W. , Miller Grady L. , Bowman Daniel C.
Published: March 2013

Nitrate leaching from turfgrasses continues to be a concern. It is proposed that selecting turfgrass genotypes with higher NO3− absorption abilities could reduce NO3− leaching. This study examined the intraspecific difference in NO3− absorption among Kentucky bluegrass (Poa pratensis L.) genotypes and how such a difference affects N absorption when roots are in competition for soil N. A nutrient solution screening procedure was used to identify Kentucky bluegrass genotypes having high vs. low NO3− uptake capacity. Tillers of 60 Kentucky bluegrass cultivars were rooted and transferred to a continuous flow solution culture system. After establishment, plants were treated to develop moderate N deficiency. Isotopically labeled (15N) KNO3 was introduced at high (1 mM) and low (0.05 mM) concentrations to screen for differences in NO3− uptake. After a brief uptake period, plants were harvested, dried, and analyzed for 15N content to determine N uptake rate. There were significant differences among genotypes for uptake rate at both high and low N concentrations. The 60 genotypes exhibited a wide range of uptake rates, with strong correlation between rates at high and low N. The cultivars Julia and Midnight were selected as representing cultivars with efficient and inefficient NO3− uptake, respectively. Julia had NO3− uptake rates averaging 56% higher than Midnight. A subsequent lysimeter study examined whether higher NO3− uptake capacity would translate into increased N absorption under competitive conditions. Tillers of the two cultivars were planted as a mixed stand in soil or sand column lysimeters. After establishment, 15N‐labeled KNO3 solution at high (2 or 1mM) and low (0.05mM) concentrations was applied to each column. After an uptake period, individual plants of each cultivar were harvested for 15N analysis. Results indicated that Julia absorbed 20 to 50% more NO3− than Midnight at the high N concentration and 25 to 71% more NO3− more than Midnight at the low N concentration. Most differences were statistically significant. This indicates that differences in NO3− absorption by Kentucky bluegrass identified in solution culture translate into differences in absorption of soil N.
American Society of Nephrology Quiz and Questionnaire 2012
Authors: Fervenza Fernando C. , Glassock Richard J. , Bleyer Anthony J.
Published: March 2013

Presentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience—that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.
Glomerular and Tubular Damage Markers in Individuals with Progressive Albuminuria
Authors: Nauta Ferdau L. , Scheven Lieneke , Meijer Esther , van Oeveren Wim , de Jong Paul E. , Bakker Stephan J.L. , Gansevoort Ron T.
Published: March 2013

Background and objectives

Albuminuria is associated with risk for renal and cardiovascular disease. It is difficult to predict which persons will progress in albuminuria. This study investigated whether assessment of urinary markers associated with damage to different parts of the nephron may help identify individuals that will progress in albuminuria.

Design, setting, participants, & measurements

Individuals were selected from a prospective community-based cohort study with serial follow-up and defined as “progressors” if they belonged to the quintile of participants with the most rapid annual increase in albuminuria, and reached an albuminuria ≥150 mg/d during follow-up. Patients with known renal disease or macroalbuminuria at baseline were excluded. Each progressor was matched to two control participants, based on baseline albuminuria, age, and sex. Furthermore, damage markers were measured in a separate set of healthy individuals.

Results

After a median follow-up of 8.6 years, 183 of 8394 participants met the criteria for progressive albuminuria. Baseline clinical characteristics were comparable between progressors and matched controls (n=366). Both had higher baseline albuminuria than the overall population. Urinary excretion of the glomerular damage marker IgG was significantly higher in progressors, whereas urinary excretion of proximal tubular damage markers and inflammatory markers was lower in these individuals compared with controls. Healthy individuals (n=109) had the lowest values for all urinary damage markers measured.

Conclusions

These data suggest that albuminuria associated with markers of glomerular damage is more likely to progress, whereas albuminuria associated with markers of tubulointerstitial damage is more likely to remain stable.
Computational intelligence based simultaneous determination of the spatial profile of the laser beam and vibrational-to-translational relaxation time by pulsed photoacoustics
Authors: Lukic Mladena , Cojbasic Zarko , Rabasovic Mihailo , Markushev Dragan , Todorovic Dragan
Published: March 2013

This paper is concerned with the possibilities of computational intelligence
application for simultaneous determination of the laser beam spatial profile
and vibrational-to-translational relaxation time of the polyatomic molecules
in gases by pulsed photoacoustics. Results regarding the application of
neural computing and genetic optimization are presented through the use of
feed forward multilayer perception networks and real-coded genetic
algorithms. Feed forward multilayer perception networks are trained in an
offline batch training regime to estimate simultaneously, and in real-time,
laser beam spatial profile R(r) (profile shape class) and
vibrational-to-translational relaxation time ?V?T from a given (theoretical)
photoacoustic signals ?p(r,t). The proposed method significantly shortens the
time required for the simultaneous determination of the laser beam spatial
profile and relaxation time and has the advantage of accurately calculating
the aforementioned quantities. Real coded genetic algorithms are used to
calculate ?V?T by fitting the ?p(r,t) with the theoretical one. The
previously developed methods determine the laser beam profile and relaxation
time with sufficient precision, but the methods based on the application of
artificial intelligence are more suitable for practical applications, such as
the real-time in-situ measurements of atmospheric pollutants.
Hydrogen atom in 2s state in a laser field
Authors: Vucic Svetlana
Published: March 2013

The hydrogen atom in the 2s state exposed to a linearly polarized laser field
is studied by using the non-perturbative non-Hermitian Floquet theory. The
electronic density of the quasi-energy H(2s) state versus the electron
coordinate is analyzed. We conclude that the decay of an atom in a
low-intensity non-resonant laser field occurs from the asymptotically distant
part of the initial state. On the other hand, the process of electron
emission in a resonant laser field is governed by the excited-bound-statepart
of the resonance wave function. With an increase in the intensity and by
increasing the degree of excitation of the initial state not too high, the
electron is ionized at smaller distances from the nucleus.
New oxidative electrophilic coupling reactions and their application to spectrophotometric determination of iron(III) in environmental waters, soils and industrial effluent samples
Authors: Al Okab , Galil Abdul
Published: March 2013

New oxidative electrophilic coupling reagents,
2-amino-2?,5-dichlorobenzophenone (MCB) or
2-amino-5-chloro-2'-fluorobenzophenone (MFB) are exploited for the
determination of trace concentrations of iron(III) in environmental water and
soil samples. The methods were based on oxidation of the electrophilic
coupling reagents, 2-amino- 2?,5-dichlorobenzophenone (MCB) or
2-amino-5-chloro-2'-fluorobenzophenone (MFB) by iron(III) and coupling with
phenoxazine (PNZ) in acidic medium to yield red color derivative having an
absorbance maximum at 520 nm, which is stable up to 12 h. Beer?s law are
obeyed for iron in the concentration ranges 0.31-1.2121 ?gmL-1 and 0.42-1.41
?gmL-1, respectively. The optimum reaction conditions and other important
analytical parameters were established. Interference due to various
non-target ions was also investigated. The developed methods were applied to
the analysis of iron(III) in various matrices. The performance of developed
methods were evaluated in terms of Student?s t-test and variance ratio F-test
that indicate the significance of developed methods over reported method.
Influence of the type of electrolyte on the morphological and crystallographic characteristics of lead powder particles
Authors: Nikolic Nebojsa , Maksimovic Vesna , Brankovic Goran , Zivkovic Predrag , Pavlovic Miomir
Published: March 2013

Lead electrodeposition processes from the basic (nitrate) and complex
(acetate) electrolytes were mutually compared by the scanning electron
microscopic and the X-ray diffraction analysis of the produced powder
particles. The shape of dendritic particles strongly depended on the type of
electrolyte. The dendrites composed of stalk and weakly developed primary
branches (the primary type) were predominantly formed from the basic
electrolyte. The ramified dendrites composed of stalk and of both primary and
secondary branches (the secondary type) were mainly formed from the complex
electrolyte. In the both type of powder particles Pb crystallites were
predominantly oriented in the (111) plane. Formation of powder particles of
the different shape with the strong (111) preferred orientation was discussed
and explained by the consideration of the general characteristics of the
growth of a crystal in the electrocrystallization processes.
Impaired endothelial function in lone atrial fibrillation
Authors: Polovina Marija , Potpara Tatjana , Giga Vojislav , Stepanovic Jelena , Ostojic Miodrag
Published: March 2013

Background/Aim. Impaired endothelial function has been previously documented
in patients with atrial fibrillation (AF) and underlying comorbidities or
older patients with idiopathic AF. The aim of this study was to evaluate
systemic endothelial function in younger AF patients (less than < 60 years
old) with lone AF (that is, without associated cardiopulmonary comorbidities,
including arterial hypertension), by comparing brachial artery flow-mediated
dilation (FMD) in lone AF patients with FMD of healthy subjects in sinus
rhythm. Methods. Two groups of participants were prospectively enrolled. The
first group comprised of 38 AF patients (the mean age 45 ? 11 years, 68%
male) with persistent (> 7 days) lone AF. The second group comprised of 28
healthy controls in sinus rhythm (the mean age 43 ? 13, 53% male), matched by
age, gender and atherosclerotic risk factors. All the participants underwent
physical examination, laboratory analysis [including determination of
C-reactive protein (CRP)], standard echocardiography and exercise-stress
testing. Brachial artery FMD and endothelium independent dilation (NMD) were
assessed with a high-resolution ultrasound probe and arterial diameters taken
from 5 consecutive cardiac cycles were averaged for each measurement to
accommodate to beat-to-beat flow variations in AF. Results. There were no
differences between the 2 groups regarding age, gender and most clinical,
laboratory and echocardiographic characteristics (all p > 0.05), apart from
the increased heart rate (p = 0.018), body mass index (p = 0.027), CRP levels
(p = 0.007) and left atrial anteroposterior dimension (p < 0.001) in AF
patients. FMD of AF patients [median value 5.0%, interquartile range (IQR)
2.87%-7.50%] was significantly lower (p < 0.001) than FMD of healthy controls
(median value 8.85%, IQR 5.80%- 12.50%), whereas there were no differences in
median NMD values (p > 0.05). In the multivariate analysis, the independent
FMD determinants in our study population were the presence of AF, smoking and
total cholesterol levels (all p < 0.001). In patients with AF, the strongest
independent FMD determinant was arrhythmia duration (p < 0.001), followed by
smoking (p = 0.013) and total cholesterol levels (p = 0.045). Conclusions.
Our findings confirm that sustained AF is associated with systemic
endothelial dysfunction even in relatively young patients with no
cardiovascular disorders or risk factors. AF is an independent contributor to
lower FMD and a prolonged arrhythmia duration may confer the risk for more
profound endothelial damage.
Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial
Authors: Slavkovic Zoran , Stamenkovic Dusica , Geric Veselin , Veljovic Milic , Ivanovic Nebojsa , Tomic Aleksandar , Randjelovic Tomislav , Raskovic Jelena , Karanikolas Menelaos
Published: March 2013

Background/Aim. Combined spinal-epidural-general anesthesia has several
advantages over general anesthesia alone. This study was designed to compare
the efficacy of intrathecal (IT) morphine alone, or in combination with
bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE)
analgesia, in patients undergoing elective total gastrectomy. Methods. This
prospective, randomized double-blind study included 60 patients undergoing
total gastrectomy under general anesthesia and CSE. We compared the analgesic
effect of lumbar IT morphine 300 ?g (the group M, n = 20) vs morphine 300 ?g
+ bupivacaine 2 mg (the group MB, n = 20) vs morphine 300 ?g + bupivacaine 2
mg + fentanyl 25 ?g (the group MBF, n = 20) given after thoracic epidural
catheter placement (T6-7) but before general anesthesia induction. Pain
visual analogue scale (VAS) at rest (R), with movement (M) and with cough
(C), and the number of analgesia requests were assessed for 72 h and after
epidural catheter removal. Results. Compared to other groups, the MBF group
required significantly fewer additional intra-operative epidural bupivacaine
doses (p < 0.001), whereas the M group required significantly more
supplemental intraoperative intravenous fentanyl, compared with the MBF (p =
0.022) and MB groups (p = 0.005). Postoperative pain relief was satisfactory
in all the groups at all the time. VAS-R and VAS-M did not differ
significantly among the groups. Compared to the M group, VAS-C scores 30 min
postoperatively were significantly lower in the MBF (p = 0.029) and MB groups
(p = 0.002). Duration of analgesia was longer in the MBF and MB groups, but
the difference reached no significance. The number of supplemental analgesia
requests was similar in all the groups in the first 12 h and during 72 h.
Additional analgesia requests after epidural catheter removal were similar in
all the groups, and side effects were infrequent. Conclusion. Compared to IT
morphine alone, triple IT combination administered as part of CSE provided
better intraoperative analgesia, but conferred no benefit with regards to
postoperative analgesia.
Reliability of Isometric Lower-Extremity Muscle Strength Measurements in Children With Cerebral Palsy: Implications for Measurement Design
Authors: Willemse Lydia , Brehm Merel A. , Scholtes Vanessa A. , Jansen Laura , Woudenberg-Vos Hester , Dallmeijer Annet J.
Published: March 2013

Background

Children with cerebral palsy (CP) typically show muscle weakness of the lower extremities, which can be measured with the use of handheld dynamometry (HHD).

Objective

The purposes of this study were: (1) to determine test-retest reliability and measurement error of isometric lower-extremity strength measurements in children with CP with the use of HHD and (2) to assess implications for measurement design.

Design

A test-retest design was used.

Methods

Fourteen children with hemiplegic (n=6) or diplegic (n=8) spastic CP (Gross Motor Function Classification System levels I–III), ages 7 to 13 years, were assessed for isometric strength on 2 separate days (occasions) with the use of HHD, with 3 trials per muscle group. The intraclass correlation coefficient, standard error of measurement, and smallest detectable difference (SDD) were calculated for different measurement designs.

Results

Intraclass correlation coefficient values of single measurements for all muscle groups ranged from .70 to .90, and the SDD was large (>30%). Regarding measurement error, the largest source of variability was found for occasion. A 2-occasion mean decreased the SDD by 9% to 14%. For trials, a greater improvement in SDD was found when 2 trials were averaged instead of 3. A measurement design of 2 trials–2 occasions was superior to the often-used approach of 3 trials–1 occasion.

Limitations

The small sample size was the major study limitation.

Conclusions

Handheld dynamometry is reliable and can be used to detect changes in isometric muscle strength in children with CP when using the mean of at least 2 trials. To further improve reliability, taking the average of 2 occasions on separate days is recommended, depending on group size and muscle group.
Toward Understanding Normal Craniocervical Rotation Occurring During the Rotation Stress Test for the Alar Ligaments
Authors: Osmotherly Peter Grant , Rivett Darren , Rowe Lindsay J.
Published: March 2013

Background

The rotation stress test is recommended for assessing alar ligament integrity. Although some authors, in the literature regarding the rotation stress test, accept that rotation will occur during testing, estimates of range occurring with a normal test response vary between 20 and 40 degrees. None of these estimates are based on formal examination of the test.

Objective

The purposes of this study were: (1) to examine the range of craniocervical rotation occurring during rotation stress testing for the alar ligaments in individuals who are healthy and (2) to investigate a measurement protocol for quantifying rotation.

Design

A within-subject experimental study was conducted.

Methods

Sixteen participants underwent magnetic resonance imaging in neutral and end-range rotation stress test positions. Measurements followed a standardized protocol relative to the position of the axis. A line connecting the transverse foramena of the axis created a reference plane. The position of the occiput in the head-neutral position was calculated as the angle formed between a line joining the foramena lacerum and the reference plane. Measurements were repeated at the end-range test position. Total rotation of the occiput was calculated as the difference in angles measured in neutral and test positions. Measurement was performed on 4 occasions, and reliability of measurements was assessed using the standard error of measurement (SEM) and the intraclass correlation coefficient (ICC).

Results

Measurement of rotation of the occiput relative to a stabilized axis ranged between 1.7 and 21.5 degrees (X̅=10.6, SD=5.1, SEM=1.14, ICC=.96, 95% confidence interval=.90–.98).

Limitations

Sustaining the test position for imaging increased the potential for loss of end-range position and image quality. Testing could be performed only in the neutral position, not in 3 planes as commonly described.

Conclusions

The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less. Rotation may be quantified using the method protocol outlined.
The Development of Cognitive, Language, and Cultural Skills From Age 3 to 6
Authors: Becker Birgit , Klein Oliver , Biedinger Nicole
Published: March 2013

This article analyzes the longitudinal development of differences in academic skills between children of Turkish origin and children of native-born German parents from age 3 to 6 in Germany with a focus on the role of immigrant parents’ acculturation to the receiving society. Growth curve models show that Turkish-origin children start with lower test scores at the age of 3 regarding German language skills and cultural knowledge but not with respect to cognitive skills. The difference in the language domain decreases until the age of 6 while it increases regarding children’s cultural knowledge. Immigrant parents’ acculturation to the receiving country is positively related with all three academic skill domains. The results point to the importance of early intervention strategies.
Indoor and Outdoor Mobility following Total Knee Arthroplasty
Authors: Storey Ava S.T. , Myrah Ainslie M. , Bauck Robyn A. , Brinkman Danielle M. , Friess Shawn N. , Webber Sandra C.
Published: March 2013

Purpose: To determine the relationship between indoor and outdoor mobility capacity in older adults with unilateral total knee arthroplasty (TKA) and, secondarily, to determine walking intensity in the same population and to compare all outcomes to a control group of older adults without knee pathology. Method: In this cross-sectional study, participants (TKA=16, mean 22.9 (SD 9.7) mo post TKA; control=22) completed indoor walking tests and a 580 m outdoor course that included varying terrain (e.g., curbs, grass, sidewalk) and frequent changes in direction. Walking capacity was assessed using stopwatches, global positioning system watches and accelerometers. Results: Outdoor walking time was moderately correlated (p<0.05) with the timed up-and-go (TUG) test (r=0.65), stair-climb test (SCT) (r=0.67 ascending, r=0.79 descending), 10 m walk test (10 mWT) (r=0.73), and 6-minute walk test (6 MWT) (r=−0.75). Based on activity counts, walking intensity levels for participants in both groups were moderate (outdoor walk and 6 MWT). There was no significant difference in walking capacity between groups (TUG, SCT, 10 mWT, 6 MWT, outdoor walk). Conclusions: Common clinical walking tests are moderately correlated with outdoor mobility. Mobility capacity of individuals post TKA was similar to controls in both indoor and outdoor environments, and participants in both groups achieved moderate physical activity levels with walking.
Gamma Knife surgery for the treatment of 5 to 15 metastases to the brain
Authors: Salvetti David J. , Nagaraja Tara G. , McNeill Ian T. , Xu Zhiyuan , Sheehan Jason
Published: March 2013

Object

It has been generally accepted that Gamma Knife surgery (GKS) is an effective primary or adjunct treatment for patients with 1–4 metastases to the brain. The number of studies detailing the use of GKS for 5 or more brain metastases, however, remains minimal. The aim of the current retrospective study was to elucidate the utility of GKS in patients with 5–15 brain metastases.

Methods

Patients were chosen for GKS based on prior MRI of these metastatic lesions and a known primary cancer diagnosis. Magnetic resonance imaging was used post-GKS to assess tumor control; patients were also followed up clinically. Overall survival (OS) from the date of GKS was used as the primary end point. Statistical analysis was performed to identify prognostic factors related to OS.

Results

Between 2003 and 2012, 96 patients were treated for a total of 704 metastatic brain lesions. The histology of these lesions varied among non–small cell lung cancer (NSCLC), breast cancer, melanoma, renal cancer, and other more rare carcinomas. At the initial treatment, 18 of the patients (18.8%) were categorized in Recursive Partitioning Analysis (RPA) Class 1 and 77 (80.2%) in RPA Class 2; none were in RPA Class 3. The median number of treated lesions was 7 (mean 7.13), and the median planned treatment volume was 6.12 cm3 (range 0.42–57.83 cm3) per patient. The median clinical follow-up was 4.1 months (range 0.1–40.70 months). Actuarial tumor control was calculated to be 92.4% at 6 months, 84.8% at 12 months, and 74.9% at 24 months post-GKS. The median OS was found to be 4.73 months (range 0.4–41.8 months). Multivariate analysis demonstrated that RPA class was a significant predictor of death (HR = 2.263, p = 0.038). Number of lesions, tumor histology, Graded Prognostic Assessment score, prior whole-brain radiation therapy, prior resection, prior chemotherapy, patient age, patient sex, controlled primary tumor, extracranial metastases, and planned treatment volume were not significant predictors of OS.

Conclusions

In patients with 5–15 brain metastases at presentation, the number of lesions did not predict survival after GKS; however, the RPA class was predictive of OS in this group of patients. Gamma Knife surgery for such patients offers an excellent rate of local tumor control.
White matter fiber tractography: why we need to move beyond DTI
Authors: Farquharson Shawna , Tournier J.-Donald , Calamante Fernando , Fabinyi Gavin , Schneider-Kolsky Michal , Jackson Graeme D. , Connelly Alan
Published: March 2013

Object

Diffusion-based MRI tractography is an imaging tool increasingly used in neurosurgical procedures to generate 3D maps of white matter pathways as an aid to identifying safe margins of resection. The majority of white matter fiber tractography software packages currently available to clinicians rely on a fundamentally flawed framework to generate fiber orientations from diffusion-weighted data, namely diffusion tensor imaging (DTI). This work provides the first extensive and systematic exploration of the practical limitations of DTI-based tractography and investigates whether the higher-order tractography model constrained spherical deconvolution provides a reasonable solution to these problems within a clinically feasible timeframe.

Methods

Comparison of tractography methodologies in visualizing the corticospinal tracts was made using the diffusion-weighted data sets from 45 healthy controls and 10 patients undergoing presurgical imaging assessment. Tensor-based and constrained spherical deconvolution–based tractography methodologies were applied to both patients and controls.

Results

Diffusion tensor imaging–based tractography methods (using both deterministic and probabilistic tractography algorithms) substantially underestimated the extent of tracks connecting to the sensorimotor cortex in all participants in the control group. In contrast, the constrained spherical deconvolution tractography method consistently produced the biologically expected fan-shaped configuration of tracks. In the clinical cases, in which tractography was performed to visualize the corticospinal pathways in patients with concomitant risk of neurological deficit following neurosurgical resection, the constrained spherical deconvolution–based and tensor-based tractography methodologies indicated very different apparent safe margins of resection; the constrained spherical deconvolution–based method identified corticospinal tracts extending to the entire sensorimotor cortex, while the tensor-based method only identified a narrow subset of tracts extending medially to the vertex.

Conclusions

This comprehensive study shows that the most widely used clinical tractography method (diffusion tensor imaging–based tractography) results in systematically unreliable and clinically misleading information. The higher-order tractography model, using the same diffusion-weighted data, clearly demonstrates fiber tracts more accurately, providing improved estimates of safety margins that may be useful in neurosurgical procedures. We therefore need to move beyond the diffusion tensor framework if we are to begin to provide neurosurgeons with biologically reliable tractography information.
Durable response of intracranial cellular hemangioma to bevacizumab and temozolomide
Authors: Yeo Kee Kiat , Puscasiu Elena , Keating Robert F. , Rood Brian R.
Published: March 2013

Cellular hemangioma is a subtype of hemangioma that is associated with cellular immaturity and the potential for recurrence. Intracranial location of these lesions is extremely rare, and definitive treatment often requires radical neurosurgical resection. The authors report a case of a 12-year-old boy with a subtemporal cellular hemangioma. He underwent gross-total resection of the tumor, but within 1.5 months the tumor recurred, necessitating a second resection. Because of its proximity to vascular structures, only subtotal resection was possible. Repeat MRI 1 month after the second surgery showed significant tumor recurrence. Given the tumor's demonstrated capacity for recurrence and its proximity to the vein of Labbé and sigmoid sinus, further resection was not indicated. In an effort to limit radiation therapy for this young patient, treatment with bevacizumab and temozolomide was chosen and achieved a complete response that has proven durable for 36 months after cessation of therapy. This is the first report of the successful use of chemotherapy to treat an intracranial hemangioma, a rare condition with limited therapeutic options.
Skull thickening, paranasal sinus expansion, and sella turcica shrinkage from chronic intracranial hypotension
Authors: Yoon Michael K. , Parsa Andrew T. , Horton Jonathan C.
Published: March 2013

In children or young adults, the morphology of the skull can be altered by excessive drainage of CSF following placement of a ventriculoperitoneal (VP) shunt. In Sunken Eyes, Sagging Brain Syndrome, gradual enlargement of the orbital cavity occurs from low or negative intracranial pressure (ICP), leading to progressive bilateral enophthalmos. The authors report several heretofore unrecognized manifestations of this syndrome, which developed in a 29-year-old man with a history of VP shunt placement following a traumatic brain injury at the age of 9 years. Magnetic resonance imaging showed typical features of chronic intracranial hypotension, and lumbar puncture yielded an unrecordable subarachnoid opening pressure. The calvaria was twice its normal thickness, owing to contraction of the inner table. The paranasal sinuses were expanded, with aeration of the anterior clinoid processes, greater sphenoid wings, and temporal bones. The sella turcica showed a 50% reduction in cross-sectional area as compared with that in control subjects, resulting in partial extrusion of the pituitary gland. These new features broaden the spectrum of clinical findings associated with low ICP. Secondary installation of a valve to restore normal ICP is recommended to halt progression of these rare complications of VP shunt placement.
Anatomical feasibility of performing a nerve transfer from the femoral branch to bilateral pelvic nerves in a cadaver: a potential method to restore bladder function following proximal spinal cord injury
Authors: Brown Justin M. , Barbe Mary F. , Albo Michael E. , Ruggieri Michael R.
Published: March 2013

Object

Nerve transfers are an effective means of restoring control to paralyzed somatic muscle groups and have recently been shown to be effective in denervated detrusor muscle in a canine model. A cadaveric study was performed to examine the anatomical feasibility of transferring femoral muscular nerve branches to vesical branches of the pelvic nerve as a method of potentially restoring innervation to control the detrusor muscle in humans.

Methods

Twenty cadavers were dissected bilaterally to expose pelvic and femoral muscular nerve branches. Ease of access and ability to transfer the nerves were assessed, as were nerve cross-sectional areas.

Results

The pelvic nerve was accessed at the base of the bladder, inferior to the ureter, and accompanied by inferior vesical vessels. Muscular branches of the femoral nerve to the vastus medialis and intermedius muscles (L-3 and L-4 origins) were followed distally for 17.4 ± 0.8 cm. Two muscle branches were split from the femoral nerve trunk, and tunneled inferior to the inguinal ligament. One branch was moved medially toward the base of the bladder and linked to the ipsilateral pelvic nerve. The second branch was tunneled superior to the bladder and linked to the contralateral pelvic nerve. The cross-sectional area of the pelvic nerve vesical branch was 2.60 ± 0.169 mm2 (mean ± SEM), and the femoral nerve branch at the suggested transection site was 4.40 ± 0.41 mm2.

Conclusions

Use of femoral nerve muscular branches from the vastus medialis and intermedius muscles for heterotopic nerve transfer of bilateral pelvic nerves is surgically feasible, based on anatomical location and cross-sectional areas.
Anatomical feasibility of C-2 pedicle screw fixation: the effect of variable angle interpolation of axial CT scans
Authors: Burke Lauren M. , Yu Warren D. , Ho Anthony , Wagner Timothy , O'Brien Joseph R.
Published: March 2013

Object

Anatomical variability of the C-2 pedicle poses a challenge for C-2 fixation. The use of multidimensional CT scanning is not widely used but might be an asset to preoperative planning. Careful preoperative planning is imperative for instrumentation at C-2. Fine-cut, noncontrast CT scanning is a useful tool for delineating anatomy; however, the axis of the images is not always along the anatomical axis of the vertebra in question. The authors evaluated the suitability of C-2 pedicles for screw placement by using OsiriX (Pixmeo) software to change the gantry angle of CT angiograms to measure the anatomical dimensions of the C-2 pedicle.

Methods

The authors conducted a retrospective review of CT angiograms of the head and neck from 47 trauma patients seen consecutively at George Washington University Hospital. For each patient, 3 independent observers determined length and width of each C-2 pedicle (94 samples) by using OsiriX. OsiriX is a DICOM viewer that enables navigation and visualization in multidimensional imaging, such as 3D imaging, which was used for this study. Sex-specific measurements were also determined. Vertebral anatomy was studied to determine whether aberrant anatomy would preclude pedicle fixation. Statistical analyses were performed.

Results

Of the 47 patients, 27 were male. Overall mean C-2 pedicle widths and lengths were 8.272 ± 1.364 mm and 27.052 ± 3.471 mm, respectively. The average widths and lengths of the pedicle in female patients were 8.040 ± 1.262 mm and 27.241 ± 2.731 mm, respectively, and those in male patients were 8.444 ± 1.414 mm and 26.913 ± 3.933 mm, respectively. The sex difference was statistically significant for width (p = 0.012) but not for length (p = 0.41). On the basis of width, the percentages of pedicles that could tolerate a 3.5-mm and 4.0-mm screw were 98% and 97%, respectively. Vertebral anatomy precluded screw length greater than 14 mm for only 3 patients.

Conclusions

Using multidimensional CT or 3D imaging, the authors found that C-2 pedicles in over 90% of patients could tolerate 3.5-mm and 4.0-mm pedicle screws. Vertebral anatomy precluded use of screw lengths greater than 14 mm for only 3 (6%) of 47 patients. Therefore, the C-2 pedicle might be more tolerant of fixation than previously reported.