Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up

Background: It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint. Purpose: To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD). Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient. Results: A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up ( P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side ( P < .001 for all). Conclusion: The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.

Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

Background: Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side.Objective: To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance.Method: We recruited 8 subjects with complete unilateral vestibular loss (4 men and 4 women, mean age 47 years) and tested them with video Head Impulse Test (vHIT) and Functional Head Impulse Test (fHIT) during passive and active movements while looking at a target. We assessed the mean absolute position error of the eye during different time frames of the head movement, the peak latency and the peak velocity of the first saccade, as well as the visual performance during the head movement.Results: Active head impulses to the lesioned side generated dynamic visual performances that were as good as when testing the intact side. Active head impulses resulted in smaller position errors during the visual perception task (p = 0.006) compared to passive head-impulses and the position error during the visual perception time frame correlated with shorter latencies of the first saccade (p &lt; 0.001).Conclusion: Actively generated head impulses toward the side with a complete vestibular loss resulted in a position error within or close to the margin necessary to obtain visual perception for a brief period of time in patients with chronic unilateral vestibular loss. This seems to be attributed to the appearance of short-latency covert saccades, which position the eyes in a more favorable position during head movements.

Open-loop analysis on sympathetically mediated arterial pressure and urine output responses in spontaneously hypertensive rats: effect of renal denervation

Primary acute sympathetic activation (PASA) causes a subsequent arterial pressure (AP) elevation. In this case, an antidiuretic effect via the renal innervation and pressure diuresis can act antagonistically on the kidneys. We examined the effect of PASA on urine output in spontaneously hypertensive rats (SHR) 4–7 days after unilateral renal denervation (RDN) (n = 9). The slope of the plot of urine flow versus AP was positive (0.120 ± 0.031 μL min−1 kg−1 mmHg−1) on the intact side, but it was less than 1/3 of the slope observed previously in normotensive Wistar–Kyoto rats (WKY). RDN did not normalize the slope of urine flow versus AP (0.179 ± 0.025 μL min−1 kg−1 mmHg−1, P = 0.098 versus the intact side). The urine flow at the operating point of the AP tended to be greater on the denervated than the intact side (29.0 ± 1.8 vs. 25.3 ± 1.9 μL min−1 kg−1, P = 0.055). The percent increase (17.2 ± 7.2%) was not different from that observed previously in WKY. Although high-resting sympathetic nerve activity is prerequisite for maintaining hypertension in SHR, the effect of sympathetic innervation on the urine output function was not greater than that in WKY.

Convolutional Neural Networks and Geometric Moments to Identify the Bilateral Symmetric Midplane in Facial Skeletons from CT Scans

In reconstructive craniofacial surgery, the bilateral symmetry of the midplane of the facial skeleton plays an important role in surgical planning. Surgeons can take advantage of the intact side of the face as a template for the malformed side by accurately locating the midplane to assist in the preparation of the surgical procedure. However, despite its importance, the location of the midline is still a subjective procedure. The aim of this study was to present a 3D technique using a convolutional neural network and geometric moments to automatically calculate the craniofacial midline symmetry of the facial skeleton from CT scans. To perform this task, a total of 195 skull images were assessed to validate the proposed technique. In the symmetry planes, the technique was found to be reliable and provided good accuracy. However, further investigations to improve the results of asymmetric images may be carried out.

Modified Arthroscopic Latarjet Procedure: Suture-button Fixation will not Cause Obvious Increasement of Superior Instability at 5-Year Follow-up

Background: Whether coracoacromial ligament (CAL) release during Latarjet procedure will increase superior instability of shoulder joint postoperatively remains controversial. This study aims to observe changes in the acromiaohumeral distance (AHD) of patients who underwent modified double-button Latarjet procedure and provide evidence to address the issue.Methods: A retrospective analysis was conducted among 155 patients who underwent modified double-button Latarjet procedure in our department from 2013 to 2015. Preoperative CT scan of bilateral shoulders were used for glenoid defect evaluation. CT scans were performed immediately after operation (PO 0) and during the follow-up at 6, 36, and 60 months postoperatively (POM) to observe the healing and remodeling of the graft, and AHD was measured. The intact sides were set as control group. VAS and objective shoulder scores, including ASES, ROWE, and Walch-Duplay scores, were recorded at each time point.Results: A total of 104 cases who met the criteria completed follow up. The average follow-up time was 62.6 ± 2.4 months. Compared with preoperative conditions, the function scores of the shoulders were significantly improved at the last follow-up. There were no statistical differences of the AHD values between bilateral shoulders preoperatively. The AHD values at PO 0 and POM 6 were significantly higher than those of intact side (p < 0.05). The AHD values at POM 36 and 60 were slightly higher than those of intact side and the differences were statistically significant (p < 0.05).Conclusions: The modified double-button Latarjet procedure not only offers satisfactory therapeutic effect but also will not cause obvious superior instability at the 5-year follow-up.

A Development of Clinical Decision Support System for Video Head Impulse Test Based on Fuzzy Inference System

This paper represents the clinical decision support system for video head impulse test (vHIT) based on fuzzy inference system. It examines the eye and head movement recorded by the eye movement tracking device, calculates the vestibulo-ocular reflex (VOR) gain, and applies fuzzy inference system to output the normality and artifact index of the test result. The position VOR gain and the proportion of covert and overt catch-up saccades (CUS) within the dataset are used as the input of the inference system. In addition, this system yields one more factor, the artifact index, which represents the current interference in the dataset. Data of fifteen vestibular neuritis patients and two of normal subjects were evaluated. The artifact index appears to be very high in the lesion side of vestibular neuritis (VN) patients, indicating highly theoretical contradictions, which are low gain but without CUS, or normal gain with the appearance of CUS. Both intact side and normal subject show high normality and low artifact index, even though the intact side has slightly lower normality and higher artifact index. In conclusion, this is a robust system, which is the first one that takes gain and CUS into account, to output not only the normality of the vHIT dataset, but also the artifacts.

INVESTIGATING THE EFFECTS OF PASSIVE MECHANICAL ANKLE ON UNILATERAL OSTEOMYOPLASTIC TRANSTIBIAL AMPUTEES

Purpose The study presents an investigation of the asymmetries in normal gait associated with the use of prosthetic mechanical passive ankle devices when performing ambulatory-related activities for unilateral osteomyoplastic transtibial amputees. Asymmetries in gait may lead to low-back pain and other long-term effects associated with hip compensation and excessive energy consumption. Methods Unilateral transtibial osteomyoplastic amputees were tasked to perform normal gait. The Vicon Motion system and Myomotion System consisting of electromyography sensors and inertial measurement units were used to collect data. Quantitative gait analysis was used for the analysis of anatomical angles for the ankle, knee, hip and pelvis. The results were compared to normative data. Result It was hypothesized that the unilateral amputees would demonstrate high peaks on the hip, knee and ankle of the intact side so as to compensate for the lack of propulsive force on the passive ankle of the prosthetic limb. All parameters for anatomical angles were found to be significant ([Formula: see text]), hip flexion ([Formula: see text]), knee flexion ([Formula: see text]) and ankle dorsiflexion ([Formula: see text]). Temporal and distance variables were quantitatively analyzed and there was no significant difference. Poor management of range of motion was observed on the ankle and the knee. There was minimum hip extension during the stance phase. There was excessive hip rotation and foot plantarflexion on the intact side of the amputee as hip compensation was being applied during the toe-off period and early swing. Amputees exhibited short stance time duration. Conclusion This study demonstrated that amputees can achieve same distance variables as normal subjects; however, this causes variations in anatomical angles which result in asymmetries in normal gait. Variations in lateral pelvic tilt indicated possible development of lower back pain and changes in posture.

Why Bilateral Damage Is Worse than Unilateral Damage to the Brain

Human and animal lesion studies have shown that behavior can be catastrophically impaired after bilateral lesions but that unilateral damage often produces little or no effect, even controlling for lesion extent. This pattern is found across many different sensory, motor, and memory domains. Despite these findings, there has been no systematic, computational explanation. We found that the same striking difference between unilateral and bilateral damage emerged in a distributed, recurrent attractor neural network. The difference persists in simple feedforward networks, where it can be understood in explicit quantitative terms. In essence, damage both distorts and reduces the magnitude of relevant activity in each hemisphere. Unilateral damage reduces the relative magnitude of the contribution to performance of the damaged side, allowing the intact side to dominate performance. In contrast, balanced bilateral damage distorts representations on both sides, which contribute equally, resulting in degraded performance. The model's ability to account for relevant patient data suggests that mechanisms similar to those in the model may operate in the brain.