OBJECTIVE: To investigate the association between postoperative upper instrumented vertebrae (UIV) tilt angle with postoperative medial shoulder and neck imbalance.
SUMMARY OF BACKGROUND DATA: Studies had found that current recommendations for UIV selection were not predictive of good postoperative shoulder balance.
METHODS: A total of 98 patients with adolescent idiopathic scoliosis with Lenke 1/2 curves who underwent posterior spinal fusion between 2013 and 2014 with minimum follow-up of 2 years were recruited. Radiological parameters: UIV tilt angle, T1 tilt, cervical axis, and clavicle angle were measured preoperatively, postoperatively, and at final follow-up.
RESULTS: Mean age was 16.2 ± 6.2 years. Mean follow-up was 37.9 ± 6.5 months. There were 73.5% Lenke 1 and 26.5% Lenke 2 curves. Significant factors affecting postoperative T1 Tilt were postoperative UIV tilt angle, preoperative T1 tilt, and preoperative UIV tilt angle. Postoperative UIV tilt angle and preoperative cervical axis were significant factors affecting cervical axis at final follow-up. UIV level was not significant independent factor that affected postoperative T1 tilt and cervical axis. There was strong correlation between postoperative UIV tilt angle and T1 tilt for the whole cohort (P
METHODS: The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system.
RESULTS: Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results.
CONCLUSION: The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially.
METHODS: Twenty-five young and healthy university students performed a triceps push-down exercise at 45% one repetition maximum (1RM) with and without CS until task failure, and the rate of fatigue (ROF), endurance time (ET) and number of repetitions (NR) for both exercises were analyzed. In addition, the first and last six repetitions of each exercise were considered non-fatiguing (NF) and fatiguing (Fa), respectively, and the root mean square (RMS), mean power frequency (MPF) and median frequency (MDF) for each exercise repetition were evaluated.
RESULTS: The lateral and long head showed significant differences (P<0.05) in the ROF between the two exercises, and all the heads showed significant (P<0.05) differences in the RMS between the two exercises under NF conditions. Only the long head showed a significant difference (P<0.05) in the MPF and MDF between the two exercises. CS increases the ET (24.74%) and NR (27%) of the exercise. The three heads showed significant differences (P<0.05) in the RMS, MPF and MDF under all exercise conditions.
CONCLUSION: A lower ROF was obtained with CS. In addition, the RMS was found to be better approximator of CS, whereas MPF and MDF were more resistant to the effect of CS. The results showed that the three heads worked independently under all conditions, and the non-synergist and synergist head pairs showed similar behavior under Fa conditions. The findings from this study provide additional insights regarding the functioning of each TB head.
PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.
CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.
CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.