Die praktische Bedeutung der Verknöcherung des Bindegewebes bei der Leitungsanestesie des nervus Mandibulare

Uspješna provodna anestezija gangliona semilunari Gasseri te mandibularnog živca u području ovalnog otvora često je onemogućena postojanjem nekih anatomskih varijacija. Pri blokadi ekstraoralnim tj. lateralnim subzigomatičnim putem osobitu zapreku mogu činiti okoštale fibrozne sveze u području ovalnog otvora: ligamentum pterygospinale Civinini i ligamentum crotaphitico-buccinatorium Hyrtl. Autori su na 530 maceriranih lubanja istražili učestalost okoštavanja tih sveza, tj. nastanka foramena pterygospinale i foramena crotaphitico - buccinatoriuma. Utvrdili su da su ti otvori češće razvijeni nego što je to opisano u literaturi. Nepotpuni foramen pterygospinale postojao je na 7,64%, a potpuni na 3,96% objekata. Nepotpuni foramen crotaphitico-buccinatorium našli su na 4,90%, a potpuni na 2,55% objekata.Napokon, autori ističu da upravo postojanje nepotpunog foramena crotaphitico-buccinatoriuma, a osobito potpunog otvora može biti zapreka provodnoj anesteziji i da na tu mogućnost uvijek treba misliti.Some anatomical variations make often a successful conduction anaesthesia of the ganglion semilunare Gasseri and of the mandibular nerve in the region of the oval foramen impossible. In blockage by the extraoral i. e. by the lateral subzygomatic way the ossified ligaments in the region of the oval foramen: the ligamentum pterygospinale Civinini and the ligamentum crotaphitico-buccinatorium Hyrtl may cause an obstacle. The authors have investigated on 530 macerated skulls the frequency of development of these ligaments i. e. the formation of the foramen pterygospinale and of the foramen crotaphitico-buccinatorium. They have established that these foramina are more often developped than it is cited in the literature. The incomplete foramen pterygospinale was present in 7,64% of case and the complet foramen in 3,96% of cases. The incomplete foramen crotaphitico-buccinatorium was present in 4,90% of cases and the complete foramen in 2,55% of cases. The authors point out finally that the existance of the incomplete and especially of the complete foramen crotaphitico-buccinatorium can be an obstacle to conduction anaesthesia which should always be kept in mind.Verschiedene anatomische Variationen können die Leitungsanestesie des Ganglion semilunare Gasseri und des N. mandibularis verhindern. Besondere Hindernisse, können bei der extraoralen Blokade antreten d. h. durch den seitlichen subzygomatischen Wege in der Gegend der ovalen Öffnung, die verknöcherne Ligamenta pterygospinale Civinini und crotaphitico-buccinatorium Hyrtl bilden. Die Autoren haben an einem Material vom 530 mazerierten Schädeln die Häufigkeit dieser verknöcherung untersucht, mit anderen Worten das Entstehen der Foramina pterygospinale und crotaphitico-buccinatorium. Es wurde bestätigt das man diese Offnungen öfters trifft, alls man es in der Literatur erwähnt. Ein partiales Foramen pterygospinale bestand im 7,64, und ein kompletes in 3,96 Fällen. Was sich des Foramen crotaphitico buccinatorium anbelangt, ein partialles wurde in 4,90 und ein komplettes in 2,55 Fällen nachgewiesen. Beschliesend konstatieren die Autoren, das bei der erwähnten Leitungsanestesie an solche Möglichkeiten immer denken soll

Vector assembly of colloids on monolayer substrates

The key to spontaneous and directed assembly is to encode the desired assembly information to building blocks in a programmable and efficient way. In computer graphics, raster graphics encodes images on a single-pixel level, conferring fine details at the expense of large file sizes, whereas vector graphics encrypts shape information into vectors that allow small file sizes and operational transformations. Here, we adapt this raster/vector concept to a 2D colloidal system and realize 'vector assembly' by manipulating particles on a colloidal monolayer substrate with optical tweezers. In contrast to raster assembly that assigns optical tweezers to each particle, vector assembly requires a minimal number of optical tweezers that allow operations like chain elongation and shortening. This vector approach enables simple uniform particles to form a vast collection of colloidal arenes and colloidenes, the spontaneous dissociation of which is achieved with precision and stage-by-stage complexity by simply removing the optical tweezers

The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value.

OBJECTIVES To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes. DESIGN We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry. RESULTS We assessed 71 AVS patients, 17 of whom had a central and 54 a peripheral cause of dizziness. 12.7% had an objective hearing loss. 'HINTS' had an accuracy of 78.9% to diagnose stroke, whereas 'HINTS' plus audiometry 73.2%. 'HINTS' sensitivity was 82.4% and specificity 77.8% compared to 'HINTS' plus audiometry showing a sensitivity of 82.4% and specificity of 70.4%. The four patients with stroke and minor stroke had all central 'HINTS'. 55% of the patients did not perceive their new unilateral hearing loss. CONCLUSIONS We found that almost one-eighth of the AVS patients had a new onset of hearing loss and only half had self-reported it. 'HINTS' plus audiometry proved to be less accurate to diagnose a central cause than 'HINTS' alone. Audiometry offered little diagnostic accuracy to detect strokes in the ED but might be useful to objectify a new hearing loss that was underestimated in the acute phase. Complete hearing loss should be considered a red flag, as three in four patients suffered from a central cause

ОБҐРУНТУВАННЯ НЕОБХІДНОСТІ ВИВЧЕННЯ МОЛЕКУЛЯРНОЇ БІОЛОГІЇ В МЕДИЧНИХ УНІВЕРСИТЕТАХ

In medical universities of most countries of the world, for the training of the modern international level doctors, it is mandatory to study the basics of molecular biology for a deeper understanding of the mechanisms of origin and development of pathological processes in the human body as well as to find ways to overcome them, develop new strategies for creating of drugs with higher efficiency and specificity without side effects. This is due primarily to the fact that the regulation of major metabolic processes both in health and various pathologies is mediated by reprogramming of genome functional activity at the level of different cell signaling systems. Thus, molecular biology provides knowledge of the molecular-genetic basis of homeostasis and the molecular mechanisms of the development of metabolic dysregulations in various pathologies, such as oncology, cardiovascular, endocrine, and others, and indicates possible ways to overcome them and therefore a detailed study of this science is very important for the training of high-level doctors of international level.У медичних університетах більшості країн світу при підготовці лікарів сучасного міжнародного рівня є обов’язковим вивчення основ молекулярної біології для більш глибокого розуміння механізмів виникнення і розвитку патологічних процесів в організмі людини, а також для пошуку шляхів їх подолання, розробки нових стратегій створення високоефективних лікарських препаратів з високою специфічністю і без побічних ефектів. Це обумовлено перш за все тим, що регуляція основних метаболічних процесів як у нормі, так і за різноманітних патологій опосередковується репрограмуванням функціональної активності геному на рівні різних сигнальних систем клітини. Таким чином, молекулярна біологія надає знання про молекулярно-генетичні основи підтримання гомеостазу і молекулярні механізми розвитку метаболічних порушень за різноманітних патологій, зокрема таких, як онкологічні, серцево-судинні, ендокринні та інші, а також вказує на можливі шляхи їх подолання, а тому детальне вивчення цієї науки має надзвичайно важливе значення для підготовки лікарів високої кваліфікації міжнародного рівня

Alexander's Law During High-Speed, Yaw-Axis Rotation: Adaptation or Saturation?

Objective: Alexander's law (AL) states the intensity of nystagmus increases when gaze is toward the direction of the quick phase. What might be its cause? A gaze-holding neural integrator (NI) that becomes imperfect as the result of an adaptive process, or saturation in the discharge of neurons in the vestibular nuclei? Methods: We induced nystagmus in normal subjects using a rapid chair acceleration around the yaw (vertical) axis to a constant velocity of 200°/second [s] and then, 90 s later, a sudden stop to induce post-rotatory nystagmus (PRN). Subjects alternated gaze every 2 s between flashing LEDs (right/left or up/down). We calculated the change in slow-phase velocity (ΔSPV) between right and left gaze when the lateral semicircular canals (SCC) were primarily stimulated (head upright) or, with the head tilted to the side, stimulating the vertical and lateral SCC together. Results: During PRN AL occurred for horizontal eye movements with the head upright and for both horizontal and vertical components of eye movements with the head tilted. AL was apparent within just a few seconds of the chair stopping when peak SPV of PRN was reached. When slow-phase velocity of PRN faded into the range of 6–18°/s AL could no longer be demonstrated. Conclusions: Our results support the idea that AL is produced by asymmetrical responses within the vestibular nuclei impairing the NI, and not by an adaptive response that develops over time. AL was related to the predicted plane of eye rotations in the orbit based on the pattern of SCC activation

Impaired fixation suppression of horizontal vestibular nystagmus during smooth pursuit: pathophysiology and clinical implications.

BACKGROUND AND PURPOSE A peripheral spontaneous nystagmus (SN) is typically enhanced or revealed by removing fixation. Conversely, failure of fixation suppression of SN is usually a sign of a central disorder. Based on Luebke and Robinson (Vision Res 1988, vol. 28 (8), pp. 941-946), who suggested that the normal fixation mechanism is disengaged during pursuit, it is hypothesized that vertical tracking in the light would bring out or enhance a horizontal SN. METHODS Eighteen patients with acute vestibular neuritis were studied. Eye movements were recorded using video-oculography at straight-ahead gaze with and without visual fixation, and during smooth pursuit. The slow-phase velocity and the fixation suppression indices of nystagmus (relative to SN in darkness) were compared in each condition. RESULTS During vertical tracking, the slow-phase velocity of horizontal SN with eyes near straight-ahead gaze was significantly higher (median 2.7°/s) than under static visual fixation (median 1.2°/s). Likewise, the fixation index was significantly higher (worse suppression) during pursuit (median 48%) than during fixation (median 26%). A release of SN was also suggested during horizontal pursuit, if one assumes superposition of SN on a normal and symmetrical pursuit capability

Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: a cross-sectional study.

OBJECTIVES We aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED). DESIGN Retrospective cross-sectional study. SETTING Tertiary referral hospital. PARTICIPANTS Adult patients presenting with dizziness. PRIMARY AND SECONDARY OUTCOME MEASURES We collected clinical data from the initial ED report from July 2015 to August 2020 and compared them with the follow-up report if available. We calculated the prevalence of vestibular syndromes and stroke prevalence in patients with dizziness. Vestibular syndromes are differentiated in acute (AVS) (eg, stroke, vestibular neuritis), episodic (EVS) (eg, benign paroxysmal positional vertigo, transient ischaemic attack) and chronic (CVS) (eg, persistent postural-perceptual dizziness) vestibular syndrome. We reported the rate of diagnostic errors using the follow-up diagnosis as the reference standard. RESULTS We included 1535 patients with dizziness. 19.7% (303) of the patients presented with AVS, 34.7% (533) with EVS, 4.6% (71) with CVS and 40.9% (628) with no or unclassifiable vestibular syndrome. The three most frequent diagnoses were stroke/minor stroke (10.1%, 155), benign paroxysmal positional vertigo (9.8%, 150) and vestibular neuritis (9.6%, 148). Among patients with AVS, 25.4% (77) had stroke. The cause of the dizziness remained unknown in 45.0% (692) and 18.0% received a false diagnosis. There was a follow-up in 662 cases (43.1%) and 58.2% with an initially unknown diagnoses received a final diagnosis. Overall, 69.9% of all 1535 patients with dizziness received neuroimaging (MRI 58.2%, CT 11.6%) in the ED. CONCLUSIONS One-fourth of patients with dizziness in the ED presented with AVS with a high prevalence (10%) of vestibular strokes. EVS was more frequent; however, the rate of undiagnosed patients with dizziness and the number of patients receiving neuroimaging were high. Almost half of them still remained without diagnosis and among those diagnosed were often misclassified. Many unclear cases of vertigo could be diagnostically clarified after a follow-up visit

Mesothelioma trends in the ACT and comparisons with the rest of Australia

OBJECTIVES Inhalation of asbestos fibres is the predominant cause of malignant mesothelioma. Domestic exposure to asbestos is a major community concern in the Australian Capital Territory (ACT) because of loose-fill asbestos home insulation. Little is known about how trends in mesothelioma rates in the ACT compare with those elsewhere. The objective of this study was to describe trends in mesothelioma rates in the ACT and compare them with those for the rest of Australia. METHODS We used de-identified data from the ACT Cancer Registry (1982- 2014), and the Western Australia (WA) Cancer Registry and the Australian Cancer Database (1982-2011). We calculated crude mesothelioma rates, by 3-year periods, for the ACT and for the rest of Australia (excluding WA). We used Poisson regression to analyse mesothelioma trends from 1994 to 2011 (complete reporting period) using an indirect standardisation approach to adjust for age and sex. RESULTS There were 140 mesothelioma cases reported to the ACT Cancer Registry between 1982 and 2014 - 81% male and 19% female. Between 1994 and 2011, age- and sex-adjusted mesothelioma rates in the ACT increased over time, on average by 12% per 3-year period (relative risk [RR] 1.12; 95% confidence interval [CI] 0.99, 1.26). Compared with the rest of Australia (excluding WA), ACT rates were, on average, lower (RR 0.84; 95% CI 0.69, 1.02), but they increased at a higher rate (RR 1.12 per 3-year period; 95% CI 0.99, 1.27). These results are strongly influenced by the higher rate of mesothelioma observed in the ACT in 2009-2011, when ACT rates became similar to those for the rest of Australia (excluding WA). CONCLUSIONS Although mesothelioma rates may have increased more in the ACT than the rest of Australia (excluding WA) during the past two decades, there is considerable uncertainty in the trends. More information is needed regarding the health risks associated with living in a house with loose-fill asbestos insulation. This is the subject of further studies within the ACT Asbestos Health Study.Includes Appendix table: Number of mesothelioma cases and person-years (PY) by sex, age group and year, ACT, 1982 to 201

Autologous Stem Cells in Achilles Tendinopathy (ASCAT): protocol for a phase IIA, single-centre, proof-of-concept study

Introduction: Achilles tendinopathy (AT) is a cause of pain and disability affecting both athletes and sedentary individuals. More than 150 000 people in the UK every year suffer from AT. While there is much preclinical work on the use of stem cells in tendon pathology, there is a scarcity of clinical data looking at the use of mesenchymal stem cells to treat tendon disease and there does not appear to be any studies of the use of autologous cultured mesenchymal stem cells (MSCs) for AT. Our hypothesis is that autologous culture expanded MSCs implanted into an area of mid-portion AT will lead to improved pain-free mechanical function. The current paper presents the protocol for a phase IIa clinical study. // Methods and analysis: The presented protocol is for a non-commercial, single-arm, open-label, phase IIa proof-of-concept study. The study will recruit 10 participants and will follow them up for 6 months. Included will be patients aged 18–70 years with chronic mid-portion AT who have failed at least 6 months of non-operative management. Participants will have a bone marrow aspirate collected from the posterior iliac crest under either local or general anaesthetic. MSCs will be isolated and expanded from the bone marrow. Four to 6 weeks after the harvest, participants will undergo implantation of the culture expanded MSCs under local anaesthetic and ultrasound guidance. The primary outcome will be safety as defined by the incidence rate of serious adverse reaction. The secondary outcomes will be efficacy as measured by patient-reported outcome measures and radiological outcome using ultrasound techniques. // Ethics and dissemination: The protocol has been approved by the National Research Ethics Service Committee (London, Harrow; reference 13/LO/1670). Trial findings will be disseminated through peer-reviewed publications and conference presentations. // Trial registration number: NCT02064062