Design, fabrication, and evaluation of single- and multi-level 3D-printed non-covering cervical spinal fusion surgery templates.

Background: Cervical spinal fusion surgeries require accurate placement of the pedicle screws. Any misplacement/misalignment of these screws may lead to injuries to the spinal cord, arteries and other organs. Template guides have emerged as accurate and cost-effective tools for the safe and rapid insertions of pedicle screws. Questions/Purposes: Novel patient-specific single- and multi-level non-covering templates for cervical pedicle screw insertions were designed, 3D-printed, and evaluated. Methods: CT scans of two patients were acquired to reconstruct their 3D spine model. Two sets of single-level (C3-C7) and multi-level (C4-C6) templates were designed and 3D-printed. Pedicle screws were inserted into the 3D-printed vertebrae by free-hand and guided techniques. For single-level templates, a total of 40 screws (2 patients × 5 vertebrae × 2 methods × 2 screws) and for multi-level templates 24 screws (2 patients × 3 vertebrae × 2 methods × 2 screws) were inserted by an experienced surgeon. Postoperative CT images were acquired to measure the errors of the entry point, 3D angle, as well as axial and sagittal plane angles of the inserted screws as compared to the initial pre-surgery designs. Accuracy of free-hand and guided screw insertions, as well as those of the single- and multi-level guides, were also compared using paired t-tests. Results: Despite the minimal removal of soft tissues, the 3D-printed templates had acceptable stability on the vertebrae during drillings and their utilization led to statistically significant reductions in all error variables. The mean error of entry point decreased from 3.02 mm (free-hand) to 0.29 mm (guided) using the single-level templates and from 5.7 mm to 0.76 mm using the multi-level templates. The percentage reduction in mean of other error variables for, respectively, single- and multi-level templates were as follows: axial plane angle: 72% and 87%, sagittal plane angle: 56% and 78%, and 3D angle: 67% and 83%. The error variables for the multi-level templates generally exceeded those of the single-level templates. The use of single- and multi-level templates also considerably reduced the duration of pedicle screw placements. Conclusion: The novel single- and multi-level non-covering templates are valuable tools for the accurate placement of cervical pedicle screws.

Socio-behavioural determinants associated with the first dental visit in Saudi children: A cross-sectional study.

BACKGROUD: Oral health is an integral component of overall well-being, understanding the age at which children have their first dental visit (FDV) and the socio-behavioural factors influencing these visits is essential for improving oral health outcomes in children. AIM: This study aimed to determine the age at which Saudi children had their FDV and the socio-behavioural predictors associated with these visits in Al Jouf Province, Kingdom of Saudi Arabia. DESIGN: This cross-sectional study used a multistage stratified random sampling technique to invite 566 parents/guardians of schoolchildren aged 12 years or younger. Multinomial logistic regression analysis was used to identify socio-behavioural variables that predict children's FDV. p < 0.05 was considered statistically significant. RESULTS: Most FDVs in children occurred between the ages of 6 and 10 years. More than half of the participants stated that FDVs occurred primarily because of dental pain. Furthermore, educated mothers reported a higher frequency of dental visits for their children. Children with a low family income were 63% (95% confidence interval 0.16-0.83; p = .015) less likely to visit a dentist between the ages of 1 and 5 years. CONCLUSION: First dental visits in children in Al Jouf Province typically occurred between the ages of 6 and 10 years, with dental pain being the main reason. Parents' or caregiver's relationships with children, parental age and familial income were identified as predictors of the FDV.

Inflammation, coagulation, endothelial dysfunction and oxidative stress in prediabetes--Biomarkers as a possible tool for early disease detection for rural screening.

OBJECTIVES: This study aims to increase understanding of the connection between oxidative stress and inflammation in diabetes disease progression to provide a basis for investigating improved diagnostic possibilities, treatment and prevention of prediabetes. DESIGN AND METHODS: Differences in the level of biochemical markers of oxidative stress (erythrocyte GSH/GSSG and urinary 8-isoprostane), inflammation (CRP, IL-6), endothelial dysfunction (plasma homocysteine, urinary 8-hydroxy-2-deoxy-guanosine) and coagulation/fibrinolysis (C5a, D-Dimer) were determined in prediabetes and control subjects. RESULTS: While no difference was found in the 8-isoprostane levels between the two groups, the erythrocyte GSH/GSSG ratio was significantly reduced in the prediabetes group compared to control, indicating increased oxidative stress in the prediabetic state. Both urinary 8-OHdG and surprisingly also plasma homocysteine were significantly elevated in the prediabetes group, indicating endothelial dysfunction. The inflammation markers were slightly elevated in the prediabetic subjects and the same trend was found for the coagulation/fibrinolysis markers C5a and D-Dimer. These results were however not significant. CONCLUSIONS: The small elevation of blood glucose levels in the prediabetic state may have a detectable influence on endothelial function as indicated by changes to 8-OHdG, indicating an increased DNA-damage and homocysteine release from endothelial cells. Increased oxidative stress as indicated by the reduced GSH/GSSG ratio is likely to be the link between the moderate hyperglycaemia in prediabetes and pathological changes in endothelial function, which in the long-term may promote atherogenesis and result in the development of cardiovascular disease. Early detection of prediabetes is essential to avoid diabetes development and the associated complications like cardiovascular disease. The GSH/GSSG ratio and biomarkers like urinary 8-OHdG and plasma homocysteine offer a possible tool for the assessment of prediabetes in prevention screenings.

Towards an assessment of bone fracture healing using pulsed mode ultrasound.

Healing rate of fractured bone differs from one patient to another which may lead to incorrect consequent medical procedures. Thus, quantitative assessment of bone healing after fracture becomes important. In this paper, we present a mathematical model which describes the interaction of a pulsed mode ultrasound waves with a multilayered biological structure. The model is applied to estimate the bone callus thickness and degree of hardness. Different frequencies are utilized to obtain highest measurement sensitivity and accuracy of callus thickness and degree of hardness. It is found that a transducer operating at 1 MHz has the highest sensitivity to the different phases of callus hardening. On the other hand, a 3 MHz transducer yields the highest sensitivity to the thickness of the callus layer. Thus, using both frequencies might prove to be useful for full quantitative assessment of the bone healing process.

How does the central nervous system address the kinetic redundancy in the lumbar spine? Three-dimensional isometric exertions with 18 Hill-model-based muscle fascicles at the L4-L5 level.

The human motor system is organized for execution of various motor tasks in a different and flexible manner. The kinetic redundancy in the human musculoskeletal system is a significant property by which the central nervous system achieves many complementary goals. An equilibrium-based biomechanical model of isometric three-dimensional exertions of trunk muscles has been developed. Following the definition and role of the uncontrolled manifold, the kinetic redundancy concept is explored in mathematical terms. The null space of the kinetically redundant system when a certain joint moment and/or stiffness are needed is derived and discussed. The aforementioned concepts have been illustrated, using a three-dimensional three-degrees-of-freedom biomechanical model of the spine with 18 anatomically oriented Hill-type-model muscle fascicles. The considerations of stability and its consequence on the internal loading of the spine and coactivation consequences are discussed in both general and specific cases. The results can shed light on the interaction mechanisms in muscle activation patterns seen in various tasks and exertions and can provide a significant understanding for future research studies and clinical practices related to low-back disorders. Alteration of recruitment patterns in low-back-pain patients has been explained on the basis of this biomechanical analysis. The higher coactivation results in higher internal loading while providing higher joint stiffness that enhances spinal stability, which guards against spinal deformation in the presence of any perturbations.

Multiple crown size variables of the upper incisors in patients with supernumerary teeth compared with controls.

AIMS: As part of ongoing studies of the aetiology of dental anomalies the aims of this study were to identify multiple components of tooth size of the upper permanent incisors in 34 patients with supernumerary teeth and to compare them with those in a control group to determine whether the presence of a supernumerary tooth has a local effect on the size of the surrounding dentition. METHODS AND RESULTS: The labial and occlusal aspects of the clinical crowns of the upper permanent central and lateral incisors on the study models of 74 subjects were digitally imaged and measured using an image analysis system and automated macro (34 patients with supernumerary in the upper incisor region: 17 males and 17 females and 40 controls: 20 males and 20 females). The macro-defined 17 variables from each view. From the labial view these were: the mesio-distal and occluso-gingival length and additional measurements along 25 and 75% of the mesio-distal line and at 25, 50 and 75% along the occluso-gingival line such that all these sub-divisions extended to the periphery of the tooth. From the occlusal view these were: the mesio-distal and labio-lingual lengths, and additional variables that sub-divided the mesio-distal again at 25 and 75% along the length and at 25, 50 and 75% along the labio-lingual dimension. Principal component analysis (PCA) was used to identify the key factors with the most random variability. Comparisons were then carried out between the supernumerary cases and control group using 2-way ANOVA. Seven factors of tooth size for the upper central incisors and eight factors for the upper lateral incisors were extracted. Most of these variables were found to be larger in the supernumerary group than in the control. Statistically significant differences were found for 5 out of 7 and 4 out of 8 for the upper central and lateral incisors respectively. CONCLUSIONS: A number of factors of tooth size were identified and found to be larger in the supernumerary group compared to the control (7 for upper central and 8 for upper lateral incisors); the majority reached the 0.05 significance level. Tooth crown size of the upper central incisor was affected more than that of the upper lateral incisor, supporting a local field effect.

Tooth size in patients with supernumerary teeth and a control group measured by image analysis system.

OBJECTIVE: The aim of this study was to compare tooth size measurements between patients with supernumerary teeth and a control group. METHOD: The supernumerary group consisted of 56 subjects (21 females and 35 males) and the control group of 40 subjects (20 females and 20 males). All available permanent teeth on the dental casts were imaged and measured from both buccal and occlusal views using an image analysis system. Mesio-distal, bucco-lingual or occluso-gingival dimensions, area and perimeter were measured from each view. RESULTS: Supernumerary tooth patients tended to have larger tooth size measurements for almost all variables than controls. Significant differences (p<0.05) were found for the mesio-distal dimension of the upper and lower incisors and the bucco-lingual dimensions of the lower first premolars. CONCLUSIONS: The results are compatible with supernumerary teeth being a complex dental anomaly with a multifactorial aetiology in which both genetic and environmental factors are important. There is some evidence of a local effect with greater differences in tooth dimension adjacent to the site of the supernumeraries.

Further studies of a model for the etiology of anomalies of tooth number and size in humans.

A multifactorial model based on an underlying continuous distribution of tooth size, with thresholds determining hypodontia and supernumeraries, has been proposed [1]. Our aim is to investigate this model by comparing tooth morphology of affected patients and their first degree relatives with normal controls. An image analysis system [2] was used to measure teeth on study models of controls, patients with hypodontia of varying degrees and location, first-degree relatives of hypodontia index cases, and patients with supernumerary teeth in the maxillary incisor region. Mesio-distal crown size in hypodontia patients was smaller than controls, and this difference was significant for all tooth types. There was a general pattern: the more severe the hypodontia, the smaller the size of the tooth formed. Patients with supernumerary teeth had permanent maxillary central and lateral incisors and canines that were significantly larger in mesio-distal width than controls. The maxillary central incisors also differed in taper in supernumerary patients compared to controls. Hypodontia prevalence was higher in first-degree relatives (22%) of hypodontia index cases than in the general population (4.4%), and unaffected relatives had smaller teeth than controls. Thus, there were generalized and localized effects within the dentition, and these findings are compatible with the statistical expectations of the proposed multifactorial model.

Feature extraction and quantification of the variability of dynamic performance profiles due to the different sagittal lift characteristics.

Investigation of manual material handling (MMH) tasks, such as lifting, requires the quantification of the various kinematic and kinetic parameters of performance for assessment of the functional capacity and/or task demand profiles. Traditional statistical descriptive analyses usually involve computing the summary statistics (maximum, minimum, mean, and/or range) of the resulting performance parameters over the cycle duration (i.e., lifting/lowering cycle). Consequently, the significant information content of the time-varying signals is diminished, limiting the sensitivity of subsequent hypothesis testing procedures. The present study developed a methodology for representing and quantifying performance data variability of the kinematic and kinetic motion profiles due to the different lift characteristics (load, mode, and speed) during MMH tasks while capturing the temporal characteristics. Using a database of motion profiles from a manual lifting experiment, the Karhunen-Loeve Expansion (KLE) feature extraction technique was shown to be quite effective for representing the various motion profiles. The number of basis vectors (eigenvectors) and corresponding coefficients needed for accurate representation were substantially smaller than the original data set, resulting in data compression. Moreover, the effects of lift characteristics were investigated using analysis of variance techniques that recognize the vectorial constitution of the waveforms. The application of these techniques will enable the quantification of highly phasic profiles and enhance the ability to document the effect of intervening measures such as educational or physical training/exercise on the kinematic and kinetic patterns of performance. Additionally, the differential influence of lift characteristics on the variability of performance during different phases of lifting and lowering provides added resolution in the analysis of MMH tasks.

Determination of the effect of lift characteristics on dynamic performance profiles during manual materials handling tasks.

In any quantitative gait or occupational biomechanics investigation, the quantification of the different kinematic, kinetic, and electromyographic parameters is essential towards assessment of functional capacity and development of a biomechanical profile of the task demands. In the current study, the authors presented a methodology for using inferential statistics to evaluate the effect of lift characteristics on phase-dependent and phase-independent variability in performance. Using a database of kinematic and kinetic profiles obtained from a manual lifting study, the phase-dependent effects of lift characteristics: box mass (load), mode (technique of lift), and speed (frequency of lift) were investigated through the use of analysis of variance (ANOVA) techniques, which recognize the vectorial constitution of the profiles. In addition, the Karhunen-Loeve Expansion (KLE) feature extraction method was used for representing the lifting patterns of measured joint angular position, velocity, acceleration, and net muscular torque profiles obtained from a 2-D biomechanical lifting model in order to study the phase-independent effects. In comparison to traditional descriptive statistical analyses currently used in various occupational biomechanics experimental investigations, this method allows the significant information content of the time varying signal to be captured, enhancing the sensitivity of subsequent hypothesis testing procedures. The application of this technique to MMH investigations allows identification of the lift characteristics that dominate the variability of task demands, hence aiding in the design and assessment of ergonomic solutions.

Unsuspected penetrating maxillo-orbitocranial injury: a case report.

A healthy 37-year-old man presented to the emergency room, complaining of blunt trauma to his mandible from a tree branch. Plain radiographs and computed tomography demonstrated a penetrating orbitocranial foreign body with the maxillary sinus as the entry site. The foreign body was a chain-saw file. It was extracted successfully through the oral cavity. The patient's recovery was uncomplicated and he suffered no neurologic or opthalmic sequelae.

Modeling of functional trunk muscle performance: interfacing ergonomics and spine rehabilitation in response to the ADA.

The combination of increasing costs of musculoskeletal injuries and the implementation of the Americans with Disabilities Act (ADA) has created the need for a more objective functional understanding of dynamic trunk performance. In this study, trunk extensor and flexor strengths were measured as a function of angular position and velocity for 20 subjects performing maximum isometric and isokinetic exertions. Results indicate that trunk strength is significantly influenced by trunk angular position, trunk angular velocity, gender, and direction, as well as by the interaction between trunk angular position and velocity. Three-dimensional surfaces of trunk strength in response to trunk angular position and velocity were constructed for each subject per direction. Such data presentation is more accurate and gives better insight about the strength profile of an individual than does the traditional use of a single strength value. The joint strength capacity profiles may be combined with joint torque requirements from a manual material handling task, such as a lifting task, to compute the dynamic utilization ratio for the trunk muscles. This ratio can be used as a unified measure of both task demand and functional capacity to guide job assignment, return to work, and prognosis during the rehabilitation processes. Furthermore, the strength regressions developed in this study would provide dynamic strength limits that can be used as functional constraints in the computer simulation of physical activities, such as lifting. In light of the ADA, this would be of great value in predicting the consequences of task modifications and/or workstation alterations without subjecting an injured worker or an individual with a disability to unnecessary testing.

Feature extraction and modeling of the variability of performance in terms of biomechanical motion patterns during MMH tasks.

In investigating manual material handling (MMH) jobs, such as lifting, the quantification of the various kinematic and kinetic parameters of the lift is an important step towards functional assessment and evaluation. Experimental data collection generates a large quantity of data for the different kinetic, kinematic, and electromyographic parameters over the various lifting cycles. In order to efficiently manage and interpret the data, it is important to use appropriate tools which would reduce the dimension of the original data set without sacrificing any important features. Furthermore, the generated parameters are often expressed as a function of the lifting cycle resulting in complex waveforms as the unit of analysis. Appropriate statistical analysis of these waveforms or motion profiles should reflect their vectorial constitution as a function of the lifting cycle rather than the usual method of using traditional descriptive statistics based on collapsing the data over the cycle.

Flow analysis-spectrophotometric determination of L-Dopa in pharmaceutical formulations by reaction with p-aminophenol.

A new method has been developed for the spectrophotometric determination of L-Dopa in pharmaceutical formulations. The method is based on the reaction between the open-chain quinone of L-Dopa, obtained in NaOH, and the benzoquinoneimine form of p-aminophenol, in the presence of KIO(4). The reaction product is determined at 574 nm by using both alternately procedures, one based on the stopped-flow and another on a flow injection approach. Under the best experimental conditions L-Dopa can be determined with a limit of detection of 52 ng/ml and a relative standard deviation of 0.2% for three replicate measurements of a solution containing 4 microg/ml.

Spectrophotometric determination of phenol and resorcinol by reaction with p-aminophenol.

Based on the reaction with p-aminophenol, a series of procedures have been developed for the spectrophotometric determination of phenol and resorcinol. Three basic approaches have been studied: (i) a batch procedure, using the dissolved oxygen as oxidant, (ii) a stopped-flow procedure by use of KIO(4) as oxidant and (iii) a flow injection (FI) procedure developed in the presence of KIO(4). Phenol can be accurately determined at 626 nm, in the stopped-flow mode, after a reaction time of 45 min in 0.005M NaOH, 0.004M KIO(4) and 500 mug/ml of PAP. The development of a manifold, which incorporates a sample parking, is a convenient approach which makes it possible to measure, in the stopped-flow mode, four solutions in one hour. The limit of detection of this method corresponds to 64 ng/ml of phenol Resorcinol can be determined by FI at 540 nm in 0.006M NaOH, 0.0002M KIO(4) and 50 mug/ml PAP with a limit of detection of 6.6 ng/ml and a sample throughput of 300 injections per hour. A combination between the FI procedure for the determination of resorcinol and the stopped-flow procedure for phenol determination provides accurate results in the analysis of spiked samples containing both phenol and resorcinol.

Spectrophotometric flow injection determination of formetanate and m-aminophenol in water after reaction with p-aminophenol.

An automated procedure has been developed for the determination of formetanate and its metabolite m-aminophenol (MAP) in water samples. MAP can be selectively determined in the presence of formetanate by direct on-line reaction with p-aminophenol and spectrophotometric measurement of the absorbance at 576 nm in the presence of KIO(4), as oxidizing agent. The method has a limit of detection of 5 x 10(-7)M, it provides a recovery percentage from 95 to 104% and permits one to carry out 120 measurements/hr. The spectrophotometric determination of formetanate must be carried out after a previous hydrolysis to MAP. To determine formetanate in the presence of MAP, two steps are necessary. Firstly, the MAP content is selectively determined as has been mentioned above. After that, the sample is treated with 0.05M NaOH at 90' degrees C, to hydrolyze the formetanate to MAP, and then the sum of both is determined spectrophotometrically. The difference between the results obtained in each step gives the formetanate concentration. The developed procedure for the determination of formetanate provides a sensitivity of 1070 absorbance units mol(-1) l and a limit of detection of 1.9 x 10(-7)M, which corresponds to 50 mug/l of formetanate hydrochloride. The method has been applied to the analysis of natural water samples fortified with formetanate and MAP, and formetanate has also been quantitatively recovered in irrigation waters at a concentration level of 1.9 x 10(-6)M which corresponds to 500 mug/l. On the other hand, working in the stopped-flow mode, for a reaction time of 100 sec, the sensitivity of the formetanate determination can be increased to 4642 absorbance units mol(-1) l but the limit of detection remains of the order of 44 mug/l.