Three-dimensional architecture of ESCRT-III flat spirals on the membrane.

The endosomal sorting complexes required for transport (ESCRTs) are responsible for membrane remodeling in many cellular processes, such as multivesicular body biogenesis, viral budding, and cytokinetic abscission. ESCRT-III, the most abundant ESCRT subunit, assembles into flat spirals as the primed state, essential to initiate membrane invagination. However, the three-dimensional architecture of ESCRT-III flat spirals remained vague for decades due to highly curved filaments with a small diameter and a single preferred orientation on the membrane. Here, we unveiled that yeast Snf7, a component of ESCRT-III, forms flat spirals on the lipid monolayers using cryogenic electron microscopy. We developed a geometry-constrained Euler angle-assigned reconstruction strategy and obtained moderate-resolution structures of Snf7 flat spirals with varying curvatures. Our analyses showed that Snf7 subunits recline on the membrane with N-terminal motifs α0 as anchors, adopt an open state with fused α2/3 helices, and bend α2/3 gradually from the outer to inner parts of flat spirals. In all, we provide the orientation and conformations of ESCRT-III flat spirals on the membrane and unveil the underlying assembly mechanism, which will serve as the initial step in understanding how ESCRTs drive membrane abscission.

Identification and Structural Characterization of Twisted Atomically Thin Bilayer Materials by Deep Learning.

Two-dimensional materials are expected to play an important role in next-generation electronics and optoelectronic devices. Recently, twisted bilayer graphene and transition metal dichalcogenides have attracted significant attention due to their unique physical properties and potential applications. In this study, we describe the use of optical microscopy to collect the color space of chemical vapor deposition (CVD) of molybdenum disulfide (MoS2) and the application of a semantic segmentation convolutional neural network (CNN) to accurately and rapidly identify thicknesses of MoS2 flakes. A second CNN model is trained to provide precise predictions on the twist angle of CVD-grown bilayer flakes. This model harnessed a data set comprising over 10,000 synthetic images, encompassing geometries spanning from hexagonal to triangular shapes. Subsequent validation of the deep learning predictions on twist angles was executed through the second harmonic generation and Raman spectroscopy. Our results introduce a scalable methodology for automated inspection of twisted atomically thin CVD-grown bilayers.

Optimal 3D angular sampling with applications to cryo-EM problems.

The goal of cryo-EM experiments in the biological sciences is to determine the atomic structure of a molecule and deduce insights into its functions and mechanisms. Despite improvements in instrumentation for data collection and new software algorithms, in most cases, individual atoms are not resolved. Model building of proteins, nucleic acids, or molecules in general, is feasible from the experimentally determined density maps at resolutions up to the range of 3-4 Angstroms. For lower-resolution maps or parts of maps, fitting smaller structures obtained by modelling or experimental techniques with higher resolution is a way to resolve the issue. In practice, we have an atomic structure, generate its density map at a given resolution, and translate/rotate the map within a region of interest in the experimental map, computing a measure-of-fit score with the corresponding areas of the experimental map. This procedure is computationally intensive since we work in 6D space. An optimal ordered list of rotations will reduce the angular error and help to find the best-fitting positions faster for a coarse global search or a local refinement. It can be used for adaptive approaches to stop fitting algorithms earlier once the desired accuracy has been achieved. We demonstrate how the performance of some fitting algorithms can be improved by grouping sets of rotations. We present an approach to generate more efficient 3D angular sampling, and provide the computer code to generate lists of optimal orientations for single and grouped rotations and the lists themselves.

Vessel density mapping of small cerebral vessels on 3D high resolution black blood MRI.

Small cerebral blood vessels are largely inaccessible to existing clinical in vivo imaging technologies. This study aims to present a novel analysis pipeline for vessel density mapping of small cerebral blood vessels from high-resolution 3D black-blood MRI at 3T. Twenty-eight subjects (10 under 35 years old, 18 over 60 years old) were imaged with the T1-weighted turbo spin-echo with variable flip angles (T1w TSE-VFA) sequence optimized for black-blood small vessel imaging with iso-0.5 mm spatial resolution (interpolated from 0.51×0.51×0.64 mm3) at 3T. Hessian-based vessel segmentation methods (Jerman, Frangi and Sato filter) were evaluated by vessel landmarks and manual annotation of lenticulostriate arteries (LSAs). Using optimized vessel segmentation, large vessel pruning and non-linear registration, a semiautomatic pipeline was proposed for quantification of small vessel density across brain regions and further for localized detection of small vessel changes across populations. Voxel-level statistics was performed to compare vessel density between two age groups. Additionally, local vessel density of aged subjects was correlated with their corresponding gross cognitive and executive function (EF) scores using Montreal Cognitive Assessment (MoCA) and EF composite scores compiled with Item Response Theory (IRT). Jerman filter showed better performance for vessel segmentation than Frangi and Sato filter which was employed in our pipeline. Small cerebral blood vessels including small artery, arterioles, small veins, and venules on the order of a few hundred microns can be delineated using the proposed analysis pipeline on 3D black-blood MRI at 3T. The mean vessel density across brain regions was significantly higher in young subjects compared to aged subjects. In the aged subjects, localized vessel density was positively correlated with MoCA and IRT EF scores. The proposed pipeline is able to segment, quantify, and detect localized differences in vessel density of small cerebral blood vessels based on 3D high-resolution black-blood MRI. This framework may serve as a tool for localized detection of small vessel density changes in normal aging and cerebral small vessel disease.

OPUS-Rota4: a gradient-based protein side-chain modeling framework assisted by deep learning-based predictors.

Accurate protein side-chain modeling is crucial for protein folding and protein design. In the past decades, many successful methods have been proposed to address this issue. However, most of them depend on the discrete samples from the rotamer library, which may have limitations on their accuracies and usages. In this study, we report an open-source toolkit for protein side-chain modeling, named OPUS-Rota4. It consists of three modules: OPUS-RotaNN2, which predicts protein side-chain dihedral angles; OPUS-RotaCM, which measures the distance and orientation information between the side chain of different residue pairs and OPUS-Fold2, which applies the constraints derived from the first two modules to guide side-chain modeling. OPUS-Rota4 adopts the dihedral angles predicted by OPUS-RotaNN2 as its initial states, and uses OPUS-Fold2 to refine the side-chain conformation with the side-chain contact map constraints derived from OPUS-RotaCM. Therefore, we convert the side-chain modeling problem into a side-chain contact map prediction problem. OPUS-Fold2 is written in Python and TensorFlow2.4, which is user-friendly to include other differentiable energy terms. OPUS-Rota4 also provides a platform in which the side-chain conformation can be dynamically adjusted under the influence of other processes. We apply OPUS-Rota4 on 15 FM predictions submitted by AlphaFold2 on CASP14, the results show that the side chains modeled by OPUS-Rota4 are closer to their native counterparts than those predicted by AlphaFold2 (e.g. the residue-wise RMSD for all residues and core residues are 0.588 and 0.472 for AlphaFold2, and 0.535 and 0.407 for OPUS-Rota4).

Correcting Edge Defects in Self-Assembled Monolayers through Thermal Annealing.

Self-assembled monolayers (SAMs) are emerging as platform technology for a myriad of applications, yet they still possess varied spatial stability and predictability issues as their properties are heavily dependent on subtle structural features. Reducing entropy within such a system serves as one of many potential solutions to increase order and therefore coherence/precision in measured properties. Here we explore controlled thermal annealing to improve edge disorders in SAMs and significantly reduce data variance. Using both odd- and even-numbered n-alkanethiol SAMs on Au, we observe statistically significant difference in the contact angles between edge and center. Thermal annealing at 40°C significantly narrows differences between edges and centre of the SAM, albeit with significant reduction in the parity dependent odd-even effect. This study provides a pathway to improve SAMs consistency through minimal external perturbation as reflected by the minimization of odd-even effect as SAMs become increasingly ordered.

Hexylation Stabilises Twisted Backbone Configurations in the Prototypical Low-Bandgap Copolymer PCDTBT.

Conjugated donor-acceptor copolymers hold great potential as materials for high-performance organic photovoltaics, organic transistors and organic thermoelectric devices. Their low optical bandgap is achieved by alternation of donor and acceptor moieties along the polymer chain, leading to a pronounced charge-transfer character of electronic excitations. However, the influence of appended side chains and of chemical defects of the backbone on their photophysical and conformational properties remains largely unexplored on the level of individual chains. Here, we employ room temperature single-molecule photoluminescence spectroscopy on four compounds based on the prototypical copolymer PCDTBT with systematically changed chemical structure. Our results show that an increasing density of statistically added hexyl chains to the TBT comonomer distorts the molecular conformation, likely through the increase of average dihedral angles along the backbone. We find that, although the conformation becomes more twisted with high hexyl density, the side chains appear to stabilize the backbone in this twisted conformation. In addition, we demonstrate that homocoupling defects along the backbone barely influence the PL spectra of single chains, and thus intra-chain electronic properties.

Quantification of needle angles for lumbar medial branch denervation targeting the posterior half of the superior articular process: an osteological study.

BACKGROUND: Lumbar medial branch radiofrequency ablation (RFA) is a common intervention to manage chronic axial low back pain originating from the facet joints. A more parasagittal approach targeting the posterior half of the lateral neck of superior articular process (SAP) was previously proposed. However, specific needle angles to achieve parallel placement at this target site have not been investigated. OBJECTIVE: To quantify and compare the needle angles, on posterior and lateral views, to achieve parallel placement of electrodes along the medial branch at the posterior half of the lateral neck of SAP at each lumbar vertebral level (L1-L5) and sacrum. DESIGN: Osteological Study. METHODS: Twelve disarticulated lumbosacral spines (n = 72 individual bones) were used in this study. Needles were placed along the periosteum of the posterior half of the lateral neck of SAP, bilaterally and photographed. Mean needle angles for each vertebral level (L1-L5) and sacrum were quantified, and statistical differences were analyzed. RESULTS: The posterior view provided the degrees of lateral displacement from the parasagittal plane (abduction angle), while the lateral view provided the degrees of declination (cranial-to-caudal angle) of the needle. Mean needle angles at each level varied, ranging from 5.63 ± 5.76° to 14.50 ± 14.24° (abduction angle, posterior view) and 40.17 ± 7.32° to 64.10 ± 9.73° (cranial-to-caudal angle, lateral view). In posterior view, a < 10-degree needle angle interval was most frequently identified (57.0% of needle placements). In lateral view, the 40-50-degree (L1-L2), 50-60-degree (L3-L5), and 60-70-degree (sacrum) needle angle intervals occurred most frequently (54.2%, 50.0%, and 41.7% of needle placements, respectively). CONCLUSIONS: Targeting the posterior half of the lateral neck of SAP required <10-degree angulation from parasagittal plane in majority of cases. However, variability of needle angles suggests a standard "one-size-fits-all" approach may not be the optimal technique.

Microscopic origin of the effect of substrate metallicity on interfacial free energies.

We investigate the effect of the metallic character of solid substrates on solid-liquid interfacial thermodynamics using molecular simulations. Building on the recent development of a semiclassical Thomas-Fermi model to tune the metallicity in classical molecular dynamics simulations, we introduce a thermodynamic integration framework to compute the evolution of the interfacial free energy as a function of the Thomas-Fermi screening length. We validate this approach against analytical results for empty capacitors and by comparing the predictions in the presence of an electrolyte with values determined from the contact angle of droplets on the surface. The general expression derived in this work highlights the role of the charge distribution within the metal. We further propose a simple model to interpret the evolution of the interfacial free energy with voltage and Thomas-Fermi length, which allows us to identify the charge correlations within the metal as the microscopic origin of the evolution of the interfacial free energy with the metallic character of the substrate. This methodology opens the door to the molecular-scale study of the effect of the metallic character of the substrate on confinement-induced transitions in ionic systems, as reported in recent atomic force microscopy and surface force apparatus experiments.

Real-Time Visual Feedback Based on MIMUs Technology Reduces Bowing Errors in Beginner Violin Students.

Violin is one of the most complex musical instruments to learn. The learning process requires constant training and many hours of exercise and is primarily based on a student-teacher interaction where the latter guides the beginner through verbal instructions, visual demonstrations, and physical guidance. The teacher's instruction and practice allow the student to learn gradually how to perform the correct gesture autonomously. Unfortunately, these traditional teaching methods require the constant supervision of a teacher and the interpretation of non-real-time feedback provided after the performance. To address these limitations, this work presents a novel interface (Visual Interface for Bowing Evaluation-VIBE) to facilitate student's progression throughout the learning process, even in the absence of direct teacher intervention. The proposed interface allows two key parameters of bowing movements to be monitored, namely, the angle between the bow and the string (i.e., α angle) and the bow tilt (i.e., ß angle), providing real-time visual feedback on how to correctly move the bow. Results collected on 24 beginners (12 exposed to visual feedback, 12 in a control group) showed a positive effect of the real-time visual feedback on the improvement of bow control. Moreover, the subjects exposed to visual feedback judged the latter as useful to correct their movement and clear in terms of the presentation of data. Although the task was rated as harder when performed with the additional feedback, the subjects did not perceive the presence of a violin teacher as essential to interpret the feedback.

Measurements of Spatial Angles Using Diamond Nitrogen-Vacancy Center Optical Detection Magnetic Resonance.

This article introduces a spatial angle measuring device based on ensemble diamond nitrogen-vacancy (NV) center optical detection magnetic resonance (ODMR). This device realizes solid-state all-optical wide-field vector magnetic field measurements for solving the angles of magnetic components in space. The system uses diamond NV center magnetic microscope imaging to obtain magnetic vector distribution and calculates the spatial angles of magnetic components based on the magnetic vector distribution. Utilizing magnetism for angle measuring enables non-contact measuring, reduces the impact on the object being measured, and ensures measurement precision and accuracy. Finally, the accuracy of the system is verified by comparing the measurement results with the set values of the angle displacement platform. The results show that the measurement error of the yaw angle of the system is 1°, and the pitch angle and roll angle are 1.5°. The experimental results are in good agreement with the expected results.

Quaternion-Based Attitude Estimation of an Aircraft Model Using Computer Vision.

Investigating aircraft flight dynamics often requires dynamic wind tunnel testing. This paper proposes a non-contact, off-board instrumentation method using vision-based techniques. The method utilises a sequential process of Harris corner detection, Kanade-Lucas-Tomasi tracking, and quaternions to identify the Euler angles from a pair of cameras, one with a side view and the other with a top view. The method validation involves simulating a 3D CAD model for rotational motion with a single degree-of-freedom. The numerical analysis quantifies the results, while the proposed approach is analysed analytically. This approach results in a 45.41% enhancement in accuracy over an earlier direction cosine matrix method. Specifically, the quaternion-based method achieves root mean square errors of 0.0101 rad/s, 0.0361 rad/s, and 0.0036 rad/s for the dynamic measurements of roll rate, pitch rate, and yaw rate, respectively. Notably, the method exhibits a 98.08% accuracy for the pitch rate. These results highlight the performance of quaternion-based attitude estimation in dynamic wind tunnel testing. Furthermore, an extended Kalman filter is applied to integrate the generated on-board instrumentation data (inertial measurement unit, potentiometer gimbal) and the results of the proposed vision-based method. The extended Kalman filter state estimation achieves root mean square errors of 0.0090 rad/s, 0.0262 rad/s, and 0.0034 rad/s for the dynamic measurements of roll rate, pitch rate, and yaw rate, respectively. This method exhibits an improved accuracy of 98.61% for the estimation of pitch rate, indicating its higher efficiency over the standalone implementation of the direction cosine method for dynamic wind tunnel testing.

An Improved Initial Alignment Method Based on SE2(3)/EKF for SINS/GNSS Integrated Navigation System with Large Misalignment Angles.

This paper proposes an improved initial alignment method for a strap-down inertial navigation system/global navigation satellite system (SINS/GNSS) integrated navigation system with large misalignment angles. Its methodology is based on the three-dimensional special Euclidean group and extended Kalman filter (SE2(3)/EKF) and aims to overcome the challenges of achieving fast alignment under large misalignment angles using traditional methods. To accurately characterize the state errors of attitude, velocity, and position, these elements are constructed as elements of a Lie group. The nonlinear error on the Lie group can then be well quantified. Additionally, a group vector mixed error model is developed, taking into account the zero bias errors of gyroscopes and accelerometers. Using this new error definition, a GNSS-assisted SINS dynamic initial alignment algorithm is derived, which is based on the invariance of velocity and position measurements. Simulation experiments demonstrate that the alignment method based on SE2(3)/EKF can achieve a higher accuracy in various scenarios with large misalignment angles, while the attitude error can be rapidly reduced to a lower level.

Effect of Data and Gap Characteristics on the Nonlinear Calculation of Motion During Locomotor Activities.

This study investigated how data series length and gaps in human kinematic data impact the accuracy of Lyapunov exponents (LyE) calculations with and without cubic spline interpolation. Kinematic time series were manipulated to create various data series lengths (28% and 100% of original) and gap durations (0.05-0.20 s). Longer gaps generally resulted in significantly higher LyE% error values in each plane in noninterpolated data. During cubic spline interpolation, only the 0.20-second gap in frontal plane data resulted in a significantly higher LyE% error. Data series length did not significantly affect LyE% error in noninterpolated data. During cubic spline interpolation, sagittal plane LyE% errors were significantly higher at shorter versus longer data series lengths. These findings suggest that not interpolating gaps in data could lead to erroneously high LyE values and mischaracterization of movement variability. When applying cubic spline, a long gap length (0.20 s) in the frontal plane or a short sagittal plane data series length (1000 data points) could also lead to erroneously high LyE values and mischaracterization of movement variability. These insights emphasize the necessity of detailed reporting on gap durations, data series lengths, and interpolation techniques when characterizing human movement variability using LyE values.

Computational approaches to amino acid side-chain conformation using combined NMR theoretical and experimental results: leucine-67 in Desulfovibrio vulgaris flavodoxin.

In this paper, we show that the combination of NMR theoretical and experimental results can help to solve the molecular structure of peptides, here it is used as an example the residue Leucine-67 in Desulfovibrio vulgaris flavodoxin. We apply a computational protocol based on the leucine amino acid dipeptide, which, using calculated and experimental spin-spin coupling constants, allows us to obtain the conformation of the amino acid side chain. Calculated results show that the best agreement is obtained when three conformers around the lateral chain angle $\chi _1$ are considered or when the dynamic effect in the torsional angles is included. The population of each structure is estimated and analyzed according to the correlation between those two approaches. Independently of the approach, the estimated $\chi _1$ angle in solution is close to the staggered value of -60$^\circ $ and deviates significantly from the average x-ray angle of -90$^\circ $.

Optimizing variable flip angles in magnetization-prepared gradient-echo sequences for efficient 3D-T1ρ mapping.

PURPOSE: To optimize the choice of the flip angles of magnetization-prepared gradient-echo sequences for improved accuracy, precision, and speed of 3D-T1ρ mapping. METHODS: We propose a new optimization approach for finding variable flip-angle values that improve magnetization-prepared gradient-echo sequences used for 3D-T1ρ mapping. This new approach can improve the accuracy and SNR, while reducing filtering effects. We demonstrate the concept in the three different versions of the magnetization-prepared gradient-echo sequences that are typically used for 3D-T1ρ mapping and evaluate their performance in model agarose phantoms (n = 4) and healthy volunteers (n = 5) for knee joint imaging. We also tested the optimization with sequence parameters targeting faster acquisitions. RESULTS: Our results show that optimized variable flip angle can improve the accuracy and the precision of the sequences, seen as a reduction of the mean of normalized absolute difference from about 5%-6% to 3%-4% in model phantoms and from 15%-16% to 11%-13% in the knee joint, and improving SNR from about 12-28 to 22-32 in agarose phantoms and about 7-14 to 13-17 in healthy volunteers. The optimization can also compensate for the loss in quality caused by making the sequence faster. This results in sequence configurations that acquire more data per unit of time with SNR and mean of normalized absolute difference measurements close to its slower versions. CONCLUSION: The optimization of the variable flip angle can be used to increase accuracy and precision, and to improve the speed of the typical imaging sequences used for quantitative 3D-T1ρ mapping of the knee joint.

Optimal flip angles for in vivo liver 3D T1 mapping and B1+ mapping at 3T.

PURPOSE: The spoiled gradient recalled echo (SPGR) sequence with variable flip angles (FAs) enables whole liver T 1 $$ {T}_1 $$ mapping at high spatial resolutions but is strongly affected by B 1 + $$ {B}_1^{+} $$ inhomogeneities. The aim of this work was to study how the precision of acquired T 1 $$ {T}_1 $$ maps is affected by the T 1 $$ {T}_1 $$ and B 1 + $$ {B}_1^{+} $$ ranges observed in the liver at 3T, as well as how noise propagates from the acquired signals into the resulting T 1 $$ {T}_1 $$ map. THEORY: The T 1 $$ {T}_1 $$ variance was estimated through the Fisher information matrix with a total noise variance including, for the first time, the B 1 + $$ {B}_1^{+} $$ map noise as well as contributions from the SPGR noise. METHODS: Simulations were used to find the optimal FAs for both the B 1 + $$ {B}_1^{+} $$ mapping and T 1 $$ {T}_1 $$ mapping. The simulations results were validated in 10 volunteers. RESULTS: Four optimized SPGR FAs of 2°, 2°, 15°, and 15° (TR = 4.1 ms) and B 1 + $$ {B}_1^{+} $$ map FAs of 65° and 130° achieved a T 1 $$ {T}_1 $$ coefficient of variation of 6.2 ± 1.7% across 10 volunteers and validated our theoretical model. Four optimal FAs outperformed five uniformly spaced FAs, saving the patient one breath-hold. For the liver B 1 + $$ {B}_1^{+} $$ and T 1 $$ {T}_1 $$ parameter space at 3T, a higher return in T 1 $$ {T}_1 $$ precision was obtained by investing FAs in the SPGR acquisition rather than in the B 1 + $$ {B}_1^{+} $$ map. CONCLUSION: A novel framework was developed and validated to calculate the SPGR T 1 $$ {T}_1 $$ variance. This framework efficiently identifies optimal FA values and determines the total number of SPGR and B 1 + $$ {B}_1^{+} $$ measurements needed to achieve a desired T 1 $$ {T}_1 $$ precision.

Quantification of Needle Angles for Traditional Lumbar Medial Branch Radiofrequency Ablation: An Osteological Study.

BACKGROUND: Clinical outcomes following lumbar medial branch radiofrequency ablation (RFA) have been inconsistent. One possible reason is less-than-optimal placement of the electrode along the medial branch at the lateral neck of superior articular process (SAP). Needle angles that define optimal placement (i.e., parallel to the medial branch) may be helpful for consistent technical performance of RFA. Despite its importance, there is a lack of anatomical studies that quantify RFA needle placement angles. OBJECTIVE: To quantify and compare needle angles to achieve parallel placement along the medial branch as it courses on the middle two-quarters of the lateral neck of the SAP at the L1-L5 vertebrae. DESIGN: Osteological Study. METHODS: Ten lumbar vertebral columns were used in this study. Needles were placed along the periosteum of the middle two-quarters of the lateral neck of SAP. Mean needle angles for L1-L5 were quantified and compared using posterior (n = 100) and lateral (n = 100) photographs. RESULTS: Mean needle angles varied ranging from 29.29 ± 17.82° to 47.22 ± 16.27° lateral to the parasagittal plane (posterior view) and 33.53 ± 10.23° to 49.19 ± 10.69° caudal to the superior vertebral endplate (lateral view). Significant differences in mean angles were found between: L1/L3 (P = .008), L1/L4 (P = .003), and L1/L5 (P = .040) in the posterior view and L1/L3 (P = .042), L1/L4 (P < .001), L1/L5 (P < .001), L2/L4 (P = .004), and L2/L5 (P = .004) in lateral view. CONCLUSIONS: Variability of needle angles suggest a standard "one-size-fits-all" approach may not be the optimal technique. Future research is necessary to determine optimal patient-specific needle angles from a more detailed and granular analysis of fluoroscopic landmarks.

Radiographic measurements for the prediction of dysphagia after occipitocervical fusion: a systematic review.

BACKGROUND: Occipitocervical fusion (OCF) is a procedure performed for multiple upper cervical pathologies. A common postprocedural complication of OCF is dysphagia, which has been linked to the narrowing of the pharyngeal space due to fixation in a hyper-flexed angle. Postoperative dysphagia is linked to reduced quality of life, prolonged hospital stay, aspiration pneumonia, and increased mortality. This has led to investigations of the association between sagittal radiographic angles and dysphagia following OCF. METHODS: A systematic review of the literature was performed to explore the current evidence regarding cervical sagittal radiographic measurements and dysphagia following OCF. A search strategy was carried out using the PubMed, Embase, and Web of Science databases from their dates of inception until August 2022. Only original English-language studies were considered. Moreover, studies had to include the correlation between dysphagia and at least one radiographic measurement in the sagittal plane. RESULTS: The search and subsequent selection process yielded eight studies that were included in the final review, totaling 329 patients in whom dysphagia had been assessed and graded. The dysphagia score by Bazaz et al. (Spine 27, 22:2453-2458, 2002) was used most often. The pooled incidence of dysphagia, in the early postoperative period, was estimated at 26.4%. At long-term follow-up (range: 17-72 months), about one-third of patients experienced resolution of symptoms, which resulted in a long-term post-OCF dysphagia incidence of 16.5%. Across the studies included, six different radiographic parameters were used to derive several measures which were repeatedly and significantly associated with the occurrence of dysphagia. CONCLUSIONS: The high incidence of postoperative dysphagia following OCF warrants close monitoring of patients, especially in the short-term postoperative period. These patients may be assessed through standardized tools where the one by Bazaz et al. was the most commonly used. Moreover, there are several radiographic measurements that can be used to predict the occurrence of dysphagia. These findings may serve as a basis for strategies to prevent the occurrence of dysphagia after OCF.

High and low performers in internal rotation after reverse total shoulder arthroplasty: a biplane fluoroscopic study.

BACKGROUND: Internal rotation in adduction is often limited after reverse total shoulder arthroplasty (rTSA), but the origins of this functional deficit are unclear. Few studies have directly compared individuals who can and cannot perform internal rotation in adduction. Little data on underlying 3D humerothoracic, scapulothoracic, and glenohumeral joint relationships in these patients are available. METHODS: Individuals >1-year postoperative to rTSA were imaged with biplane fluoroscopy in resting neutral and internal rotation in adduction poses. Subjects could either perform internal rotation in adduction with their hand at T12 or higher (high, N = 7), or below the hip pocket (low, N = 8). Demographics, the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and scapular notching grade were recorded. Joint orientation angles were derived from model-based markerless tracking of the scapula and humerus relative to the torso. The 3D implant models were aligned to preoperative computed tomography models to evaluate bone-implant impingement. RESULTS: The Simple Shoulder Test was highest in the high group (11 ± 1 vs. 9 ± 2, P = .019). Two subjects per group had scapular notching (grades 1 and 2), and 3 high group and 4 low group subjects had impingement below the glenoid. In the neutral pose, the scapula had 7° more upward rotation in the high group (P = .100), and the low group demonstrated 9° more posterior tilt (P = .017) and 14° more glenohumeral elevation (P = .047). In the internal rotation pose, axial rotation was >45° higher in the high group (P ≤ .008) and the low group again had 11° more glenohumeral elevation (P = .058). Large rotational differences within subject groups arose from a combination of differences in the resting neutral and maximum internal rotation in adduction poses, not only the terminal arm position. CONCLUSIONS: Individuals who were able to perform high internal rotation in adduction after rTSA demonstrated differences in joint orientation and anatomic biases versus patients with low internal rotation. The high rotation group had 7° more resting scapular upward rotation and used a 15°-30° change in scapular tilt to perform internal rotation in adduction versus patients in the low group. The combination of altered resting scapular posture and restricted scapulothoracic range of motion could prohibit glenohumeral rotation required to reach internal rotation in adduction. In addition, inter-patient variation in humeral torsion may contribute substantially to postoperative internal rotation differences. These data point toward modifiable implant design and placement factors, as well as foci for physical therapy to strengthen and mobilize the scapula and glenohumeral joint in response to rTSA surgery.