A Case of Segmental Vitiligo Occurring Where Herpes Zoster Occurred Previously as an Isotopic Response / 대한피부과학회지

Wolf's isotopic response is defined as the occurrence of a new skin disorder at the site of another unrelated skin disease that has already healed. In most cases of isotopic response, the initial dermatosis is herpes infection, and the most frequent second dermatoses are granulomatous reactions. Various interpretations of this phenomenon have been attempted. However, the exact mechanism has not been identified yet. Herein, we report a case in which the secondary disease was segmental vitiligo that appeared over the same dermatomes of herpes zoster. A 71-year-old woman presented with well-defined, depigmented patches on the left chest and back. She had been diagnosed with herpes zoster on the same dermatomes and treated with an antiviral agent 3 years ago. Histological examination showed decreased basal melanin pigments and melanocytes. Consequently, the patient was diagnosed with segmental vitiligo based on the clinical and histological findings.

Diagnosis of Rotator Cuff Tears with Non-Arthrographic MR Imaging: 3D Fat-Suppressed Isotropic Intermediate-Weighted Turbo Spin-Echo Sequence versus Conventional 2D Sequences at 3T

PURPOSE: To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences. MATERIALS AND METHODS: Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE. RESULTS: The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSE-SPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05). CONCLUSION: TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

Analysis of the stress state in articular cartilage defect repairing area / 生物医学工程学杂志

Based on transversely isotropic theory, a finite element model for three-dimensional solid-liquid coupling defect repair of articular cartilage was established. By studying stress state of host cartilage near the restoration interface, we identified deformation type of cartilage and discussed the cause of restoration interface cracking. The results showed that the host cartilage surface node near the restoration interface underwent compression deformation in the condition of surface layer defect repair. When the middle layer, deep layer or full-thickness defect were repaired, the node underwent tensile deformation. At this point, the radial dimension of cartilage increased, which might cause restoration interface cracking. If elastic modulus of the tissue engineered cartilage (TEC) was lower (0.1 MPa, 0.3 MPa), the host cartilage surface layer and middle layer mainly underwent tensile deformation. While elastic modulus of TEC was higher (0.6 MPa, 0.9 MPa), each layer of host cartilage underwent compression deformation. Therefore, the elastic modulus of TEC could be increased properly for full-thickness defect repair. This article provides a new idea for evaluating the effect of cartilage tissue engineering repair, and has a certain guiding significance for clinical practice.

Diagnosis of Nerve Root Compromise of the Lumbar Spine: Evaluation of the Performance of Three-dimensional Isotropic T2-weighted Turbo Spin-Echo SPACE Sequence at 3T

OBJECTIVE: To explore the performance of three-dimensional (3D) isotropic T2-weighted turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) sequence on a 3T system, for the evaluation of nerve root compromise by disc herniation or stenosis from central to extraforaminal location of the lumbar spine, when used alone or in combination with conventional two-dimensional (2D) TSE sequence. MATERIALS AND METHODS: Thirty-seven patients who had undergone 3T spine MRI including 2D and 3D sequences, and had subsequent spine surgery for nerve root compromise at a total of 39 nerve levels, were analyzed. A total of 78 nerve roots (48 symptomatic and 30 asymptomatic sites) were graded (0 to 3) using different MRI sets of 2D, 3D (axial plus sagittal), 3D (all planes), and combination of 2D and 3D sequences, with respect to the nerve root compromise caused by posterior disc herniations, lateral recess stenoses, neural foraminal stenoses, or extraforaminal disc herniations; grading was done independently by two readers. Diagnostic performance was compared between different imaging sets using the receiver operating characteristics (ROC) curve analysis. RESULTS: There were no statistically significant differences (p = 0.203 to > 0.999) in the ROC curve area between the imaging sets for both readers 1 and 2, except for combined 2D and 3D (0.843) vs. 2D (0.802) for reader 1 (p = 0.035), and combined 2D and 3D (0.820) vs. 3D including all planes (0.765) for reader 2 (p = 0.049). CONCLUSION: The performance of 3D isotropic T2-weighted TSE sequence of the lumbar spine, whether axial plus sagittal images, or all planes of images, was not significantly different from that of 2D TSE sequences, for the evaluation of nerve root compromise of the lumbar spine. Combining 2D and 3D might possibly improve the diagnostic accuracy compared with either one.

Influence of different abutment diameter of implants on the peri‑implant stress in the crestal bone: A Three‑dimensional finite element analysis ‑ In vitro study.

Purpose of the Study: The study was designed to evaluate and compare stress distribution in transcortical section of bone with normal abutment and platform switched abutment under vertical and oblique forces in posterior mandible region. Materials and Methods: A three‑dimensional finite element model was designed using ANSYS 13.0 software. The type of bone selection for the model was made of type II mandibular bone, having cortical bone thickness ranging from 0.595 mm to 1.515 mm with the crestal region measuring 1.5 mm surrounding dense trabecular bone. The implant will be modulated at 5 mm restorative platform and tapering down to 4.5 mm wide at the threads, 13 mm long with an abutment 3 mm in height. The models will be designed for two situations: (1) An implant with a 5 mm diameter abutment representing a standard platform in the posterior mandible region. (2) An implant with a 4.5 mm diameter abutment representing platform switching in the posterior mandible region. Force application was performed in both oblique and vertical conditions using 100 N as a representative masticatory force. For oblique loading, a force of 100 N was applied at 15° from the vertical axis. von Mises stress analysis was evaluated. Results: The results of the study showed cortical stress in the conventional and platform switching model under oblique forces were 59.329 MPa and 39.952 MPa, respectively. Cortical stress in the conventional and platform switching model under vertical forces was 13.914 MPa and 12.793 MPa, respectively. Conclusion: Results from this study showed the platform switched abutment led to relative decrease in von Mises stress in transcortical section of bone compared to normal abutment under vertical and oblique forces in posterior mandible region.

Monobloque aspecto funcional: postes de fibra de vidrio / Monoblocks and functionality: the case for fiberglass posts

Durante muchos años se han utilizado los postes colados, considerados como un estándar en la odontología protésica, pero presentan limitantes técnicas y mecánicas, ya que exhiben altos módulos de elasticidad y, por lo mismo, imposibilitan la capacidad de disipar las fuerzas con efectividad, lo que significa concentrar tensiones dentro del conducto radicular. Literatura basada en evidencia científica describe a los postes de fibra de vidrio con módulos de elasticidad semejantes o próximos a la dentina, presentando propiedades anisotrópicas, en comparación con los postes tradicionales, que presentan propiedades isotrópicas. Se propone un concepto restaurador que involucra el poste, el cemento y la dentina, constituyendo un complejo homogéneo denominado ®monobloque¼ que permite un mejor comportamiento mecánico benéfico para el remanente dentario

For many years now, cast posts have been regarded as standard in prosthetics despite the technical and mechanical limitations caused by their high moduli of elasticity, which prevent the forces involved from being effectively dissipated and, therefore, concentrate stress within the root canal. Scientifi c evidence-based literature describes fi berglass posts with moduli of elasticity similar to or approaching that of dentin as having anisotropic properties, as opposed to the isotropic properties of traditional posts. We propose a restorative approach that involves the post, the cement, and the dentin, forming a homogeneous complex known as a ®monobloc¼ that enables enhanced mechanical behavior that benefits the remaining tooth structure.

Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears

OBJECTIVE: To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. MATERIALS AND METHODS: The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). RESULTS: Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. CONCLUSION: 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

Quantitative Assessment and Ligament Traceability of Volume Isotropic Turbo Spin Echo Acquisition (VISTA) Ankle Magnetic Resonance Imaging: Fat Suppression versus without Fat Suppression

PURPOSE: To compare the image quality and ligament traceability in ankle images obtained using Volume Isotropic Turbo Spin Echo Acquisition (VISTA) MRI with and without fat suppression. MATERIALS AND METHODS: The signal-to-noise ratios (SNRs) in images from a phantom and from the ankle of a volunteer were compared. Ten ankles from 10 non-symptomatic volunteers were imaged for comparisons of contrast ratio (CR) and ligament traceability. All examinations were performed using VISTA sequences with and without fat suppression on a 3T MRI scanner. The SNRs were obtained from images with subjects and without subjects (noise-only). Contrast ratios from images of the 10 ankles were acquired between fluid and tendon (F-T), F-cartilage (C), F-ligament (L), fat (f)-T, f-C and f-L. Two musculoskeletal radiologists independently scored the traceability of 7 ligaments, in sagittal, axial and coronal images respectively, based on a 4-point scale (1 as not traceable through 4 as clearly traceable). The Wilcoxon signed-rank test was used to compare the CR. Fisher's exact test and Pearson's chi-squared test were used to compare the ligament traceability. RESULTS: The SNRs did not differ significantly between the two sequences except in bone marrow. VISTA SPAIR showed the higher CR only in F-T (p = 0.04), whereas VISTA showed higher CR in f-T (p = 0.005), f-C (p = 0.005) and f-L (p = 0.005). The calcaneofibular ligament traceability with VISTA was superior to that obtained with VISTA SPAIR (p < 0.05) in all planes. CONCLUSION: VISTA showed significant superiority to VISTA SPAIR in tracing CFL due to the superior CR between fat and ligament.

Application of balanced turbo field echo and enhanced T1 high-resolution isotropic volume excitation imaging in patients before performing microvascular decompression in the posterior cranial fossa / 中华神经医学杂志

Objective To explore the applied value of balanced turbo field echo (BTFE)Cine-MR imaging and enhanced T1 high-resolution isotropic volume excitation (e-THRIVE) imaging in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) before performing microvascular decompression (MVD).Methods One hundred and twenty-one patients (74 patients with TN and 47 with HFS),admitted to our hospital from April 2009 to December 2011,were chosen in our study; a scan with ACHIEVA NOVA DUAL A-serial 1.5 T MR Machine using the BTFE and e-THRIVE serial besides conventional head MR imaging was performed on these patients.All the MR imaging data were retrospectively analyzed.Results All the patients were confirmed by microvascular decompression.The facial nerves of 74 patients with TN and 47 with HFS were displayed well.Responsible capillaries were found in 118 patients (98％):the related vessel was superior cerebellar artery in 52 patients (70％) of 74 patients with TN and anterior inferior cerebellar artery in 29 patients (625) of 47 patients with HFS.The compression style included oblique cross,parallel or vertical compression.Conclusion BTFE MR imaging and e-THRIVE imaging can show the trigeminal nerve,facial nerve and microvascular vessel in the posterior cranial fossa clearly; combining space-link method and multiplanar reconstruction,they can help us find the related vessel and provide preoperative guidance before microvascular decompression for patients with TN and HFS.

Qualitative and Quantitative Assessment of Isotropic Ankle Magnetic Resonance Imaging: Three-Dimensional Isotropic Intermediate-Weighted Turbo Spin Echo versus Three-Dimensional Isotropic Fast Field Echo Sequences

OBJECTIVE: To compare the image quality of volume isotropic turbo spin echo acquisition (VISTA) imaging method with that of the three-dimensional (3D) isotropic fast field echo (FFE) imaging method applied for ankle joint imaging. MATERIALS AND METHODS: MR imaging of the ankles of 10 healthy volunteers was performed with VISTA and 3D FFE sequences by using a 3.0 T machine. Two radiologists retrospectively assessed the tissue contrast between fluid and cartilage (F-C), and fluid and the Achilles tendon (F-T) with use of a 4-point scale. For a quantitative analysis, signal-to-noise ratio (SNR) was obtained by imaging phantom, and the contrast ratios (CRs) were calculated between F-T and F-C. Statistical analyses for differences in grades of tissue contrast and CRs were performed. RESULTS: VISTA had significantly superior grades in tissue contrast of F-T (p = 0.001). Results of 3D FFE had superior grades in tissue contrast of F-C, but these result were not statistically significant (p = 0.157). VISTA had significantly superior CRs in F-T (p = 0.002), and 3D FFE had superior CRs in F-C (p = 0.003). The SNR of VISTA was higher than that of 3D FFE (49.24 vs. 15.94). CONCLUSION: VISTA demonstrates superior tissue contrast between fluid and the Achiles tendon in terms of quantitative and qualitative analysis, while 3D FFE shows superior tissue contrast between fluid and cartilage in terms of quantitative analysis.

Modelo de endurecimiento isotrópico con esquema de integración explícita para biomateriales y su aplicación a la expansión de stents / Isotropic hardening model with explicit integration scheme for biomaterial and its application to stents expansion

Se presenta un modelo de endurecimiento isotrópico para biomateriales metálicos, el cual emplea un esquema de integración explícita bajo una formulación incremental. Para la implementación computacional se programó un elemento finito de usuario UEL en lenguaje FORTRAN para su ejecución en el software ABAQUS. Con el fin de validar el modelo se resuelven dos ejemplos tipo benchmark y sus resultados son comparados con ANSYS y el UMAT de Dunne y Petrinic para ABAQUS. Finalmente, el modelo es usado para simular la extensión de un stent coronario fabricado en acero inoxidable 316L. Se concluye que el modelo posee un error numérico aceptable teniendo en cuenta que el elemento finito fue programado por completo y no posee ninguna de las optimizaciones de los códigos comerciales. En trabajos futuros el UEL será acoplado con modelos de mecánica de daño continuo para la predicción de la falla por fatiga, cuyo análisis es un estándar básico en la manufactura de stents

A isotropic hardening model is presented for metallic biomaterials, which uses a explicit integration scheme under increasing formula. To computer implementation a finite element from UEL user was programmed in FORTRAN language for its execution in the ABAQUS software. To model validation two examples type benchmark were solved and results are compared with ANSYS and the UMAT of Dunne and Petrinic for ABAQUS. Finally, model is used to simulate the extension of a coronary stent manufactures in 316L stainless steel. We conclude that the model has an acceptable numerical error taking into account that finite element was programmed as a whole and has not any of the optimizations of commercial codes. In future papers the UEL will be coupled with continuous damage mechanics model to predict the failure due to fatigue, whose analysis is a basic standard in stent manufacturing

Nanoemulsions as vehicles for transdermal delivery of glycyrrhizin

The present investigation aims to evaluate an isotropic and thermodynamically stable nanoemulsion formulation for transdermal delivery of glycyrrhizin (GZ), with minimum surfactant and cosurfactant (Smix) concentrations that could improve its solubility, permeation enhancement, and stability. Pseudo-ternary phase diagrams were developed and various nanoemulsion formulations were prepared using soyabean oil as oil, Span 80, Brij 35 as a surfactant and isopropyl alcohol as a cosurfactant. Nanoemulsion formulations that passed the thermodynamic stability tests were characterized for pH, viscosity and droplet size using a transmission electron microscopy. The transdermal ability of glycyrrhizin through human cadaver skin was determined using Franz diffusion cells. The in vitro skin permeation profile of the optimized nanoemulsion formulation (NE2) was compared to that of conventional gel. A significant increase in permeability parameters such as steady-state flux (Jss) and permeability coefficient (Kp) was observed in the optimized nanoemulsion formulation (NE2), which consisted of 1 percent wt/wt of mono ammonium glycyrrhizinate (MAG), 32.4 percent Span 80, 3.7 percent Brij 35, 10 percent isopropyl alcohol, 46.5 percent soyabean oil and 6.4 percent distilled water. No obvious skin irritation was observed for the studied nanoemulsion formulation (NE2) or the gel. The results indicated that nanoemulsions are promising vehicles for transdermal delivery of glycyrrhizin through human cadaver skin, without the use of additional permeation enhancers, because excipients of nanoemulsions act as permeation enhancers themselves.

O objetivo da investigação é avaliar uma nanoemulsão isotrópica termodinamicamente estável para a administração transdérmica da glicirrizina (GZ), com concentrações mínimas de tensoativo e co-tensoativo (Smix), que poderiam melhorar a sua solubilidade, a permeação e a estabilidade. Os diagramas pseudo-ternários de fase foram desenvolvidos e diversas nanoemulsões foram preparadas com óleo de soja como óleo, Span 80, Brij 35 como tensoativos e álcool isopropílico como co-tensoativo. As nanoemulsões que passaram por testes de estabilidade termodinâmica foram caracterizadas por pH, viscosidade, tamanho de gota e microscopia eletrônica de transmissão. A capacidade transdérmica da glicirrizina em passar através da pele de cadáver humano foi determinada por células de difusão de Franz. O perfil in vitro de permeação cutânea da formulação otimizada (NE2) foi comparada com a de gel convencional. Observou-se aumento significativo nos parâmetros de permeabilidade, como fluxo de equilíbrio (JSS) e coeficiente de permeabilidade (Kp) na formulação otimizado (NE2), que consistiu de 1 por cento wt/wt de monoglicirrizinato de amônio (MAG), 32,4 por cento de Span 80, 3,7 por cento de Brij 35, 10 por cento de álcool isopropílico, 46,5 por cento de óleo de soja e 6,4 por cento de água destilada. Não se observou irritação óbvia da pele para as nanoemulsões estudadas (NE2) ou de gel. Os resultados indicaram que nanoemulsões são promissores veículos para a administração transdérmica de glicirrizina através da pele de cadáveres humanos, sem o uso adicional de promotor de permeação, porque excipientes de nanoemulsões atuam como promotores de permeação.

Imaging anatomic characteristics of petrosal vein studied by Three-dimensional imaging technology of magnetic resonance / 中华神经医学杂志

Objective To analyze the normal anatomy of petrosal vein and the space adjacent relationship between the petrosal vein and the homolateral trigeminal nerve by balanced turbo field echo (B-TFE) Cine-MR imaging and enhanced T1 high-resolution isotropic volume excitation (e-THRIVE)imaging.Methods Forty-one patients with facial spasm and epileptiform neuralgia were selected and taken a scan with ACHIEVA NOVA DUAL A-serial 1.5T MR machine using the BTFE and e-THRIVE series.The space adjacent relationship between the petrosal vein and the trigeminal nerve in cerebellopontine angle were observed.Results The 82 sides of petrosal veins and homolateral trigeminal nerves (41 cases) were displayed well.Petrosal veins were located in cavitas subarachnoidealis,partly in free state; the number of trunk ofpetrosal vein could be 1,2,3,respectively,responding to 70 (86%),10 (12%),2 (2%).The petrosal veins located in the dorsal-lateral of trigeminal nerve were found in 74 sides (37 cases,91%,by BTFE,e-THRIVE series),the petrosal veins located in the ventri-lateral of trigeminal nerve in 6 sides (3 cases,7%,by e-THRIVE series),and the petrosal veins located in the right upon trigeminal nerve in 2 sides (1 cases,2%,by BTFE series).Conclusion B-TFE MR imaging and e-THR/VE imaging,showing the petrosal veins and trigeminal nerves clearly and evaluating their relationship accurately,can provide information of topographic anatomy before microsurgical vascular decompression.

Evaluation of Magnetization Transfer Ratio Imaging by Phase Sensitive Method in Knee Joint / 의학물리

Although MR imaging is generally applicable to depict knee joint deterioration it, is sometimes occurred to mis-read and mis-diagnose the common knee joint diseases. In this study, we employed magnetization transfer ratio (MTR) method to improve the diagnosis of the various knee joint diseases. Spin-echo (SE) T2-weighted images (TR/TE 3,400-3,500/90?100 ms) were obtained in seven cases of knee joint deterioration, FSE T2-weighted images (TR/TE 4,500-5,000/100?108 ms) were obtained in seven cases of knee joint deterioration, gradient-echo (GRE) T2-weighted images (TR/TE 9/4.56/50degrees flip angle, NEX 1) were obtained in 3 cases of knee joint deterioration, In six cases of knee joint deterioration, fat suppression was performed using a T2-weighted short T1/tau inverse recovery (STIR) sequence (TR/TE =2,894-3,215 ms/70 ms, NEX 3, ETL 9). Calculation of MTR for individual pixels was performed on registration of unsaturated and saturated images. After processing to make MTR images, the images were displayed in gray color. For improving diagnosis, three-dimensional isotropic volume images, the MR tristimulus color mapping and the MTR map was employed. MTR images showed diagnostic images quality to assess the patients' pathologies. The intensity difference between MTR images and conventional MRI was seen on the color bar. The profile graph on MTR imaging effect showed a quantitative measure of the relative decrease in signal intensity due to the MT pulse. To diagnose the pathologies of the knee joint, the profile graph data was shown on the image as a small cross. The present study indicated that MTR images in the knee joint were feasible. Investigation of physical change on MTR imaging enables to provide us more insight in the physical and technical basis of MTR imaging. MTR images could be useful for rapid assessment of diseases that we examine unambiguous contrast in MT images of knee disorder patients.