Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes.

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications.Level of Evidence: Level IV: Case series.

Kinematic analysis of a Duchenne smile.

OBJECTIVE: Facial expressions are communicative motor outputs, whose kinematics likely are due to musculoskeletal anatomy, neuromotor activity and the well-being and internal states of the individual. However, little has been published on the kinematics of facial expression. This study quantified lip, eye and cheek movements during the production of a Duchenne smile involving movement of lips and tissues surrounding the eyes. DESIGN: The three-dimensional positions of 20 markers placed around the eyes, cheeks, lips and chins of 24 young adult female subjects were digitized while they performed smiles after practicing to feedback from an investigator trained in the facial action coding system (FACS). Displacement, velocity and acceleration variables were extracted and analyzed from the markers. RESULTS: Results demonstrated several consistencies across subjects including: (1) relatively high peak velocities, accelerations and displacements for lip and cheek markers in the vertical and anteroposterior dimensions, (2) relatively large movements of the lower lateral eye region compared with other eye regions. CONCLUSION: The results indicate that there is significant movement in the anteroposterior dimension that is not observable in frontal views of the face alone.

Functional connectivity of human chewing: an fcMRI study.

Mastication is one of the most important orofacial functions. The neurobiological mechanisms of masticatory control have been investigated in animal models, but less so in humans. This project used functional connectivity magnetic resonance imaging (fcMRI) to assess the positive temporal correlations among activated brain areas during a gum-chewing task. Twenty-nine healthy young-adults underwent an fcMRI scanning protocol while they chewed gum. Seed-based fcMRI analyses were performed with the motor cortex and cerebellum as regions of interest. Both left and right motor cortices were reciprocally functionally connected and functionally connected with the post-central gyrus, cerebellum, cingulate cortex, and precuneus. The cerebellar seeds showed functional connections with the contralateral cerebellar hemispheres, bilateral sensorimotor cortices, left superior temporal gyrus, and left cingulate cortex. These results are the first to identify functional central networks engaged during mastication.

Brain activity and human unilateral chewing: an FMRI study.

Brain mechanisms underlying mastication have been studied in non-human mammals but less so in humans. We used functional magnetic resonance imaging (fMRI) to evaluate brain activity in humans during gum chewing. Chewing was associated with activations in the cerebellum, motor cortex and caudate, cingulate, and brainstem. We also divided the 25-second chew-blocks into 5 segments of equal 5-second durations and evaluated activations within and between each of the 5 segments. This analysis revealed activation clusters unique to the initial segment, which may indicate brain regions involved with initiating chewing. Several clusters were uniquely activated during the last segment as well, which may represent brain regions involved with anticipatory or motor events associated with the end of the chew-block. In conclusion, this study provided evidence for specific brain areas associated with chewing in humans and demonstrated that brain activation patterns may dynamically change over the course of chewing sequences.

Posterior insular molecular changes in myofascial pain.

Temporomandibular disorders (TMD) include craniocervical pain conditions with unclear etiologies. Central changes are suspected; however, few neuroimaging studies of TMD exist. Single-voxel proton magnetic resonance spectroscopy ((1)H-MRS) was used before and after pressure-pain testing to assess glutamate (Glu), glutamine (Gln), N-acetylaspartate (NAA), and choline (Cho) levels in the right and left posterior insulae of 11 individuals with myofascial TMD and 11 matched control individuals. Glu levels were significantly lower in all individuals after pain testing. Among those with TMD, left-insular Gln levels were related to reported pain, left posterior insular NAA and Cho levels were significantly higher at baseline than in control individuals, and NAA levels were significantly correlated with pain-symptom duration, suggesting adaptive changes. The results suggest that significant central cellular and molecular changes can occur in individuals with TMD.

Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia.

Osteoporosis in adult males is an under-recognized problem. Patients with haemophilia have several predisposing factors for developing decreased bone mineral density (BMD) including prolonged periods of immobility, reduced weight bearing and co-morbidities associated with bone loss. To establish prevalence and risk factors associated with decreased BMD in patients with haemophilia. Adults with moderate or severe haemophilia A or B underwent dual-energy X-ray absorptiometry (DXA). BMD was correlated to laboratory values, joint mobility measurements and physical activity questionnaires. Thirty patients completed evaluations. The median age was 41.5 years (range 18-61). Median lowest T-score by DXA was -1.7 (range: -5.8 to +0.6), with the femoral neck being the site of the lowest T-scores. Based on World Health Organization criteria, 70% of patients had decreased BMD. Twenty-seven per cent of the participants (n = 8) had osteoporosis and 43% (n = 13) had osteopenia. Variables associated with increased bone loss included lower serum 25-hydroxyvitamin D levels (P = 0.03), lower body mass index (P = 0.047), lower activity scores (P = 0.02), decreased joint range of motion (P = 0.046), HIV (P = 0.03), HCV (P = 0.02), history of inhibitor (P = 0.01) and age (P = 0.03). Adults with haemophilia are at increased risk for developing osteoporosis. A history of HCV and HIV infections, decreased joint range-of-motion, decreased activity levels, history of an inhibitor and low body weight predict bone loss and suggest a population to target for screening. A high prevalence of vitamin D insufficiency was observed. Future studies should investigate interventions, including vitamin D supplementation, to prevent bone loss and fractures for this at-risk population.

Licking rate adaptations to increased mandibular weight in the adult rat.

In this experiment, chronic mandibular loading was used to study adaptation in licking rate. Twenty-four 115-day-old rats were randomly divided into two groups. The experimental group received 1.791 +/- 0.083 g submandibular gold implants, and the control group received 0.179 +/- 0.009 g submandibular acrylic implants. The animals were videotaped while lapping on two separate occasions preoperatively, and once every week postoperatively for 12 weeks. The videotapes were used to obtain licking rates for each animal at each taping session. The findings showed that licking rate decreased significantly after surgery for both groups; however, the decrease was similar for both the experimental and control groups. This indicates that licking rate was affected by the experimental design, but not specifically by the weight of the gold implant.

Evidence that angiotensin II enhances apomorphine-induced jaw movements via AT1 receptors in the ventrolateral striatum: studies by magnet-sensing system in freely moving rats.

The role of angiotensin AT(1) receptors in the ventrolateral striatum in modulating apomorphine-induced jaw movements was studied using a magnet-sensing system combined with an intracerebral drug microinjection technique in freely moving rats. Bilateral injections of angiotensin II (1 and 2 micro g/0.2 micro l in each side) into the ventrolateral striatum, which alone did not significantly elicit jaw movements, dose-dependently enhanced apomorphine (1 mg/kg i.v.)-induced repetitive jaw movements. The enhancement of apomorphine-induced jaw movements by angiotensin II (2 micro g) was dose-dependently antagonized by the angiotensin AT(1) receptor antagonist losartan (15 and 30 mg/kg i.p.), given 3 h before, while losartan (30 mg/kg i.p.) alone did not significantly affect the apomorphine (1 mg/kg)-induced jaw movements. These results indicate that angiotensin II enhances apomorphine-induced jaw movements via stimulation of angiotensin AT(1) receptors located in the ventrolateral striatum.

Metatarsalgia localizada por sinovitis e inestabilidad de la articulación metatarso-falángica del II dedo del pie / Metatarsalgia focus by sinovitis and inestability of the joint falange-metatarsal of the second finger of feet

La sinovitis y la inestabilidad de la articulación metatarso-falangica (MF) del II dedo son las causas mas frecuentes de metatarsalgia localizada en esta articulación del pie, frecuentemente mal diagnosticada y por ende, mal manejada por el ortopedista general. La historia natural comprende estudios tan precoces como la sinovitis sin alteración de estructuras peri-articulares, pasando por la inestabilidad franca,y terminando con las deformidades angulares y la luxación completa de la articulación MF. El interrogatorio minucioso y dirigido, el examen físico específico y la clasificación del diagnóstico con las claves para el manejo exitoso de la patología. La corrección quirúrgica de esta condición debe estar siempre asociada a la correción de deformidades asociadas como el hallux valgus y los dedos en garra.

Morphometric analysis of human mastication.

Motor activity studies usually involve analyzing behavior characteristics that are easily observed and scored. The advantage of these methods is that behavioral variation can be rapidly assayed. The disadvantage is that considerable behavioral information is lost. At the other extreme are descriptive kinematic studies that provide detailed quantification of behavior characteristics. The disadvantage of these descriptive studies has been the time-intensive nature of data acquisition and analysis. Recent technological advances provide means for scoring and analyzing many motor activity characteristics simultaneously without a significant increase in scoring and analysis time. The methods described in this paper provide an expeditious means of preserving the richness of motor activity for experimental and clinical neurobehavioral research purposes.

Relationship between anteroposterior maxillomandibular morphology and masticatory jaw movement patterns.

The causal relationships between oral function and craniomandibular morphology are poorly understood. The aim of this study was to determine whether quantifiable features of masticatory jaw movements and associated EMG activity correlated with variation in morphology as defined by the ANB angle. Thirty-six healthy subjects with no previous orthodontic treatment, asymptomatic masticatory muscles, and asymptomatic temporomandibular joints participated. While subjects chewed gum, jaw movement data and surface EMG data were digitized and then quantified into a 300 variable vector for each subject. ANB angle measurements were calculated from digitized tracings of lateral cephalographs. Step-wise linear regression and discriminant analyses were used to determine the relationship between the ANB angle and a subset of the variables defining jaw movement patterns and EMG patterns. A linear combination of seven jaw movements and EMG variables accounted for over 75% of the variation in the ANB angle (adjusted x R2 = 0.78, P <.001). A jackknifed cross-validation of the discriminant analysis, which was forced to use the same seven variables as the regression analysis, resulted in correct classification of 14 of 20 skeletal Class I, 7 of 9 skeletal Class II, and 7 of 7 skeletal Class III subjects. These results suggest that there is an association between anteroposterior skeletal morphology, as quantified by the ANB angle, and masticatory jaw movement patterns, as quantified in this study.

Comparison of chin and jaw movements during gum chewing.

STATEMENT OF PROBLEM: Knowledge of mastication is based on studies that use jaw tracking equipment in nonroutine settings. Ethologists would argue that such data probably does not reflect routine masticatory function. If jaw movements could be tracked noninvasively, then the hypothesis that jaw tracking equipment and nonroutine settings alter mastication could be investigated. PURPOSE: This study quantitatively evaluated the relationship between chin and jaw movements during a gum-chewing task. MATERIAL AND METHODS: Masticatory chin and jaw movements of 50 subjects were tracked in the x-, y-, and z-axes for 15 seconds, which resulted in approximately 15 chewing cycles obtained per subject. For each chewing cycle, magnitude and timing of displacement, velocity, and acceleration extrema in each axis were computed for both jaw and chin movement data. Extrema means were calculated for each 15-second trial. The respective means representing chin versus jaw movements were compared with linear regression and correlation analyses. RESULTS: All mean extrema were significantly correlated (r range 0. 30-0.99; P <.05). Magnitude correlations were larger than timing correlations for acceleration extrema. In contrast, magnitude correlations were smaller than timing correlations for displacement extrema. The highest correlation occurred for chewing rate. CONCLUSIONS: Chin and jaw movements were correlated during chewing; however, only chewing rate was highly predictable from chin movement data.

Temporal dynamics of human masticatory sequences.

Many motor behaviors produced by humans and other mammals are temporally segmented. That is, sequences of rhythmic or repetitive behavior occur as a series of brief, 2- to 4-s bouts separated from each other by pauses or posture adjustments. Little is known about the physiological mechanisms underlying temporal segmentation, although several hypotheses have been advanced. Experimental and modeling studies are currently underway to gain insight into this phenomenon. One of the problems hampering advancement is the lack of relatively simple behavior models that can be studied in both humans and other mammals. We have recently reported that temporal segmentation occurs in guinea pig chewing sequences. Thus, it seems logical to explore whether temporal segmentation occurs in human chewing sequences as well. Toward this end, the current study evaluated the temporal dynamics of chewing sequences in humans. Thirteen subjects were videotaped on campus eating areas during lunch-time. Inter-occlude intervals, i.e., time between maximum jaw closures, were calculated using a custom computer program, which also recorded whether the interval represented a chew or a pause in chewing. Chewing rate, pause durations, and chewing burst durations, i.e., duration of continuous chewing uninterrupted by pauses, were calculated. Median chewing burst duration for the sample was 2.91 s. This corroborates other studies' findings of 3-s temporal segmentation in repetitive movements. We conclude that automatic chewing sequences contain temporal segmentation. Future work is required to gain insight into whether the physiological mechanisms of this time-based phenomenon are similar among different species.

Intermittency in mastication and apomorphine-induced gnawing.

Rhythmic behaviors like mastication, gnawing, and locomotion, are characterized by temporal segmentation or intermittency. That is, they frequently occur as a series of short bursts interrupted by pauses rather than as one long uninterrupted burst. The function of intermittency as well as the mechanisms that produce it are unknown. Biogenic amine systems may play a role in producing intermittency; however, experimental work to confirm this is only in its infancy. The current study evaluates the structure of intermittency associated with mastication and apomorphine-induced gnawing in the guinea pig. Thirteen free-roaming animals were videotaped while masticating or gnawing. Eight animals were given 0.5 mg/kg i.m. apomorphine and videotaped while gnawing. The remaining five animals received no apomorphine injections, but were taped while feeding on alfalfa pellets. Custom software was used to score instances of maximum jaw closures in videotaped mastication and gnawing sequences. The time between successive maximum jaw closures, called the interocclude interval (IOI), was calculated for all scored sequences. A cutoff IOI value of 0.26 s differentiated pauses (IOI values equal or greater than 0.26 s) from chews or gnaws (IOI values less than 0.26 s). Two or more successive chews or gnaws, without intervening pauses, defined behavior bursts. Chew, gnaw, and burst durations were quantified and compared. Chew and gnaw durations were similar. However, chewing bursts were significantly longer than gnawing bursts. The significance of these results is presented in light of previous neurophysiological work on rhythmic jaw movements and intermittency.

Evidence of sex-specific differences in masticatory jaw movement patterns.

The complexity of human oral functional movements has not been studied in detail quantitatively, and only recently have studies begun to evaluate whether such movements contain sex-specific characteristics. Therefore, the purposes of this study were: (1) to quantify in detail the jaw movements and associated masticatory electromyographic activity occurring during gum chewing, and (2) to explore these data for evidence of sex specificity. Fourteen male and 17 female subjects participated in the study. Approximately 11 right- and 11 left-sided chewing cycles and associated masticatory electromyographic activity were sampled from each subject. The samples were quantified into 165 variables per chewing cycle, averaged to create a single multivariate vector for each subject, and then analyzed by a step-wise discriminant analysis. With a combination of 6 variables, a jackknifed cross-validation test found the probability of correct classification to be 93.5%. These findings support the hypothesis that masticatory jaw movements contain sex-specific features.

Haloperidol affects guinea pig chewing burst durations.

Previous investigations have reported that most movement patterns in humans and other mammalian species are partitioned into 1-5-s units. This finding has led to the hypothesis that a highly conservative physiological system, common among mammalian species, segments ongoing movement patterns into 1-5-s 'chunks'. However, to date little or no work has been done to explore the physiological and neurochemical nature of this segmenting phenomenon; therefore, it is unknown whether the same evolutionarily conservative mechanism controls partitioning of all movement patterns. The literature suggests that central dopamine plays a key role in this 1-5-s partitioning. If this is so, then dopamine blockers should result in significant alterations in the 1-5-s segmentation of mammalian movement patterns. To test this hypothesis, the current study determined whether the neuroleptic haloperidol significantly affected guinea pig chewing burst durations, which reportedly average 1-3 s and are therefore considered to manifest this partitioning phenomenon. Seven male albino guinea pigs received daily 0.5 mg/kg i.m. haloperidol injections, and three male albino guinea pigs received comparable saline injections (controls). After either 3 or 11 weeks, injections were stopped, and 1 week thereafter the animals were starved for 24 h and then videotaped singly in an experimental arena. Animals inevitably fed on alfalfa pellets during the taping session, and the chewing bursts that occurred while the animals fed were timed. The results showed that control animals' chewing bursts had durations similar to those previously reported for free-roaming, non-drug-treated guinea pigs. However, haloperidol-treated guinea pigs' chewing bursts were significantly more variable in duration (p = 0.0013) than those of matched control animals. Inspection of the data from individual animals revealed that two haloperidol-treated animals had abnormally short chewing burst durations, whereas three haloperidol-treated animals had abnormally long chewing burst durations. The fact that haloperidol treatment was associated with either abnormally short or long chewing burst durations is reminiscent of neuroleptic-induced human movement disorders, which reportedly range from a 'paucity of movement' to 'perseverant movements'. This suggests that intact central dopaminergic systems may play an important role in modulating the duration of mammalian movement patterns, which normally ranges 0.2-5 s.

Validity of a brief questionnaire in screening asymptomatic subjects from subjects with tension-type headaches or temporomandibular disorders.

Clinical investigations of temporomandibular disorders require objective, repeatable methods for screening diseased subjects from non-diseased control subjects. This study evaluated whether information gathered from a short, public domain questionnaire was useful in distinguishing temporomandibular disorder subjects (n = 216) from non-temporomandibular disorder controls (n = 69) and tension-type headache subjects (n = 22). The questionnaire consisted of eight questions relating to jaw pain (i.e., location of pain, precipitating factors, and temporal pattern of pain) and five questions relating to jaw function (i.e., joint noises, locking, and difficulty in opening). There were five possible answers to each question which ranged from 0 (no symptoms) to 4 (unbearable or constant symptoms). The total scores for the eight pain questions and the five jaw function questions were used to determine the questionnaire's sensitivity and specificity in each group, and ROC curves were plotted to identify the best cutoff point for disease presence or absence. Results showed that the questionnaire reliably distinguished between the control group and temporomandibular disorder group with 90.3%-97.7% sensitivity and 95.7%-100% specificity at cutoff values between 5 and 9. These results support the use of the questionnaire as a primary screening tool for general practice and as a supplementary screening tool for clinical temporomandibular disorder studies. However, results also showed that the questionnaire was unable to distinguish easily between TMD subjects and temporalis region tension-type headache subjects.

[Effects of smoking on the genital tract of the woman]. / Auswirkungen des Rauchens auf den Genitaltrakt der Frau.

Cigarette smoking exerts a carcinogenous effect in various organs, either by direct contact or by distant nocivity. The authors present a survey of literature dealing with the effect of cigarette smoking on the female genital tract. The respective data show clearly that cigarette smoking may induce carcinoma of the cervix, whereas no significant correlation between cigarette smoking and carcinoma of the uterus can be established. Epidemiologic, etiologic and pathogenetic aspects of cigarette smoking and its influence on the genital tract are presented and discussed.