Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: A comparative cadaver study

OBJECTIVES: To compare the practicability, visualization of structures, and iatrogenic damage of direct and transthecal approaches to the navicular bursa for diagnostic needle endoscopy. STUDY DESIGN: Descriptive study. SAMPLE POPULATION: Equine cadaver forelimbs (n = 30). METHODS: Direct and transthecal approaches for insertion of a needle endoscope into the navicular bursa were performed. Video recordings of endoscopic procedures were assessed to determine all structures visualized within the navicular bursa. Number of attempts to gain access to the navicular bursa and total time for insertion and examination were recorded. Distribution and severity of iatrogenic lesions were assessed and scored after dissection. RESULTS: There were no statistical differences for number of attempts or time needed for insertion and examination between direct and transthecal approaches. The direct approach offered significantly increased visibility of the ipsilateral abaxial and proximal margins of the navicular bone, and ipsilateral collateral sesamoidean ligament. Iatrogenic lesions were superficial and focal, regardless of approach taken, or whether a blunt or sharp trocar tip was used. CONCLUSIONS: The direct approach provided significantly better visualization of the ipsilateral structures within the navicular bursa compared to the transthecal approach. Needle endoscopy offers a reliable technique to evaluate the navicular bursa and may complement or replace other diagnostic modalities in horses with lameness localized to the navicular region.

Sentinel lymph node biopsy in thick malignant melanoma: A 16-year single unit experience.

BACKGROUND The role of sentinel lymph node biopsy (SLNB) and its benefits in patients with thick melanoma is still controversial. OBJECTIVES We evaluated the clinical effect of SLNB in patients with thick melanoma. METHODS We performed a retrospective cohort review (1996-2012) of thick melanomas. Collected data included the patient and tumour characteristics. Locoregional recurrence, distant metastases, disease free and overall survival were compared between the patients with positive and negative SLNB. RESULTS 126 thick melanomas with a mean age of 64.09 years were included in the study. Positive SLNB were found in 47 (37.3%) patients. Significantly more locoregional recurrence (P = 0.002) and distant metastases (P = 0.030) were detected in the patients with positive SLNB. Furthermore, the patients with negative SLNB showed significantly better disease free survival (P = 0.021). CONCLUSIONS Positive SLNB might be prognostic factor in thick melanoma and aggravates the outcome of thick melanomas.

Anatomy of the nail unit and the nail biopsy

The nail unit is the largest and a rather complex skin appendage. It is located on the dorsal aspect of the tips of fingers and toes and has important protective and sensory functions. Development begins in utero between weeks 7 and 8 and is fully formed at birth. For its correct development, a great number of signals are necessary. Anatomically, it consists of 4 epithelial components: the matrix that forms the nail plate; the nail bed that firmly attaches the plate to the distal phalanx; the hyponychium that forms a natural barrier at the physiological point of separation of the nail from the bed; and the eponychium that represents the undersurface of the proximal nail fold which is responsible for the formation of the cuticle. The connective tissue components of the matrix and nail bed dermis are located between the corresponding epithelia and the bone of the distal phalanx. Characteristics of the connective tissue include: a morphogenetic potency for the regeneration of their epithelia; the lateral and proximal nail folds form a distally open frame for the growing nail; and the tip of the digit has rich sensible and sensory innervation. The blood supply is provided by the paired volar and dorsal digital arteries. Veins and lymphatic vessels are less well defined. The microscopic anatomy varies from nail subregion to subregion. Several different biopsy techniques are available for the histopathological evaluation of nail alterations.

Muscle velocity recovery cycles: Comparison between surface and needle recordings.

INTRODUCTION Recording of muscle velocity recovery cycles (MVRCs) has been developed as a technique to investigate the pathophysiology of muscle diseases. MVRCs have been measured by direct muscle stimulation and concentric electromyographic needle recording. This study was undertaken to determine whether recordings can be made with surface electrodes. METHODS MVRCs with 1 and 2 conditioning stimuli were recorded simultaneously with concentric needle and surface electrodes from the brachioradialis muscle in 12 healthy volunteers. Muscle relative refractory period, early and late supernormality, and extra-late supernormality were compared between the recording techniques. RESULTS Surface recordings were possible in all subjects. The multifiber action potentials recorded with surface electrodes were smaller than those recorded with needles, but there was no significant difference between any of their MVRC properties. CONCLUSIONS MVRCs can be recorded with surface electrodes in healthy subjects. The use of surface electrodes may facilitate the technique of recording MVRCs. Muscle Nerve 53: 205-208, 2016.

The potential role of endometrial nerve fibers in the pathogenesis of pain during endometrial biopsy at office hysteroscopy

We aimed to evaluate whether nerve fibers are present in the endometrial layer of patients submitted to office hysteroscopy and their potential contribution to the pathogenesis of pain during that procedure. Through a prospective case-control study performed in tertiary centers for women's health, endometrium samples were collected during operative office hysteroscopy from 198 cycling women who previously underwent laparoscopy and/or magnetic resonance imaging investigation for infertility assessment. Samples were classified according to the degree of the pain patients experienced and scored from values ranging from 0 (absence of discomfort/pain) to 10 (intolerable pain) on a 10-cm visual analog scale (VAS). The presence of nerve fiber markers (S100, NSE, SP, VIP, NPY, NKA, NKB, NKR1, NKR2, and NKR3) in the endometrium was also evaluated by morphologic and immunohistochemical analyses. We found that S-100, NSE, NKR1, NK-A, NK-B, VIP, and NPY, were immunolocalized in samples of endometrium, in significantly (P < .01, for all) higher levels in samples collected from patients with VAS score > 5 (group A) than ≤ 5 (group B) and significantly (P < .0001 for all) positively correlated with VAS levels. A statistically significant (P = .018) higher prevalence of endometriosis and/or adenomyosis was depicted in patients of group A than group B. Data from the present study led us to conclude that nerve fibers are expressed at the level of the functional layer of the endometrium and may contribute to pain generation during office hysteroscopy, mainly in women affected by endometriosis and adenomyosis.

Endoscopic Biopsy for Intra- and Paraventricular Tumors: Rates of Complications, Mortality, and Tumor Cell Dissemination

Background and Study Aim Intra- and paraventricular tumors are frequently associated with cerebrospinal fluid (CSF) pathway obstruction. Thus the aim of an endoscopic approach is to restore patency of the CSF pathways and to obtain a tumor biopsy. Because endoscopic tumor biopsy may increase tumor cell dissemination, this study sought to evaluate this risk. Patients, Materials, and Methods Forty-four patients who underwent endoscopic biopsies for ventricular or paraventricular tumors between 1993 and 2011 were included in the study. Charts and images were reviewed retrospectively to evaluate rates of adverse events, mortality, and tumor cell dissemination. Adverse events, mortality, and tumor cell dissemination were evaluated. Results Postoperative clinical condition improved in 63.0% of patients, remained stable in 30.4%, and worsened in 6.6%. One patient (2.2%) had a postoperative thalamic stroke leading to hemiparesis and hemineglect. No procedure-related deaths occurred. Postoperative tumor cell dissemination was observed in 14.3% of patients available for follow-up. Conclusions For patients presenting with occlusive hydrocephalus due to tumors in or adjacent to the ventricular system, endoscopic CSF diversion is the procedure of first choice. Tumor biopsy in the current study did not affect safety or efficacy.

Sural nerve conduction studies using ultrasound-guided needle positioning: Influence of age and recording location.

INTRODUCTION The aim of this study was to compare orthodromic sural nerve conduction study (NCS) results using ultrasound-guided needle positioning (USNP) to surface electrode recordings. METHODS 51 healthy subjects aged 24 - 80 years, divided into 5 age groups, were examined. Electrical stimuli were applied behind the lateral malleolus. Sensory nerve action potentials (SNAPs) were recorded 8 and 15 cm proximally with surface and needle electrodes. RESULTS Mean SNAP amplitudes in µV (surface/needle electrodes) averaged 12.7 (SD 7.6)/40.6 (SD 20.8), P<0.001, for subjects aged 20-29 years, and 5.0 (SD 2.4)/19.8 (SD 9.8), P<0.01, for subjects aged > 60 years. SNAP amplitudes were smaller at the proximal recording location. DISCUSSION NCS using USNP yield higher amplitude responses than surface electrodes in all age groups at all recording sites. SNAP amplitudes are smaller at proximal recording locations due to sural nerve branching. This article is protected by copyright. All rights reserved.

Factors associated with needle sharing among Black male injection drug users in Harris County, Texas

Background. Injection drug users (IDUs) are at increased risk for HIV transmission due to unique risk behaviors, such as sharing needles. In Houston, IDUs account for 18% of all HIV/AIDS cases among Black males. ^ Objectives. This analysis compared demographic, behavioral, and psychosocial characteristics of needle sharing and non-sharing IDUs in a population of Black males in Harris County, Texas. ^ Methods. Data used for this analysis were from the second IDU cycle of the National HIV Behavioral Surveillance System. This dataset included a sample of 288 Black male IDUs. Univariate and multivariate statistical analysis were performed to determine statistically significant associations of needle sharing in this population and to create a functional model to inform local HIV prevention programs. ^ Results. Half of the participants in this analysis shared needles in the past 12 months. Compared to non-sharers, sharers were more likely to be homeless (OR=3.70, p<0.01) or arrested in the past year (OR=2.31, p<0.01), inject cocaine (OR=2.07, p<0.01), report male-to-male sex in the past year (OR=6.97, p<0.01), and to exchange sex for money or drugs. Sharers were less likely than non-sharers to graduate high school (OR=0.36, p<0.01), earn $5,000 or more a year (OR=1.15, p=0.05), get needles from a medical source (OR=0.59, p=0.03), and ever test for HIV (OR=0.17, p<0.01). Sharers were more likely to report depressive symptoms (OR=3.49, p<0.01), lower scores on the family support scale (mean difference 0.41, p=0.01) and decision-making confidence scale (mean difference 0.38, p<0.01), and greater risk-taking (mean difference -0.49, p<0.01) than non-sharers. In a multivariable logistic regression, sharers were less likely to have graduated high school (OR=0.33, p<0.01) and have been tested for HIV (OR=0.12, p<0.01) and were more likely to have been arrested in the past year (OR=2.3, p<0.01), get needles from a street source (OR=3.87, p<0.01), report male-to-male sex (OR=7.01, p<0.01), and have depressive symptoms (OR=2.36, p=0.02) and increased risk-taking (OR=1.78, p=0.01). ^ Conclusions. IDUs that shared needles are different from those that did not, reporting lower socioeconomic status, increased sexual and risk behaviors, increased depressive symptoms and increased risk-taking. These findings suggest that intervention programs that also address these demographic, behavioral, and psychosocial factors may be more successful in decreasing needle sharing among this population.^

Design and kinematic analysis of 3PSS-1S wrist for needle insertion guidance

In this work it is presented a complete kinematic analysis of the 3PSS-1S parallel mechanism for its implementation as a spherical wrist for a needle insertion guidance robot. The spherical 3PSS-1S mechanism is a low weight and reduced dimension parallel mechanism that allows spherical movements providing the requirements needed for the serial–parallel robotic arm for needle insertion guidance. The solution of its direct kinematic is computed with a numerical method based on the Newton–Raphson formulation and a constraint function of the mechanism. The input–output velocity equation is obtained with the use of screw theory. Three types of singular postures are identified during simulations and verified in the real prototype. The 3PSS-1S can perform pure rotations of ±45°±45°, ±40°±40°, ±60°±60° along the View the MathML sourcex, View the MathML sourcey, View the MathML sourcez axes respectively.

A taxonomic tool for identifying needle remains of south-western European Pinus species of the Late Quaternary

Primer trabajo a nivel mundial sobre la diferenciación de especies de Pinus con clave dicotómica a través de la estructura cuticular

A taxonomic tool for identifying needle remains of south-western European Pinus species of the Late Quaternary

This work provides a tool whereby the needle remains of native, south-western European Pinus spp. can be easily identified from species-specific epidermal features. To construct this tool, the needles of P. uncinata, P. sylvestris, P. nigra, P. pinaster, P. pinea and P. halepensis were gathered across the Northern Hemisphere range of each taxon and compared with non-indigenous trees growing in two South Australian Botanic Gardens. Three needles from each of these species were taken from three adult trees growing at three different localities. Light microscopy was used to observe the key epidermal and stomatal features of the needles. To improve interpretation, additional scanning electron microscopy samples were prepared. Epidermal features, including variation in the diameter of the epistomatal chamber aperture (pore), are described. A taxonomic key based on the size, shape and arrangement of the subsidiary cells of the stomatal complexes was constructed. This key enables the identification of pine needle fragments at the species level (except those belonging to the group P. gr. nigra-uncinata). Despite their overlapping range, pore size was helpful in distinguishing between P. nigra and P. uncinata and between three groups of species. Isolated stomata were also observed. Cluster and discriminant analyses of stomatal variables described in earlier studies were performed. Overlap in guard cell variables hampers species-level identification of isolated stomata. Species discrimination is improved if groups of ecological affinity are considered.

Multiscale analysis of the mechanical behavior of needle-punched nonwoven fabrics

Los fieltros son una familia de materiales textiles constituidos por una red desordenada de fibras conectadas por medio de enlaces térmicos, químicos o mecánicos. Presentan menor rigidez y resistencia (al igual que un menor coste de procesado) que sus homólogos tejidos, pero mayor deformabilidad y capacidad de absorción de energía. Los fieltros se emplean en diversas aplicaciones en ingeniería tales como aislamiento térmico, geotextiles, láminas ignífugas, filtración y absorción de agua, impacto balístico, etc. En particular, los fieltros punzonados fabricados con fibras de alta resistencia presentan una excelente resistencia frente a impacto balístico, ofreciendo las mismas prestaciones que los materiales tejidos con un tercio de la densidad areal. Sin embargo, se sabe muy poco acerca de los mecanismos de deformación y fallo a nivel microscópico, ni sobre como influyen en las propiedades mecánicas del material. Esta carencia de conocimiento dificulta la optimización del comportamiento mecánico de estos materiales y también limita el desarrollo de modelos constitutivos basados en mecanismos físicos, que puedan ser útiles en el diseño de componentes estructurales. En esta tesis doctoral se ha llevado a cabo un estudio minucioso con el fin de determinar los mecanismos de deformación y las propiedades mecánicas de fieltros punzonados fabricados con fibras de polietileno de ultra alto peso molecular. Los procesos de deformación y disipación de energía se han caracterizado en detalle por medio de una combinación de técnicas experimentales (ensayos mecánicos macroscópicos a velocidades de deformación cuasi-estáticas y dinámicas, impacto balístico, ensayos de extracción de una o múltiples fibras, microscopía óptica, tomografía computarizada de rayos X y difracción de rayos X de gran ángulo) que proporcionan información de los mecanismos dominantes a distintas escalas. Los ensayos mecánicos macroscópicos muestran que el fieltro presenta una resistencia y ductilidad excepcionales. El estado inicial de las fibras es curvado, y la carga se transmite por el fieltro a través de una red aleatoria e isótropa de nudos creada por el proceso de punzonamiento, resultando en la formación de una red activa de fibra. La rotación y el estirado de las fibras activas es seguido por el deslizamiento y extracción de la fibra de los puntos de anclaje mecánico. La mayor parte de la resistencia y la energía disipada es proporcionada por la extracción de las fibras activas de los nudos, y la fractura final tiene lugar como consecuencia del desenredo total de la red en una sección dada donde la deformación macroscópica se localiza. No obstante, aunque la distribución inicial de la orientación de las fibras es isótropa, las propiedades mecánicas resultantes (en términos de rigidez, resistencia y energía absorbida) son muy anisótropas. Los ensayos de extracción de múltiples fibras en diferentes orientaciones muestran que la estructura de los nudos conecta más fibras en la dirección transversal en comparación con la dirección de la máquina. La mejor interconectividad de las fibras a lo largo de la dirección transversal da lugar a una esqueleto activo de fibras más denso, mejorando las propiedades mecánicas. En términos de afinidad, los fieltros deformados a lo largo de la dirección transversal exhiben deformación afín (la deformación macroscópica transfiere directamente a las fibras por el material circundante), mientras que el fieltro deformado a lo largo de la dirección de la máquina presenta deformación no afín, y la mayor parte de la deformación macroscópica no es transmitida a las fibras. A partir de estas observaciones experimentales, se ha desarrollado un modelo constitutivo para fieltros punzonados confinados por enlaces mecánicos. El modelo considera los efectos de la deformación no afín, la conectividad anisótropa inducida durante el punzonamiento, la curvatura y re-orientación de la fibra, así como el desenredo y extracción de la fibra de los nudos. El modelo proporciona la respuesta de un mesodominio del material correspondiente al volumen asociado a un elemento finito, y se divide en dos bloques. El primer bloque representa el comportamiento de la red y establece la relación entre el gradiente de deformación macroscópico y la respuesta microscópica, obtenido a partir de la integración de la respuesta de las fibras en el mesodominio. El segundo bloque describe el comportamiento de la fibra, teniendo en cuenta las características de la deformación de cada familia de fibras en el mesodominio, incluyendo deformación no afín, estiramiento, deslizamiento y extracción. En la medida de lo posible, se ha asignado un significado físico claro a los parámetros del modelo, por lo que se pueden identificar por medio de ensayos independientes. Las simulaciones numéricas basadas en el modelo se adecúan a los resultados experimentales de ensayos cuasi-estáticos y balísticos desde el punto de vista de la respuesta mecánica macroscópica y de los micromecanismos de deformación. Además, suministran información adicional sobre la influencia de las características microstructurales (orientación de la fibra, conectividad de la fibra anisótropa, afinidad, etc) en el comportamiento mecánico de los fieltros punzonados. Nonwoven fabrics are a class of textile material made up of a disordered fiber network linked by either thermal, chemical or mechanical bonds. They present lower stiffness and strength (as well as processing cost) than the woven counterparts but much higher deformability and energy absorption capability and are used in many different engineering applications (including thermal insulation, geotextiles, fireproof layers, filtration and water absorption, ballistic impact, etc). In particular, needle-punched nonwoven fabrics manufactured with high strength fibers present an excellent performance for ballistic protection, providing the same ballistic protection with one third of the areal weight as compared to dry woven fabrics. Nevertheless, very little is known about their deformation and fracture micromechanisms at the microscopic level and how they contribute to the macroscopic mechanical properties. This lack of knowledge hinders the optimization of their mechanical performance and also limits the development of physically-based models of the mechanical behavior that can be used in the design of structural components with these materials. In this thesis, a thorough study was carried out to ascertain the micromechanisms of deformation and the mechanical properties of a needle-punched nonwoven fabric made up by ultra high molecular weight polyethylene fibers. The deformation and energy dissipation processes were characterized in detail by a combination of experimental techniques (macroscopic mechanical tests at quasi-static and high strain rates, ballistic impact, single fiber and multi fiber pull-out tests, optical microscopy, X-ray computed tomography and wide angle X-ray diffraction) that provided information of the dominant mechanisms at different length scales. The macroscopic mechanical tests showed that the nonwoven fabric presented an outstanding strength and energy absorption capacity. It was found that fibers were initially curved and the load was transferred within the fabric through the random and isotropic network of knots created by needlepunching, leading to the formation of an active fiber network. Uncurling and stretching of the active fibers was followed by fiber sliding and pull-out from the entanglement points. Most of the strength and energy dissipation was provided by the extraction of the active fibers from the knots and final fracture occurred by the total disentanglement of the fiber network in a given section at which the macroscopic deformation was localized. However, although the initial fiber orientation distribution was isotropic, the mechanical properties (in terms of stiffness, strength and energy absorption) were highly anisotropic. Pull-out tests of multiple fibers at different orientations showed that structure of the knots connected more fibers in the transverse direction as compared with the machine direction. The better fiber interconnection along the transverse direction led to a denser active fiber skeleton, enhancing the mechanical response. In terms of affinity, fabrics deformed along the transverse direction essentially displayed affine deformation {i.e. the macroscopic strain was directly transferred to the fibers by the surrounding fabric, while fabrics deformed along the machine direction underwent non-affine deformation, and most of the macroscopic strain was not transferred to the fibers. Based on these experimental observations, a constitutive model for the mechanical behavior of the mechanically-entangled nonwoven fiber network was developed. The model accounted for the effects of non-affine deformation, anisotropic connectivity induced by the entanglement points, fiber uncurling and re-orientation as well as fiber disentanglement and pull-out from the knots. The model provided the constitutive response for a mesodomain of the fabric corresponding to the volume associated to a finite element and is divided in two blocks. The first one was the network model which established the relationship between the macroscopic deformation gradient and the microscopic response obtained by integrating the response of the fibers in the mesodomain. The second one was the fiber model, which took into account the deformation features of each set of fibers in the mesodomain, including non-affinity, uncurling, pull-out and disentanglement. As far as possible, a clear physical meaning is given to the model parameters, so they can be identified by means of independent tests. The numerical simulations based on the model were in very good agreement with the experimental results of in-plane and ballistic mechanical response of the fabrics in terms of the macroscopic mechanical response and of the micromechanisms of deformation. In addition, it provided additional information about the influence of the microstructural features (fiber orientation, anisotropic fiber connectivity, affinity) on the mechanical performance of mechanically-entangled nonwoven fabrics.

Effect of age on in vivo rates of mitochondrial protein synthesis in human skeletal muscle

A progressive decline in muscle performance in the rapidly expanding aging population is causing a dramatic increase in disability and health care costs. A decrease in muscle endurance capacity due to mitochondrial decay likely contributes to this decline in muscle performance. We developed a novel stable isotope technique to measure in vivo rates of mitochondrial protein synthesis in human skeletal muscle using needle biopsy samples and applied this technique to elucidate a potential mechanism for the age-related decline in the mitochondrial content and function of skeletal muscle. The fractional rate of muscle mitochondrial protein synthesis in young humans (24 ± 1 year) was 0.081 ± 0.004%·h−1, and this rate declined to 0.047 ± 0.005%·h−1 by middle age (54 ± 1 year; P < 0.01). No further decline in the rate of mitochondrial protein synthesis (0.051 ± 0.004%·h−1) occurred with advancing age (73 ± 2 years). The mitochondrial synthesis rate was about 95% higher than that of mixed protein in the young, whereas it was approximately 35% higher in the middle-aged and elderly subjects. In addition, decreasing activities of mitochondrial enzymes were observed in muscle homogenates (cytochrome c oxidase and citrate synthase) and in isolated mitochondria (citrate synthase) with increasing age, indicating declines in muscle oxidative capacity and mitochondrial function, respectively. The decrease in the rates of mitochondrial protein synthesis is likely to be responsible for this decline in muscle oxidative capacity and mitochondrial function. These changes in muscle mitochondrial protein metabolism may contribute to the age-related decline in aerobic capacity and muscle performance.

Contribution of Salmonella typhimurium type III secretion components to needle complex formation

The prgHIJK operon encodes components of the Salmonella typhimurium pathogenicity island 1 type III secretion system (TTSS). Previously, prgH and prgK were shown to be required for formation of the supramolecular type III secretion needle complex (NC) [Kubori, T., et al. (1998) Science 280, 602–605]. This work indicates that all prg operon genes are required for NC formation. PrgH multimerizes into a distinct tetrameric-shaped structure that may be an early intermediate of NC assembly and may provide the structural foundation required for PrgK oligomerization. PrgH and PrgK, in the absence of other TTSS components, oligomerize into ring-shaped structures identical in appearance and size to the base of the NC, indicating that they are likely the major inner membrane structural components required for secretion. PrgI and PrgJ cofractionate with the NC and are secreted into the culture supernatant. NC from prgI and prgJ mutants have an identical morphology to the envelope-spanning (basal body) NC components, but are missing the external needle, indicating that PrgI and PrgJ are required for full NC assembly and are likely components of the external needle. Therefore, PrgI and PrgJ are secreted through the NC basal body, composed in part of PrgH/K and InvG/H rings, to participate in assembly of the more distal components of the NC.