Removal of fractured endodontic instruments using an Nd:YAG laser.

OBJECTIVE Fractured endodontic instruments inhibit optimal cleaning and filling of dental root canals, which may result in a less favorable prognosis for the tooth. Several techniques are available to remove fractured instruments; however, healthy tooth substance often must be destroyed in the process. This study was intended to evaluate Nd:YAG laser treatment as a method to remove fractured stainless steel instruments without destroying healthy tooth substance. METHOD AND MATERIALS Stainless steel endodontic instruments were fractured in 33 unprocessed root canals of mandibular central and lateral incisors and premolars in vitro. A brass tube charged with solder was placed at the coronal end of the fractured instrument and laser energy was used to melt the solder, connecting the fractured instrument with the brass tube. The success rates of connecting and removal of fractured instruments from the root channel were recorded for each case. RESULTS Connecting was achieved in every case in which more than 1.5 mm of the fractured instrument was tangible (22 out of 22). In cases where less than 1.5 mm was tangible, the rate for successful connection decreased to 4 out of 11 (36.4%). Fractured endodontic instruments were removed successfully in 17 out of 22 cases (77.3%) in which more than 1.5 mm was tangible. If less than 1.5 mm was tangible, the removal success rate decreased to 3 out of 11 cases (27.3%). CONCLUSION Our data support Nd:YAG laser-mediated connecting of a brass tube to a fractured endodontic instrument as a feasible and tissue conserving removal approach when more than 1.5 mm of the instrument is tangible.

Effect of different breathing AIDS on ventilation distribution in adults with cystic fibrosis.

BACKGROUND AND OBJECTIVES We investigated the effect of different breathing aids on ventilation distribution in healthy adults and subjects with cystic fibrosis (CF). METHODS In 11 healthy adults and 9 adults with CF electrical impedance tomography measurements were performed during spontaneous breathing, continuous positive airway pressure (CPAP) and positive expiratory pressure (PEP) therapy randomly applied in upright and lateral position. Spatial and temporal ventilation distribution was assessed. RESULTS The proportion of ventilation directed to the dependent lung significantly increased in lateral position compared to upright in healthy and CF. This effect was enhanced with CPAP but neutralised with PEP, whereas the effect of PEP was larger in the healthy group. Temporal ventilation distribution showed exactly the opposite with homogenisation during CPAP and increased inhomogeneity with PEP. CONCLUSIONS PEP shows distinct differences to CPAP with respect to its impact on ventilation distribution in healthy adults and CF subjects EIT might be used to individualise respiratory physiotherapy.

Role of electrophysiological studies in predicting risk of ventricular arrhythmia in early repolarization syndrome.

BACKGROUND The early repolarization (ER) pattern is associated with an increased risk of arrhythmogenic sudden death. However, strategies for risk stratification of patients with the ER pattern are not fully defined. OBJECTIVES This study sought to determine the role of electrophysiology studies (EPS) in risk stratification of patients with ER syndrome. METHODS In a multicenter study, 81 patients with ER syndrome (age 36 ± 13 years, 60 males) and aborted sudden death due to ventricular fibrillation (VF) were included. EPS were performed following the index VF episode using a standard protocol. Inducibility was defined by the provocation of sustained VF. Patients were followed up by serial implantable cardioverter-defibrillator interrogations. RESULTS Despite a recent history of aborted sudden death, VF was inducible in only 18 of 81 (22%) patients. During follow-up of 7.0 ± 4.9 years, 6 of 18 (33%) patients with inducible VF during EPS experienced VF recurrences, whereas 21 of 63 (33%) patients who were noninducible experienced recurrent VF (p = 0.93). VF storm occurred in 3 patients from the inducible VF group and in 4 patients in the noninducible group. VF inducibility was not associated with maximum J-wave amplitude (VF inducible vs. VF noninducible; 0.23 ± 0.11 mV vs. 0.21 ± 0.11 mV; p = 0.42) or J-wave distribution (inferior, odds ratio [OR]: 0.96 [95% confidence interval (CI): 0.33 to 2.81]; p = 0.95; lateral, OR: 1.57 [95% CI: 0.35 to 7.04]; p = 0.56; inferior and lateral, OR: 0.83 [95% CI: 0.27 to 2.55]; p = 0.74), which have previously been demonstrated to predict outcome in patients with an ER pattern. CONCLUSIONS Our findings indicate that current programmed stimulation protocols do not enhance risk stratification in ER syndrome.

Nerve Transfers for Persistent Traumatic Peroneal Nerve Palsy: The Inselspital Bern Experience

BACKGROUND Patients in whom conventional peroneal nerve repair surgery failed to reconstitute useful foot lift need to be evaluated for their suitability to undergo a concomitant tendon transfer procedure or nerve transfers. OBJECTIVE To report our first clinical experience with nerve transfers for persistent traumatic peroneal nerve palsy. METHODS Between 2007 and 2013, 8 patients were operated on for foot drop after unsuccessful nerve surgery. Six patients without fatty degeneration of the anterior tibial muscle and proximal lesion of the peroneal nerve were oriented for tibial to peroneal nerve transfer. In the other 2 cases where the anterior and lateral compartments were destructed, the anterior tibial muscle function was reconstructed with a neurotized lateral gastrocnemius transfer. For each patient, we graded postoperative results using the Bureau of Meteorology Research Centre scheme and the Ninkovic assessment scale. RESULTS Of the 6 patients who underwent nerve transfer of the anterior tibial muscle, 2 patients had excellent results, 1 patient had good results, 1 patient had fair results, and 2 patients had poor results. Of the 2 patients that underwent neurotized lateral gastrocnemius transfer, 1 patient achieved excellent results after tenolysis, whereas 1 patient achieved poor results. After the nerve transfer, 5 patients did not wear an ankle-foot orthosis. Four patients did not limp. Four patients were able to walk barefoot, navigate stairs, and participate in activities. CONCLUSION Early clinical results after tibial to peroneal nerve transfer and neurotized lateral gastrocnemius transfer appear mixed. The results of nerve transfer seem, on the whole, less reliable than the literature reports on tendon transfer. ABBREVIATIONS EMG, electromyographyNAP, nerve action potential.

Cortical control of facial expression.

The present topical review deals with the motor control of facial expressions in humans. Facial expressions are a central part of human communication. Emotional face expressions have a crucial role in human non-verbal behavior, allowing a rapid transfer of information between individuals. Facial expressions can be both voluntarily or emotionally controlled. Recent studies in non-human primates and humans revealed that the motor control of facial expressions has a distributed neural representation. At least 5 cortical regions on the medial and lateral aspects of each hemisphere are involved: the primary motor cortex, the ventral lateral premotor cortex, the supplementary motor area on the medial wall, and, finally, the rostral and caudal cingulate cortex. The results of studies in humans and non-human primates suggest that the innervation of the face is bilaterally controlled for the upper part, and mainly contralaterally controlled for the lower part. Furthermore, the primary motor cortex, the ventral lateral premotor cortex, and the supplementary motor area are essential for the voluntary control of facial expressions. In contrast, the cingulate cortical areas are important for emotional expression, since they receive input from different structures of the limbic system. This article is protected by copyright. All rights reserved.

Biomechanical properties of the atlantoaxial joint with naturally-occurring instability in a toy breed dog. A comparative descriptive cadaveric study

The biomechanical properties of the atlanto-axial joint in a young Yorkshire Terrier dog with spontaneous atlantoaxial instability were compared to those of another young toy breed dog with a healthy atlantoaxial joint. The range-of-motion was increased in flexion and lateral bending in the unstable joint. In addition, lateral bending led to torsion and dorsal dislocation of the axis within the atlas. On gross examination, the dens ligaments were absent and a longitudinal tear of the tectorial membrane was observed. These findings suggest that both ventral and lateral flexion may lead to severe spinal cord compression, and that the tectorial membrane may play a protective role in some cases of atlantoaxial instability.

Northeast Greenland - Digital Bathymetric Compilation, with links to DBM in ArcGIS format

A new digital bathymetric model (DBM) for the Northeast Greenland (NEG) continental shelf (74°N - 81°N) is presented. The DBM has a grid cell size of 250 m × 250 m and incorporates bathymetric data from 30 multibeam cruises, more than 20 single-beam cruises and first reflector depths from industrial seismic lines. The new DBM substantially improves the bathymetry compared to older models. The DBM not only allows a better delineation of previously known seafloor morphology but, in addition, reveals the presence of previously unmapped morphological features including glacially derived troughs, fjords, grounding-zone wedges, and lateral moraines. These submarine landforms are used to infer the past extent and ice-flow dynamics of the Greenland Ice Sheet during the last full-glacial period of the Quaternary and subsequent ice retreat across the continental shelf. The DBM reveals cross-shelf bathymetric troughs that may enable the inflow of warm Atlantic water masses across the shelf, driving enhanced basal melting of the marine-terminating outlet glaciers draining the ice sheet to the coast in Northeast Greenland. Knolls, sinks, and hummocky seafloor on the middle shelf are also suggested to be related to salt diapirism. North-south-orientated elongate depressions are identified that probably relate to ice-marginal processes in combination with erosion caused by the East Greenland Current. A single guyot-like peak has been discovered and is interpreted to have been produced during a volcanic event approximately 55 Ma ago.

Late Pleistocene oxygen isotope record of biognic silica

We determined the isotopic composition of oxygen in marine diatoms in eight deep-sea cores recovered from the Atlantic sector of the Southern Ocean. The analytical reproducibility and core-to-core consistency of the isotopic signal suggests that diatom delta18O can be used as a new paleocenographic tool to reconstruct past variations in surface water characteristics and to generate 18O -isotope-based stratigraphy for the Southern Ocean. The data indicate that diatom delta18O reflects sea surface temperature and seawater isotopic composition and that diatoms retain their isotopic signal on timescales of a least 430 ka. The delta18O analyses of different diatom assemblages reveal that the isotopic signal is free of species effects and that the common Antarctic species have the same water-opal fractionation. The transition from the last glacial maximum (LGM) to the Holocene is fully recorded in high sedimentation rate cores. An 18O enrichment during the LGM, a post-LGM meltwater spike and an input of meltwater during the late Holocene are the main isotopic features observed in down core records. The origin of this meltwater was very likely melting icebergs and/or continental ice or by melting sea ice that had accumulated snow. The most pronounced meltwater effects are recorded in cores that are associated with the Weddel gyre. Our results provide the basis for extending isotope studies to oceanic regions devoid of carbonate; further, isotopic stratigraphies may be constructed for records and regions where they were previously not possible.

Particle flux determined from traps in the Canary Island region

We present a 3 year record of deep water particle flux at the recently initiated ESTOC (European Station for Time-series in the Ocean, Canary Islands) located in the eastern subtropical North Atlantic gyre. Particle flux was highly seasonal, with flux maxima occurring in late winter-early spring. A comparison with historic CZCS (Coastal Zone Colour Scanner) data shows that these flux maxima occurred about 1 month after maximum chlorophyll was observed in surface waters in a presumed primary source region 100 km * 100 km northeast of the trap location. The main components of the particles collected with the traps were mineral particles and carbonate, both correlating strongly with organic matter sedimentation. Mineral particles in the sinking matter are indicative of the high aeolian input from the African desert regions. Comparing particle fluxes at 1 km and 3 km depth, we find that particle sedimentation increased substantially with depth. Yearly organic carbon sedimentation was 0.6 g m**-2 at 1 km depth compared with 0.8 g m**-2 at 3 km. We hypothesize that higher phytoplankton biomass observed further north could be a source of laterally advecting particles that interact with fast sinking particles originating from the primary source region. This hypothesis is also supported by the differences in size distribution of lithogenic matter found at the two trap depths.

Safety-related issues for high-speed railway bridges

Railway bridges have specific requirements related to safety, which often are critical aspects of design. In this paper the main phenomena are reviewed, namely vertical dynamic effects for impact effect of moving loads and resonance in high-speed, service limit states which affect the safety of running traffic, and lateral dynamic effects.