Sphincter of Oddi laxity:An important factor in hepatolithiasis

AIM:To evaluate the importance of sphincter of Oddi laxity (SOL) in hepatolithiasis (HL).METHODS:Subjects included 98 patients diagnosed with HL between 2002 and 2007. Detailed histories were taken and the subjects were monitored until July 2008. HL patients were divided into two groups:Group included 45 patients with SOL,and Group included 53 patients without. Recurrence and reoperation indices of both groups were calculated and compared.RESULTS:The recurrence index was 0.135 in Group and 0.018 in Group fldex was 0.070 in Group and 0.010 in Group (P <0.001). The mean frequency of biliary operation was 2.07in Group (P = 0.001). Differences between the two groups are significant.CONCLUSION:HL patients with SOL tend to have a higher risk of recurrence and a larger demand for re-operation than those without this condition.

Midtrimester pregnancy loss and cervical incompetence—Is there an association with connective tissue laxity?

Objectives: The basic mechanisms of cervical incompetence remain unknown although preliminary histological, biochemical and DNA studies suggest connective tissue pathology may be a contributing factor. Certain connective tissue disorders are known to be associated with obstetric complications. Utilising a standardised established scoring system for connective tissue laxity, this study aimed to test the relationship between clinical evidence of connective tissue laxity and cervical incompetence. Methods: This case-control study involved pregnant and non-pregnant women with a history of mid-trimester pregnancy loss in the absence of major bleeding, infection and uterine abnormalities and a control group of women with uncomplicated obstetric histories. Relevant medical details were obtained. Connective tissue laxity was assessed utilizing the Beighton scoring system. Potential confounding factors, including age, pregnancy and gestation were explored. Results: The frequency of connective tissue laxity between the cases [n = 29] was not statistically different from the controls [n = 58] [p = 0.391] suggesting a lack of association between cervical incompetence and clinical evidence of connective tissue laxity. Conclusion: Although no clear evidence of connective tissue laxity was demonstrated, it is possible that cervical incompetence is associated with abnormal connective tissue. But this abnormality is different from the defect that underlies joint hypermobility and skin elasticity.

Comparison of a simplified skin pointer device compared with a skeletal marker for knee rotation laxity: A cadaveric study using a rotation-meter

AIM To compare the measurements of knee rotation laxity by non-invasive skin pointer with a knee rotation jig in cadaveric knees against a skeletally mounted marker. METHODS Six pairs of cadaveric legs were mounted on a knee rotation jig. One Kirscher wire was driven into the tibial tubercle as a bone marker and a skin pointer was attached. Rotational forces of 3, 6 and 9 nm applied at 0°, 30°, 45°, 60° and 90° of knee flexion were analysed using the Pearson correlation coefficient and paired t-test. RESULTS Total rotation recorded with the skin pointer significantly correlated with the bone marker at 3 nm at 0°(skin pointer 23.9 ± 26.0° vs bone marker 16.3 ± 17.3°, r = 0.92; P = 0.0), 30°(41.7 ± 15.5° vs 33.1 ± 14.7°, r = 0.63; P = 0.037), 45°(49.0 ± 17.0° vs 40.3 ± 11.2°, r = 0.81; P = 0.002), 60°(45.7 ± 17.5° vs 34.7 ± 9.5°, r = 0.86; P = 0.001) and 90°(29.2 ± 10.9° vs 21.2 ± 6.8°, r = 0.69; P = 0.019) of knee flexion and 6 nm at 0°(51.1 ± 37.7° vs 38.6 ± 30.1°, r = 0.90; P = 0.0), 30°(64.6 ± 21.6° vs 54.3 ± 15.1°, r = 0.73; P = 0.011), 45°(67.7 ± 20.6° vs 55.5 ± 9.5°, r = 0.65; P = 0.029), 60°(62.9 ± 22.4° vs 45.8 ± 13.1°,r = 0.65; P = 0.031) and 90°(43.6 ± 17.6° vs 31.0 ± 6.3°, r = 0.62; P = 0.043) of knee flexion and at 9 nm at 0°(69.7 ± 40.0° vs 55.6 ± 30.6°, r = 0.86; P = 0.001) and 60°(74.5 ± 27.6° vs 57.1 ± 11.5°, r = 0.77; P = 0.006). No statistically significant correlation with 9 nm at 30°(79.2 ± 25.1° vs 66.9 ± 15.4°, r = 0.59; P = 0.055), 45°(80.7 ± 24.7° vs 65.5 ± 11.2°, r = 0.51; P = 0.11) and 90°(54.7 ± 21.1° vs 39.4 ± 8.2°, r = 0.55; P = 0.079). We recognize that 9 nm of torque may be not tolerated in vivo due to pain. Knee rotation was at its maximum at 45° of knee flexion and increased with increasing torque.CONCLUSION The skin pointer and knee rotation jig can be a reliable and simple means of quantifying knee rotational laxity with future clinical application.

CONGENITAL DISLOCATION OF THE HIP AND JOINT LAXITY

The authors reviewed 200 normal children and 225 cases of congenitaldislocation of the hip (CDH), all below 5 years of age. These cases were checked at thehip, ankle, elbow, wrist and knee for hyper-extension and thumb-radius angle at the wrist.From the values of 200 normal cases, SD was derived. Joint laxity was graded by the fol-lowing method (Wynne Davies, Tsuyama). SD±2=2 points, SD±1=1 point,【SD=0point. The result showed that in the normal group there were 8-12% of joint laxity,whereas in the CDH group there were 34-46%. Dividing the CDH and normal groups in-to boys and girls, and those below 2 and those aged 2-5 years group (50 each), itshowed a P value of 【0.01, 【0.02, 【0.01 and 【0.001 respectively. The authors believedthat CDH has a congenital fibrous tissue defect, probably associated with abnormality ofthe collagen fibres. The authors discuss this with clinical problems.

Clinical Analysis Supports Articulo-Autonomic Dysplasia as a Unifying Pathogenic Mechanism in Ehlers-Danlos Syndrome and Related Conditions

Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.

WRINKLE LIMIT BLANK HOLDER FORCE MODELS IN SQUARE-BOX DEEP DRAWING WITH VARIABLE SEGMENT BLANK-HOLDERS

Constituting the reasonable control models of the wrinkle limit blank holder forces is the sticking point of the processes of the deep drawing with variable blank-holder forces, especially in the square-box forming. To begin with, a mode of segmenting flange of the square-box into eight zones is put forward according to the fact that the uniformity of flange deforming can be improved by control-ling segment blank-holders. Considering the integral influence of shear stress, a new concept, strain relaxation factor is defined. Hereby, the law of distribution of stress and stain in the deforming flange of square-box is achieved. Then based on these mechanical analysis models and the energy principle, the wrinkling flexivity functions of the straight flange and the circle flange are given, and the corresponding formulae of wrinkling limit blank-holder force in these two situations are also educed. In these processes, ply-anisotropy, strain hardening, thickness and friction are considered. In the end, a calculating example is designed to validate the rationality of the formulae of wrinkling limit blank-holder force, at the same time, the influences of the ply-anisotropy exponent and the strain hardening exponent on the wrinkle limit blank holder forces are also analyzed.

Objective Assessment of Skin Tightening Using Multisource, Phase-Controlled Radiofrequency in Asians

Background: Radiofrequency has been proven to penetrate deeper than optical light sources independent of skin color allowing a safer treatment for the Asian skin type. Many studies have indicated the efficacy of various types of devices, but have not included a sufficient objective evaluation. Multisource radiofrequency uses multiple phase controlled radiofrequency generators with real time impedance control, allowing painless, deeper dermal heating with better adaptation to differences in individual skin impedance. In this study we used three-dimensional imaging for the objective evaluation of facial skin tightening by multisource phase-controlled radiofrequency. Methods: Twenty Japanese patients were treated with a multisource phase-controlled radiofrequency device. Three-dimensional imaging was performed with a Canfield Scientific Vectra camera and software, and quantitative volume measurements were taken to evaluate the change in the post-treatment volume. The patients then provided subjective assessments. Results: Objective assessments of the treated cheek volume evaluated by a three-dimensional color schematic representation with quantitative volume measurements showed significant improvement three months after the final treatment. The mean volume reduction at the last post-treatment visit was 3.878 ± 2.86 mL. The post-treatment volume was significantly reduced compared to the pretreatment volume in all of the volunteers (P = 0.0007). Ninety-five percent of volunteers reported satisfaction with the improvement of skin laxity, and ninety percent of volunteers reported satisfaction with the improvement of wrinkles, such as the nasolabial folds. Conclusions: The advantages of these multisource phase-controlled radiofrequency treatments are its high efficacy for skin tightening associated with minimal level of discomfort, minimal side effects, and low cost. Taken together, these characteristics facilitate the ability to give repeated treatments as a stand alone treatment or adjunct to surgery. This study provides for the first time a qualitative and quantitative volumetric assessment, proving the ability of the technology to reduce the volume through non invasive skin tightening.

Scheduling Non-stationary Bursts of Real-time and Non-real-time Traffic in ATM Networks

The problem of scheduling real time and non real time traffic in an ATM switch multiplexor when bursts of either type of traffic occur is studied. The scheduling algorithms studied are: Queue Length Threshold (QLT) and Minimum Laxity Threshold (MLT). Analytic results based on Markov Chains are used. In addition the results are compared with an optimal (but impractical) scheduling determined via dynamic programming. Dynamic programming is used in this paper to show that MLT gives a near optimal performance trade off between real time and non real time traffic for constant arrival rates. The trade off QLT allows is not close to optimal. For non real time bursts MLT still gives a close to optimal trade off. For real time bursts the trade off MLT allows between real time and non real time traffic is not as close to optimal, but even where the MLT trade off is not near optimal, the QLT trade off is much worse than the MLT trade off.

Sensitivity, repeatability and reproducibility study with a leg prototype of arecently developed knee arthrometer: The DYNEELAX®

Sagittal knee laxity is often quantified using arthrometers. Adding rotational laxity and compliance measurementsis relatively new and could bring new information for anterior cruciate ligament (ACL) injury diagnosis. TheDYNEELAX® is a new knee arthrometer able to evaluate simultaneously tibial translation and rotation. Thepurpose is to assess the sensitivity, reproducibility and repeatability of the DYNEELAX® with a prototype leg toprovide accurate instructions before using it in clinical practice. Sensitivity is studied by varying 7 parameters(positioning and sensors), and reproducibility by repeating measurement series with a group of two experiencedoperators and a group of two non-experienced operators. Repeatability is assessed throughout the study. Theresults showed that DYNEELAX® is poorly sensitive to the angle and the position of the displacement sensor, andthe angle of the rotation sensor. It is a bit sensitive to positioning of patella and ankle supports. It is very sensitiveto the tightening of the patella and ankle supports. It exists a significant difference only between groups (p <0.001), but there is no significant difference between the two experienced operators (p > 0.215), or between thetwo non-experienced operators (p > 0.229). Variation coefficients for intra-series are on average inferior to 5% fortranslation and rotation tests. Then, the DYNEELAX® presented encouraging results with a good accuracy and agood reliability but operators must be careful about positioning.

A novel mutation in COL1A2 leads to osteogenesis imperfecta/Ehlers-Danlos overlap syndrome with brachydactyly

Osteogenesis imperfecta(OI)is mainly characterized by bone fragility and Ehlers-Danlos syndrome(EDS)by connective tissue defects.Mutations in COL1A1 or COL1A2 can lead to both syndromes.OI/EDS overlap syndrome is mostly caused by helical mutations near the amino-proteinase cleavage site of type Ⅰ procollagen.In this study,we identified a Thai patient having OI type Ⅲ,EDS,brachydactyly,and dentinogenesis imperfecta.His dentition showed delayed eruption,early exfoliation,and severe malocclusion.For the first time,ultrastructural analysis of the tooth affected with OI/EDS showed that the tooth had enamel inversion,bonelike dentin,loss of dentinal tubules,and reduction in hardness and elasticity,suggesting severe developmental disturbance.These severe dental defects have never been reported in OI or EDS.Exome sequencing identified a novel de novo heterozygous glycine substitution,c.3296G>A,p.Gly1099Glu,in exon 49 of COL1A2.Three patients with mutations in the exon 49 of COL1A2 were previously reported to have OI with brachydactyly and intracranial hemorrhage.Notably,two of these three patients did not show hyperextensible joints and hypermobile skin,while our patient at the age of 5 years had not developed intracranial hemorrhage.Here,we demonstrate that the novel glycine substitution in the carboxyl region of alpha2(Ⅰ)collagen triple helix leads to OI/EDS with brachydactyly and severe tooth defects,expanding the genotypic and phenotypic spectra of OI/EDS overlap syndrome.