Acute aortic dissection mimicking as ureteral calculus

AbstractAcute aortic dissection is an uncommon but life-threatening emergency, which is often missed in up to 38% of patients on initial evaluation, and in up to 28% of patients the diagnosis is made at autopsy. Painless aortic dissection has been reported, but is relatively uncommon. The mortality rates are estimated at 50% by 48 hours and increase by 1% per hour if undiagnosed. We report a case of atypical aortic dissection who presented to ER with subtle unspecific renal colicky like pain as a primary symptom, which had made the prompt diagnosis very challenging and difficult

Personality as a Predictor of Student Success in Programming Principles

Large numbers of college students continue to fail to successfully complete programming principles courses. However, little research has addressed potential reasons for student failure. Many educators simply assume that high failure rates are acceptable – that computer programming is difficult and some students simply “don’t get it.” Some researchers (i.e., Bishop-Clark & Wheeler, 1994; Carland & Carland, 1990) have studied personality as a predictor of success in computer programming courses. However, with the exception of Woszczynski & Guthrie (2003), few studies have attempted to gather cognitive profiles (Krause, 2000) and match performance to profile type exhibited. Krause’s work shows that students with identified profiles can apply certain study skills to improve the probability of success in the classroom, and Woszczynski & Guthrie (2003) extended this research to the programming classroom, identifying underperforming cognitive profile groups. This study identified the primary cognitive profile of 236 students in a programming principles course at a southeastern university and matched profile to final average in programming principles I. Overall, intuitive thinkers (NT) tended to perform better in programming principles I than sensor feelers (SF). We found no other differences in performance between other paired profiles. We recommend a number of interventions to reach underperforming groups

Cytokine Profile in Plasma Extracellular Vesicles of Parkinson's Disease and the Association with Cognitive Function

Plasma extracellular vesicles (EVs) containing various molecules, including cytokines, can reflect the intracellular condition and participate in cell-to-cell signaling, thus emerging as biomarkers for Parkinson’s disease (PD). Inflammation may be a crucial risk factor for PD development and progression. The present study investigated the role of plasma EV cytokines as the biomarkers of PD. This cross-sectional study recruited 113 patients with PD, with mild to moderate stage disease, and 48 controls. Plasma EVs were isolated, and the levels of cytokines, including pro-interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1, were evaluated. Patients with PD had significantly increased plasma EV pro-IL-1β and TNF-α levels compared with controls after adjustment for age and sex. Despite the lack of a significant association between plasma EV cytokines and motor symptom severity in patients with PD, cognitive dysfunction severity, assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment, was significantly associated with plasma EV pro-IL-1β, IL-6, IL-10, and TNF-α levels. This association was PD specific and not found in controls. Furthermore, patients with PD cognitive deficit (MMSE < 26) exhibited a distinguished EV cytokine profile compared to those without cognitive deficit. The findings support the concept of inflammatory pathogenesis in the development and progression of PD and indicate that plasma EV cytokines may serve as PD biomarkers in future

Fabrication and Performance of MEMS-Based Pressure Sensor Packages Using Patterned Ultra-Thick Photoresists

A novel plastic packaging of a piezoresistive pressure sensor using a patterned ultra-thick photoresist is experimentally and theoretically investigated. Two pressure sensor packages of the sacrifice-replacement and dam-ring type were used in this study. The characteristics of the packaged pressure sensors were investigated by using a finite-element (FE) model and experimental measurements. The results show that the thermal signal drift of the packaged pressure sensor with a small sensing-channel opening or with a thin silicon membrane for the dam-ring approach had a high packaging induced thermal stress, leading to a high temperature coefficient of span (TCO) response of −0.19% span/°C. The results also show that the thermal signal drift of the packaged pressure sensors with a large sensing-channel opening for sacrifice-replacement approach significantly reduced packaging induced thermal stress, and hence a low TCO response of −0.065% span/°C. However, the packaged pressure sensors of both the sacrifice-replacement and dam-ring type still met the specification −0.2% span/°C of the unpackaged pressure sensor. In addition, the size of proposed packages was 4 × 4 × 1.5 mm3 which was about seven times less than the commercialized packages. With the same packaging requirement, the proposed packaging approaches may provide an adequate solution for use in other open-cavity sensors, such as gas sensors, image sensors, and humidity sensors

Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome – an experimental study in porcine model

<p>Abstract</p> <p>Background</p> <p>The association of lumbar spine instability between laminectomy and laminotomy has been clinically studied, but the corresponding <it>in vitro </it>biomechanical studies have not been reported. We investigated the hypothesis that the integrity of the posterior complex (spinous process-interspinous ligament-spinous process) plays an important role on the postoperative spinal stability in decompressive surgery.</p> <p>Methods</p> <p>Eight porcine lumbar spine specimens were studied. Each specimen was tested intact and after two decompression procedures. All posterior components were preserved in Group A (Intact). In Group B (Bilateral laminotomy), the inferior margin of L4 lamina and superior margin of L5 lamina were removed, but the L4–L5 supraspinous ligament was preserved. Fenestrations were made on both sides. In Group C (Laminectomy) the lamina and spinous processes of lower L4 and upper L5 were removed. Ligamentum flavum and supraspinous ligament of L4–L5 were removed. A hydraulic testing machine was used to generate an increasing moment up to 8400 N-mm in flexion and extension. Intervertebral displacement at decompressive level L4–L5 was measured by extensometer</p> <p>Results</p> <p>The results indicated that, under extension motion, intervertebral displacement between the specimen in intact form and at two different decompression levels did not significantly differ (<it>P </it>> 0.05). However, under flexion motion, intervertebral displacement of the laminectomy specimens at decompression level L4–L5 was statistically greater than in intact or bilateral laminotomy specimens (<it>P </it>= 0.0000963 and <it>P </it>= 0.000418, respectively). No difference was found between intact and bilateral laminotomy groups. (<it>P </it>> 0.05).</p> <p>Conclusion</p> <p>We concluded that a lumbar spine with posterior complex integrity is less likely to develop segment instability than a lumbar spine with a destroyed anchoring point for supraspinous ligament.</p

Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty

BACKGROUND: Polymethylmethacrylate (PMMA) is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty. METHODS: The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group), the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container), the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C) overnight before mixing. In group 3 (ice bath cooling), the syringes were immediately submerged in ice water after mixing the bone cement at room temperature. RESULTS: The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time) for ice bath cooling was longer than for that of the precooling method (p < 0.05). CONCLUSIONS: Both precooling (i.e. lowering the initial temperature) and ice bath cooling (i.e. lowering the surrounding temperature) can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take advantage of the improved injectability without any increased cost

Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: A comparative study between cannulated screws with cement injection and solid screws with cement pre-filling

<p>Abstract</p> <p>Background</p> <p>Pedicle screws with PMMA cement augmentation have been shown to significantly improve the fixation strength in a severely osteoporotic spine. However, the efficacy of screw fixation for different cement augmentation techniques, namely solid screws with retrograde cement pre-filling versus cannulated screws with cement injection through perforation, remains unknown. This study aimed to determine the difference in pullout strength between conical and cylindrical screws based on the aforementioned cement augmentation techniques. The potential loss of fixation upon partial screw removal after screw insertion was also examined.</p> <p>Method</p> <p>The Taguchi method with an L₈array was employed to determine the significance of design factors. Conical and cylindrical pedicle screws with solid or cannulated designs were installed using two different screw augmentation techniques: solid screws with retrograde cement pre-filling and cannulated screws with cement injection through perforation. Uniform synthetic bones (test block) simulating severe osteoporosis were used to provide a platform for each screw design and cement augmentation technique. Pedicle screws at full insertion and after a 360-degree back-out from full insertion were then tested for axial pullout failure using a mechanical testing machine.</p> <p>Results</p> <p>The results revealed the following 1) Regardless of the screw outer geometry (conical or cylindrical), solid screws with retrograde cement pre-filling exhibited significantly higher pullout strength than did cannulated screws with cement injection through perforation (<it>p </it>= 0.0129 for conical screws; <it>p </it>= 0.005 for cylindrical screws). 2) For a given cement augmentation technique (screws without cement augmentation, cannulated screws with cement injection or solid screws with cement pre-filling), no significant difference in pullout strength was found between conical and cylindrical screws (<it>p ></it>0.05). 3) Cement infiltration into the open cell of the test block led to the formation of a cement/bone composite structure. Observations of the failed specimens indicated that failure occurred at the composite/bone interface, whereas the composite remained well bonded to the screws. This result implies that the screw/composite interfacial strength was much higher than the composite/bone interfacial strength. 4) The back-out of the screw by 360 degrees from full insertion did not decrease the pullout strength in any of the studied cases. 5) Generally, larger standard deviations were found for the screw back-out cases, implying that the results of full insertion cases are more repeatable than those of the back-out cases.</p> <p>Conclusions</p> <p>Solid screws with retrograde cement pre-filling offer improved initial fixation strength when compared to that of cannulated screws with cement injection through perforation for both the conically and cylindrically shaped screw. Our results also suggest that the fixation screws can be backed out by 360 degrees for intra-operative adjustment without the loss of fixation strength.</p