Abduction extension cervical nerve root stress test: anatomical basis and clinical relevance

Purpose: While the Lasègue straight leg raising test is an established test for lumbar nerve root compression, an established equivalent for cervical nerve root compression is missing. The aim of this bi-modal study was to find the most effective way to stretch the cervical nerve roots anatomically in cadavers and to assess its value in the clinical setting. Methods: Three positional maneuvers of the upper limb were tested on three cadavers to determine the displacement by stretch of the nerve roots C5, C6 and C7. The maneuver which was most efficient in nerve root displacement was applied in 24 patients with confirmed symptomatic cervical nerve root compression (cases) and 65 controls to assess the clinical value of the test. Results: The most efficient way to displace the cervical nerve roots by stretch was to apply dorsal pressure on the humeral head with the shoulder in 80° of abduction and 30° of extension, with slight elbow flexion while the head is facing the contralateral side. This maneuver produced 4-5mm of nerve root displacement in cadavers. This test aggravated radicular symptoms in 79% of the patients with cervical nerve root compression and was negative in 98% of the controls. Conclusion: The described abduction extension test with posterior push on the humeral head creates a fulcrum over which the brachial plexus can be displaced to create stress on cervical nerve roots. This simple test is easy to perform clinically and aggravates radicular symptoms in most of the patients with cervical nerve root compression while it is negative in nearly all of the control

Comparison of Genetic Patterns of E. coli Strains Isolated from Patients with Cystitis and Pyelonephritis, Using Pulsed Field Gel Electrophoresis

Abstract: Background & Aims: Urinary tract infection (UTI) is one of the most frequently acquired bacterial infections caused by a large genetically heterogeneous group of Escherichia coli which are called uropathogenic E. coli (UPEC). Cystitis and pyelonephritis are two most common symptoms seen in patients with UTI. The genetic diversity of this organism has hampered the identification of UTI strains and it is unclear whether all UPEC isolates are capable of causing both cystitis and pyelonephritis. Therefore, Careful selection of appropriate genotyping methods is mandatory. The most popular method is Pulsed Field Gel Electrophoresis (PFGE) that is used in the present study to evaluate the genetic patterns of UPEC. Methods: In this cross-sectional study a total of 90 E. coli strains consisting of 48 isolates causing pyelonephritis and 42 isolates causing cystitis in children were analyzed by PFGE and their corresponding patterns were compared. Results: Sixty six PFGE profiles were obtained from the genome of E. coli strains by this genotyping method. Most strains exhibited twelve and thirteen bands and the patterns with eight or nineteen bands had the lowest rate. Genome size of strains was between 1610-4170 kbp. Conclusion: According to these results, it can be suggested that in some cases the strains causing pyelonephritis or cystitis have common patterns and different clinical symptoms could be attributed to different gene factors. Keywords: Escherichia coli, Pyelonephritis, Cystitis, Pulsed Field Gel Electrophoresis » XM

Negative muscle pennation angle as a sign of massive musculotendinous retraction after tendon tear: paradoxical function of the vastus lateralis muscle

Case report In the presented case, an isolated vastus lateralis tendon tear resulted in a negative pennation angle of the distal muscle fibers acting paradoxical to the physiological direction of the proximal muscle fibers. This observation makes the value of an in situ repair of a far retracted tendon tear with interposition of a graft questionable and emphasizes early over late anatomic surgical restoration of the muscle architecture after tendon tear

Prevalence of silicosis among workers in stone-cutter and silica powder production factories

Background: Use of industry and technology must be based on protection of health as well as the environment. In other words, constant development of technology should fulfil human needs and not pose a health hazard. Silicosis is one of the oldest industry-induced occupational pulmonary diseases which is caused through exposure to particles of crystalline silica in respirable sizes and still is a major health hazard in workers exposed to silica all over the world. Since there is no cure for silicosis and in affected patients the disease may continue to progress even after leaving the workforce, dust control in the working environment is the only way to overcome this disease. Materials and Methods: An analytical cross-sectional study was performed on workers of the 27 stone-cutter factories in Malayer- Azandarian during 2001-2002. Sampling method was un-randomized and considering the type of study, all factory workers who were about 100 individuals entered the study. The study was done via clinical examination, questionnaire, spirometry, and chest x-ray. Results: Study results demonstrated that lung examination was abnormal in 21 workers accompanied by respiratory symptoms as follows: Twelve cases had irritative coughs. Four cases had coughs and dyspnea and 5 complained of exertional dyspnea. In 10 of them a significant change was seen in their chest x-ray. Fourteen cases had an abnormal spirogram curve in evaluation of their respiratory status and only in 4 patients spirometry was abnormal. Most patients with silicosis were under the age of 44 and had almost 5 years of working experience. Six patients were smokers. In conclusion, 10 workers had silicosis (10) (6 cases of simple silicosis and 4 cases of the complicated type) and the diagnosis was confirmed by chest radiography. © 2006 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran

First in man in-situ augmented reality pedicle screw navigation

Background Augmented reality (AR) is a rising technology gaining increasing utility in medicine. By superimposing the surgical site and the operator's visual field with computer-generated information, it has the potential to enhance the cognitive skills of surgeons. This is the report of the first in man case with "direct holographic navigation" as part of a randomized controlled trial. Case description A pointing instrument was equipped with a sterile fiducial marker, which was used to obtain a digital representation of the intraoperative bony anatomy of the lumbar spine. Subsequently, a previously validated registration method was applied to superimpose the surgery plan with the intraoperative anatomy. The registration result is shown in situ as a 3D AR hologram of the preoperative 3D vertebra model with the planned screw trajectory and entry point for validation and approval by the surgeon. After achieving alignment with the surgery plan, a borehole is drilled and the pedicle screw placed. Postoperativ computer tomography was used to measure accuracy of this novel method for surgical navigation. Outcome Correct screw positions entirely within bone were documented with a postoperative CT, with an accuracy similar to current standard of care methods for surgical navigation. The patient was mobilized uneventfully on the first postoperative day with little pain medication and dismissed on the fourth postoperative day. Conclusion This first in man report of direct AR navigation demonstrates feasibility in vivo. The continuation of this randomized controlled study will evaluate the value of this novel technology

STR-925: BONDING BEHAVIOR IN BRIDGE STEEL-REINFORCED ELASTOMERIC ISOLATORS

Steel-reinforced elastomeric isolators (SREIs) have been shown to be efficient devices to protect structures against moderate and severe earthquakes by isolating them from ground motions. Bridge elastomeric isolators, however, deteriorate when undergone repetitive loading cycles due to either earthquakes or traffic loadings. One major damage type observed dominantly in these devices is delamination or de-bonding between rubber and supporting plates and steel reinforcements, if cold-bonded. This paper investigates potential damage scenarios likely to occur in cold-bonded bridge SREIs. It also looks into bonding properties of rubber and steel in tension and shear, the two important functional characteristics of elastomeric isolators. In this study, experimental tests are employed in order to observe the bonding behavior between rubber and steel. Damage states have been organized and it is observed that the adhesive properties and level of shear deformations govern bonding characteristics

Conditional Generative Data Augmentation for Clinical Audio Datasets

In this work, we propose a novel data augmentation method for clinical audio datasets based on a conditional Wasserstein Generative Adversarial Network with Gradient Penalty (cWGAN-GP), operating on log-mel spectrograms. To validate our method, we created a clinical audio dataset which was recorded in a real-world operating room during Total Hip Arthroplasty (THA) procedures and contains typical sounds which resemble the different phases of the intervention. We demonstrate the capability of the proposed method to generate realistic class-conditioned samples from the dataset distribution and show that training with the generated augmented samples outperforms classical audio augmentation methods in terms of classification performance. The performance was evaluated using a ResNet-18 classifier which shows a mean Macro F1-score improvement of 1.70% in a 5-fold cross validation experiment using the proposed augmentation method. Because clinical data is often expensive to acquire, the development of realistic and high-quality data augmentation methods is crucial to improve the robustness and generalization capabilities of learning-based algorithms which is especially important for safety-critical medical applications. Therefore, the proposed data augmentation method is an important step towards improving the data bottleneck for clinical audio-based machine learning systems

Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran

Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject. The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05. Out of 149 cases, 61.64 were male with the mean age of 30.81 years. A total of 66 participants (44.29) (95 confidence interval CI: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term 'medical professionalism' before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P=0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67. The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of this concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals. © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved

Clinical outcome and long-term follow-up after liposuction procedures

Liposuction is one of the most common aesthetic procedure used in plastic surgery. Reports are available on the results, the probable complications, and the feedback of patients. However, systematic studies dealing with these aspects using reliable large-enough data are still needed. The data comprised 116 procedures during a 6-year period up to 2005. The data were processed and categories of results were formed. Furthermore, a follow-up examination and a survey on the feedback of patients were carried out. Significant differences were identified in indications, results, and complications. The follow-up examinations and the survey showed satisfying results. In the majority of cases, surgeons were satisfied with the operations. In conclusion, if conducted by qualified surgeons in appropriate surgical conditions and postoperative care possibilities, liposuction may be considered as a reliable surgical procedure. The success of this procedure depends, however, on suitable infrastructure and operative competenc