Cervical spinal cord dimensions and clinical outcomes in adults with Klippel-Feil syndrome: A comparison with matched controls.

Study Design Retrospective case–control study. Objectives To confirm the fact that spinal cord dimensions are smaller in adults with Klippel-Feil syndrome (KFS) than in pediatric patients with KFS and to compare the clinical characteristics and outcomes of neurologic complications in patients with KFS with matched controls. Methods We performed an independent 1:2 case–control retrospective radiographic and chart review of a consecutive series of adults with KFS who underwent surgical intervention. The control group consisted of consecutive non-KFS surgical patients. Patients were matched in 1:2 case–control manner. Their charts were reviewed and the clinical characteristics were compared. Axial T2-weighted magnetic resonance imaging (MRI) was used to measure the anteroposterior and mediolateral axial spinal cord and spinal canal at the operative levels and measurements were compared. Results A total of 22 patients with KFS and 44 controls were identified. The KFS group had a tendency of more myeloradiculopathy, and the control group had a tendency toward more radiculopathy. Both tendencies, however, were not significantly different. MRIs of 10 patients from the KFS group and 22 controls were available. There was no difference in the area of both spinal cord and canal at the operative levels. Conclusion Contrary to the finding in previous reports on pediatric patients, there were no differences between KFS and well-matched control groups in terms of age of onset, presentation, revision rate, complication rate, surgical outcome, and cross-sectional spinal cord and canal dimensions at the operative level

The incidence of bifid c7 spinous processes

For posterior cervical surgery, if the operation only involves the lower cervical area, counting from C2 is impractical and the level may not be visible on X-rays. In such cases, we usually place a marker at the top of the incision and also rely on the size and monofid shape of the C7 spinous process. Relying on the C7 morphology, however, we initially instrumented the wrong levels in a case where the patient had a bifid C7 spinous process. We therefore sought to determine the frequency of bifid cervicothoracic spinous processes. Computed tomography axial images of C6, C7, and T1 from 516 patients were evaluated. The spinous processes were classified into three categories: “bifid,” “partially bifid,” and “monofid.” C6 spinous process was monofid in 47.9% of cases, partially bifid in 4.2% of cases, and bifid in 47.9% of cases. C7 spinous process was monofid in 99.2% of cases, partially bifid in 0.5% of cases, and bifid in 0.3% of cases. T1 was monofid in all cases. A truly bifid C7 spinous process occurs 0.3% of the time and therefore is not a reliable landmark for choosing fusion levels. This knowledge hopefully helps prevent the type of wrong-level instrumentation that we performed

Electromagnetic Meson Production in the Nucleon Resonance Region

Recent experimental and theoretical advances in investigating electromagnetic meson production reactions in the nucleon resonance region are reviewed.Comment: 75 pages, 42 figure

Mechanical and corrosion resistance properties of TiO2nanoparticles reinforced Ni coating by electrodeposition

Coatings have been widely used in engineering and decoration to protect components and products and enhance their life span. Nickel (Ni) is one of the most important hard coatings. Improvement in its tribological and mechanical properties would greatly enhance its use in industry. Nanocomposite coatings of metals with various reinforced nanoparticles have been developed in last few decades. Titania (TiO2) exhibit excellent mechanical properties. It is believed that TiO2 incorporation in Ni matrix will improve the properties of Ni coatings significantly. The main purpose of the current work is to investigate the mechanical and anti-corrosion properties of the electroplated nickel nanocomposite with a small percentage of TiO2. The surface morphology of nanocomposite coating was characterized by scanning electron microscopy (SEM). The hardness of the nanocoating was carried out using micromaterials nanoplatform. The sliding wear rate of the coating at room temperature in dry condition was assessed by a reciprocating ball-on-disk computer-controlled oscillating tribotester. The results showed the nanocomposite coatings have a smoother and more compact surface than the pure Ni layer and have higher hardness and lower wear rate than the pure Ni coating. The anti-corrosion property of nanocomposite coating was carried out in 3.5% NaCl and high concentrated 35% NaCl solution, respectively. The results also showed that the nanocomposite coating improves the corrosion resistance significantly. This present work reveals that incorporation of TiO2 in nickel nanocomposite coating can achieve improved corrosion resistance and mechanical properties of both hardness and wear resistance performances, and the improvement becomes stronger as the content of TiO2 is increased

Clinical determinants of poor six-minute walk test performance in patients with left ventricular systolic dysfunction and no major structural heart disease

Background: The clinical determinants of six-minute walk test (6-MWT) performance in patients with left ventricular systolic dysfunction (LVSD) have rarely been investigated, and it is not clear whether they differ from patients referred for the assessment of symptoms of heart failure who do not have major structural heart disease (MSHD). Methods and Results: 571 patients with LVSD enrolled in a chronic disease management programme (79% male; mean age 71 ± 10 years; BMI 28 ± 5) completed a 6-MWT with a mean distance 337 ± 103 m. 688 patients referred with suspected heart failure but in whom MSHD was excluded (49% male; mean age 70 ± 11 years; BMI 28 ± 6) had a mean 6-MWT distance of 391 ± 106 m (P 300 m. In patients with LVSD, predictors of poor walking distance (≤ 300 m) included age ≥ 75 years (OR = 4.0, 95% CI = 2.4-6.4); low BMI ( 80 beats·min - 1 (OR = 2.2, 95% CI = 1.3-3.5); and being female (OR = 2.0, 95% CI = 1.3-3.0). Serum creatinine and NT-proBNP showed dose-response effects, as did self-perceived feelings of depression and anxiety. Determinants of 6-MWT in patients without MSHD were similar including age ≥ 75 years (OR = 6.0, 95% CI = 3.4-10.4), anaemia (OR = 2.8, 95% CI = 1.6-4.9), resting HR > 80 beats·min - 1 (OR = 2.5, 95% CI = 1.4-4.4) and being female (OR = 1.6, 95% CI = 1.9-2.4). NT-proBNP and self-perceived feelings of depression and anxiety also showed dose-response effects. Conclusion: The determinants of poor 6-MWT performance depend on physical-cardiovascular and non-cardiovascular, and psychological factors. Clinical predictors for poor walking performance are similar for patients with LVSD and without MSHD. © 2005 European Society of Cardiology