New Primates (Mammalia) From The Early and Middle Eocene Of Pakistan And Their Paleobiogeographical Implications

http://deepblue.lib.umich.edu/bitstream/2027.42/61363/1/GunnellContributions32 no1.pd

Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement:A Three-Dimensional Quantification

Background: Crouzon syndrome is characterized by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-center retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates whether the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphologic outcomes. Methods: Patients with Crouzon syndrome who underwent FFMBA with internal distraction [Hôpital Necker-Enfants Malades (Paris, France)] or external distraction [Great Ormond Street Hospital for Children (London, United Kingdom)] were compared. Digital Imaging and Communications in Medicine files of preoperative and postoperative computed tomographic scans were converted to three-dimensional bone meshes and skeletal movements were assessed using nonrigid iterative closest point registration. Displacements were visualized using color maps and statistical analysis of the vectors was undertaken. Results: Fifty-one patients met the strict inclusion criteria. Twenty-five underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement, whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant (P &lt; 0.01). Conclusions: Morphologic changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.</p

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

Reslip of a Previously Fixed Slipped Upper Femoral Epiphysis with an Associated Vitamin D Deficiency

Slipped upper femoral epiphysis (SUFE) is a relatively common adolescent hip disorder that represents a biomechanical instability of the proximal femoral growth plate. A link between vitamin D deficiency and SUFE has emerged in recent years; however, we present a unique case of a 10-year-old girl who presented with a reslip of a previously fixed SUFE with an associated vitamin D deficiency

Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification

INTRODUCTION: Crouzon syndrome is characterised by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-centre retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates if the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphological outcomes. METHODS: Patients with Crouzon syndrome who underwent FFMBA with internal distraction (Necker, Hôpital Necker - Enfants Malades, Paris) or external distraction (GOSH, Great Ormond Street Hospital for Children, London) were compared. DICOM files of pre- and post-operative CT-scans were converted to three-dimensional bone meshes and skeletal movements were assessed using non-rigid iterative closest point registration. Displacements were visualised using colour maps and statistical analysis of the vectors undertaken. RESULTS: 51 patients met the strict inclusion criteria. 25 underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant (p<0.01). CONCLUSION: Morphological changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis

Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement:A Three-Dimensional Quantification

Background: Crouzon syndrome is characterized by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-center retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates whether the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphologic outcomes. Methods: Patients with Crouzon syndrome who underwent FFMBA with internal distraction [Hôpital Necker-Enfants Malades (Paris, France)] or external distraction [Great Ormond Street Hospital for Children (London, United Kingdom)] were compared. Digital Imaging and Communications in Medicine files of preoperative and postoperative computed tomographic scans were converted to three-dimensional bone meshes and skeletal movements were assessed using nonrigid iterative closest point registration. Displacements were visualized using color maps and statistical analysis of the vectors was undertaken. Results: Fifty-one patients met the strict inclusion criteria. Twenty-five underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement, whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant (P &lt; 0.01). Conclusions: Morphologic changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.</p

Influence of the stoichiometry and grain morphology on the magnetic properties of Co substituted Ni–Zn nanoferrites

International audienceA set of Co substituted Ni–Zn nanoferrites with a nominal composition Co0.2Ni0.3Zn0.5Fe2O4 was prepared by the polyol method. The influence of a number of synthetic parameters on the structure, microstructure, and the magnetic properties was investigated. X-ray diffraction, infrared, energy dispersive X-ray, transmission electron microscopy, and vibrating sample magnetometry were employed for this purpose. The X-ray diffraction results confirmed the formation of a single phase nanocrystalline spinel-type ferrite powders. In addition, the cell parameter and the integrated intensity ratio I220/I422 was found to vary with the synthesis conditions suggesting deviation from the nominal chemical composition and/or a probable deviation from the preferential (that of the bulk) cations occupancy of the tetrahedral (A) and the octahedral (B) spinel sites. For the so-called bulk ferrite obtained by moderate sintering nanoparticles of the stoichiometric ferrite, a cation distribution similar to that of the bulk was suggested. Transmission electron microscopy analysis of the as-produced ferrites revealed the formation of nanoparticles with mean particle size in the range ~4–12 nm. The magnetic properties of both as-prepared nanoparticles and the so-called bulk ferrite were studied. All the as-produced particles exhibited superparamagnetic behavior at room temperature with a gradual decrease of the blocking temperature with the decrease of crystallite size. Additionally, the saturation magnetization, the coercivity, and the Curie temperature were found to be clearly dependent on the stoichiometry, the cations occupancy, and/or the grains morphology. For the stoichiometric ferrites the relatively higher Curie temperature values measured for the smaller particles was interpreted on the basis on the cations distribution change; for the as-produced nanoparticles a fraction of Zn2+ ions is expected to migrate from A to B sites accompanied with a reverse transfer of an equal amount of the paramagnetic cations from B to A sites