Search results for: scapular posterior tilting
Commenced in January 2007
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Edition: International
Paper Count: 314

Search results for: scapular posterior tilting

224 Neurophysiology of Domain Specific Execution Costs of Grasping in Working Memory Phases

Authors: Rumeysa Gunduz, Dirk Koester, Thomas Schack

Abstract:

Previous behavioral studies have shown that working memory (WM) and manual actions share limited capacity cognitive resources, which in turn results in execution costs of manual actions in WM. However, to the best of our knowledge, there is no study investigating the neurophysiology of execution costs. The current study aims to fill this research gap investigating the neurophysiology of execution costs of grasping in WM phases (encoding, maintenance, retrieval) considering verbal and visuospatial domains of WM. A WM-grasping dual task paradigm was implemented to examine execution costs. Baseline single task required performing verbal or visuospatial version of a WM task. Dual task required performing the WM task embedded in a high precision grasp to place task. 30 participants were tested in a 2 (single vs. dual task) x 2 (visuo-spatial vs. verbal WM) within subject design. Event related potentials (ERPs) were extracted for each WM phase separately in the single and dual tasks. Memory performance for visuospatial WM, but not for verbal WM, was significantly lower in the dual task compared to the single task. Encoding related ERPs in the single task revealed different ERPs of verbal WM and visuospatial WM at bilateral anterior sites and right posterior site. In the dual task, bilateral anterior difference disappeared due to bilaterally increased anterior negativities for visuospatial WM. Maintenance related ERPs in the dual task revealed different ERPs of verbal WM and visuospatial WM at bilateral posterior sites. There was also anterior negativity for visuospatial WM. Retrieval related ERPs in the single task revealed different ERPs of verbal WM and visuospatial WM at bilateral posterior sites. In the dual task, there was no difference between verbal WM and visuospatial WM. Behavioral and ERP findings suggest that execution of grasping shares cognitive resources only with visuospatial WM, which in turn results in domain specific execution costs. Moreover, ERP findings suggest unique patterns of costs in each WM phase, which supports the idea that each WM phase reflects a separate cognitive process. This study not only contributes to the understanding of cognitive principles of manual action control, but also contributes to the understanding of WM as an entity consisting of separate modalities and cognitive processes.

Keywords: dual task, grasping execution, neurophysiology, working memory domains, working memory phases

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223 Usage Of the Transpedicular Screw Fixation Method in the Treatment of Pediatric Patients with Injuries of the Thoracic and Lumbar Spine.

Authors: S. D. Zalepugin, A. E. Murzich, D. G. Satskevich, A. B. Palivanov

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Introduction. The incidence of spinal injuries in patients under 18 years of age has increased significantly in recent years, which represents a significant economic, social and medical problem. The most common method of surgical stabilization of spinal fractures in pediatric patients is transpedicular posterior spinal fusion, which is widely used by spinal neurosurgeons in adult patients. Purpose of the study: This study evaluates the results of treatment of thoracolumbar spine lesions in children using the transpedicular screw fixation method. Materials and methods. From 2019 to 2024, 35 children with injuries to the thoracic and lumbar spine underwent surgical treatment using the transpedicular screw fixation method. Among the injured, girls prevailed (21 cases, 60%). The age of the victims ranged from 9 to 17 years. The main causes of damage were: catatrauma (19 cases), road accident (5 cases), sports injury (6 cases), and other reasons - 5 cases. In 5 cases, suicidal attempts occurred. Co-injury was observed in most cases (20 patients, or 57%), which is natural for high-energy injury. Vertebral-spinal injury with neurological disorders was observed in 13 patients, the disorders ranged from mild inferior (4 children) to moderate/severe paraparesis (5 patients) and inferior paraplegia (4 children). 6 children had pelvic organ dysfunction in the form of urinary and fecal retention or incontinence. All thirty-five patients, within a period of 1 to 57 days after the injury, underwent several surgical interventions from the posterior surgical access using a screw fixation method (posterior decompression + spinal fusion). In 12 cases, it was necessary to perform the second stage of surgical treatment - anterior decompression of the spinal cord or its roots. Verticalization of patients was carried out within 1 to 5 days after surgery. Results. In all patients, the nearest, up to 1 year, results were evaluated. In children operated in 2019-2021, the results were studied in terms of 3 to 5 years. The procedures used, clinical results and the quality of the fixative installation were assessed. All patients managed to achieve positive results. The use of internal fixation made it possible to carry out early verticalization of children, eliminate pain syndrome and achieve a regression of neurological disorders in most patients (especially in cases when the operation was performed early after injury - from 1 to 3 days). Within the first month, the ability to self-care was fully restored. Bone fusion was observed within 6-12 months after surgery. There were no complications after surgery. The analysis of postoperative radiographs, CT and MRI images revealed the correct standing of the screws in all cases. Conclusion. The posterior spinal fusion using the new method of screw fixation in pediatric patients allows to achieve durable stabilization of damage, begins early rehabilitation of patients and reduces the duration of hospital treatment by 2-3 times. Thus, we recommend the use of a transpedicular fixator in children as a reliable, technically feasible method for restoring spinal stability with a low risk of intra- and postoperative complications.

Keywords: pediatric patients, spinal injuries, transpedicular stabilization, operative treatment

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222 Comparison of the Effect of Semi-Rigid Ankle Bracing Performance among Ankle Injured Versus Non-Injured Adolescent Female Hockey Players

Authors: T. J. Ellapen, N. Acampora, S. Dawson, J. Arling, C. Van Niekerk, H. J. Van Heerden

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Objectives: To determine the comparative proprioceptive performance of injured versus non-injured adolescent female hockey players when wearing an ankle brace. Methods: Data were collected from 100 high school players who belonged to the Highway Secondary School KZN Hockey league via voluntary parental informed consent and player assent. Players completed an injury questionnaire probing the prevalence and nature of hockey injuries (March-August 2013). Subsequently players completed a Biodex proprioceptive test with and without an ankle brace. Probability was set at p≤ 0.05. Results: Twenty-two players sustained ankle injuries within the six months (p<0.001). Injured players performed similarly without bracing Right Anterior Posterior Index (RAPI): 2.8±0.9; Right Medial Lateral Index (RMLI): 1.9±0.7; Left Anterior Posterior Index (LAPI) LAPI: 2.7; Left Medial Lateral Index (LMLI): 1.7±0.6) as compared to bracing (RAPI: 2.7±1.4; RMLI: 1.8±0.6; LAPI: 2.6±1.0; LMLI: 1.5±0.6) (p>0.05). However, bracing (RAPI: 2.2±0.8; RMLI: 1.5±0.5; LAPI: 2.4±0.9; MLI: 1.5±0.5) improved the ankle stability of the non-injured group as compared to their unbraced performance (RAPI: 2.5±1.0; RMLI: 1.8±0.8; LAPI: 2.8±1.1; LMLI: 1.8±0.6) (p<0.05). Conclusion: Ankle bracing did not enhance the stability of injured ankles. However ankle bracing has an ergogenic effect enhancing the stability of healthy ankles.

Keywords: hockey, proprioception, ankle, bracing

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221 Clinical Outcomes and Surgical Complications in Patients with Cervical Disk Degeneration

Authors: Mirzashahi Babak, Mansouri Pejman, Najafi Arvin, Farzan Mahmoud

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Introduction: There are several surgical treatment choices for cervical spondylotic myelopathy (CSM). The aim of this study is to evaluate clinical outcomes and surgical complications in patients with cervical disk degeneration (CDD) undergoing either anterior cervical discectomy with or without fusion or cervical laminectomy and fusion. Methods: This prospective case series study included 45 consecutive patients with cervical spondylotic myelopathy between January 2010 and November 2014. There were 28 males and 17 females, with a mean age of 47 (range 37-68) years. The mean clinical follow-up was 14 months (range 3-24 months). The Neck Disability Index (NDI), visual analog scale (VAS) neck and arm pain, Short Form-36 (SF-36) were used as the functional outcome measurements. All of the complications in our patients were recorded. Results: In our study group, 26 patients underwent only one or two level anterior cervical discectomy. Ten patients underwent anterior cervical discectomy and fusion (ACDF) and nine cases underwent posterior laminectomy and fusion. We have found a statistically significant improvement between mean preoperative (29, range 19-43) and postoperative (7, range 0-12) NDI scores following surgery (P < 0.05). Also, there was a statistically significant difference between pre and post-operative VAS and SF-36 score (p < 0.05). There was a 7% overall complication rate (n = 3). The only complication in our patients was surgical site cellulitis which has been managed with oral antibiotic therapy. Conclusion: Both anterior cervical discectomy with or without fusion or posterior laminectomy and fusion are safe and efficacious treatment options for the management of CSM. The clinical outcomes seem to be fairly reproducible.

Keywords: cervical, myelopathy, discectomy, fusion, laminectomy

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220 Multiple Variations of the Nerves of Gluteal Region and Their Clinical Implications, a Case Report

Authors: A. M. Prasad

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Knowledge of variations of nerves of gluteal region is important for clinicians administering intramuscular injections, for orthopedic surgeons dealing with the hip surgeries, possibly for physiotherapists managing the painful conditions and paralysis of this region. Herein, we report multiple variations of the nerves of gluteal region. In the current case, the sciatic nerve was absent. The common peroneal and tibial nerves arose from sacral plexus and reached the gluteal region through greater sciatic foramen above and below piriformis respectively. The common peroneal nerve gave a muscular branch to the gluteus maximus. The inferior gluteal nerve and posterior cutaneous nerve of the thigh arose from a common trunk. The common trunk was formed by three roots. Upper and middle roots arose from sacral plexus and entered gluteal region through greater sciatic foramen respectively above and below piriformis. The lower root arose from the pudendal nerve and joined the common trunk. These variations were seen in the right gluteal region of an adult male cadaver aged approximately 70 years. Innervation of gluteus maximus by common peroneal nerve and presence of a common trunk of inferior gluteal nerve and posterior cutaneous nerve of the thigh make this case unique. The variant nerves may be subjected to iatrogenic injuries during surgical approach to the hip. They may also get compressed if there is a hypertrophy of the piriformis syndrome. Hence, the knowledge of these variations is of importance to clinicians, orthopedic surgeons and possibly for physiotherapists.

Keywords: gluteal region, multiple variations, nerve injury, sciatic nerve

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219 From Responses of Macroinvertebrate Metrics to the Definition of Reference Thresholds

Authors: Hounyèmè Romuald, Mama Daouda, Argillier Christine

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The present study focused on the use of benthic macrofauna to define the reference state of an anthropized lagoon (Nokoué-Benin) from the responses of relevant metrics to proxies. The approach used is a combination of a joint species distribution model and Bayesian networks. The joint species distribution model was used to select the relevant metrics and generate posterior probabilities that were then converted into posterior response probabilities for each of the quality classes (pressure levels), which will constitute the conditional probability tables allowing the establishment of the probabilistic graph representing the different causal relationships between metrics and pressure proxies. For the definition of the reference thresholds, the predicted responses for low-pressure levels were read via probability density diagrams. Observations collected during high and low water periods spanning 03 consecutive years (2004-2006), sampling 33 macroinvertebrate taxa present at all seasons and sampling points, and measurements of 14 environmental parameters were used as application data. The study demonstrated reliable inferences, selection of 07 relevant metrics and definition of quality thresholds for each environmental parameter. The relevance of the metrics as well as the reference thresholds for ecological assessment despite the small sample size, suggests the potential for wider applicability of the approach for aquatic ecosystem monitoring and assessment programs in developing countries generally characterized by a lack of monitoring data.

Keywords: pressure proxies, bayesian inference, bioindicators, acadjas, functional traits

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218 The Patterns of Cross-Sentence: An Event-Related Potential Study of Mathematical Word Problem

Authors: Tien-Ching Yao, Ching-Ching Lu

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Understanding human language processing is one of the main challenges of current cognitive neuroscience. The aims of the present study were to use a sentence decision task combined with event-related potentials to investigate the psychological reality of "cross-sentence patterns." Therefore, we take the math word problems the experimental materials and use the ERPs' P600 component to verify. In this study, the experimental material consisted of 200 math word problems with three different conditions were used ( multiplication word problems、division word problems type 1、division word problems type 2 ). Eighteen Mandarin native speakers participated in the ERPs study (14 of whom were female). The result of the grand average waveforms suggests a later posterior positivity at around 500ms - 900ms. These findings were tested statistically using repeated measures ANOVAs at the component caused by the stimulus type of different questions. Results suggest that three conditions present significant (P < 0.05) on the Mean Amplitude, Latency, and Peak Amplitude. The result showed the characteristic timing and posterior scalp distribution of a P600 effect. We interpreted these characteristic responses as the psychological reality of "cross-sentence patterns." These results provide insights into the sentence processing issues in linguistic theory and psycholinguistic models of language processing and advance our understanding of how people make sense of information during language comprehension.

Keywords: language processing, sentence comprehension, event-related potentials, cross-sentence patterns

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217 Analgesic Efficacy of IPACK Block in Primary Total Knee Arthroplasty (90 CASES)

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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216 Development of a System for Measuring the Three-axis Pedal Force in Cycling and Its Applications

Authors: Joo-Hack Lee, Jin-Seung Choi, Dong-Won Kang, Jeong-Woo Seo, Ju-Young Kim, Dae-Hyeok Kim, Seung-Tae Yang, Gye-Rae Tack

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For cycling, the analysis of the pedal force is one of the important factors in the study of exercise ability assessment and overuse injuries. In past studies, a two-axis measurement sensor was used at the sagittal plane to measure the force only in the anterior, posterior, and vertical directions and to analyze the loss of force and the injury on the frontal plane due to the forces in the right and left directions. In this study, which is a basic study on diverse analyses of the pedal force that consider the forces on the sagittal plane and the frontal plane, a three-axis pedal force measurement sensor was developed to measure the anterior-posterior (Fx), medio-lateral (Fz), and vertical (Fy) forces. The sensor was fabricated with a size and shape similar to those of the general flat pedal, and had a 550g weight that allowed smooth pedaling. Its measurement range was ±1000 N for Fx and Fz and ±2000 N for Fy, and its non-linearity, hysteresis, and repeatability were approximately 0.5%. The data were sampled at 1000 Hz using a signal collector. To use the developed sensor, the pedaling efficiency (index of efficiency, IE) and the range of left and right (medio-lateral, ML) forces were measured with two seat heights (low and high). The results of the measurement showed that the IE was higher and the force range in the ML direction was lower with the high position than with the low position. The developed measurement sensor and its application results will be useful in understanding and explaining the complicated pedaling technique, and will enable diverse kinematic analyses of the pedal force on the sagittal plane and the frontal plane.

Keywords: cycling, pedal force, index of effectiveness, measuring

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215 Effects on Cortical Thickness due to Musical Training in Elementary School Children: The Importance of Manual Structural Analysis

Authors: Saba Daneshmand, Assal Habibi

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Studying musicians has become a prominent approach in macrostructural neuroscience research aimed at exploring the influence of environmental factors on brain development due to the significant impact of musical training on the brain. Although longitudinal studies can establish a direct causal relationship between musical training and brain development, only a limited number of studies have been conducted for a long enough duration. We recruited children for the experimental music group to participate in an after-school music program which was compared to the control group that had no such after-school program or enrichment activities. We ultimately calculated cortical thickness, a distinct measure of development. When a task such as playing an instrument occurs frequently, the associated neural processes become quicker and more refined over time, causing only the necessary pathways to remain; this, therefore, results in cortical thinning. The Brain and Music Lab has identified the anterior and posterior superior temporal gyrus, Heschl's gyrus, and the inferior regions to be involved with musicianship. The past study only found that the posterior superior temporal gyrus experienced a larger thinning in the music group compared to the control; however, we expect our ongoing study to produce similar but more intense results, including thinning in the other regions associated with musicianship. We believe the limited results of the previous study are due to its short duration which is why this ongoing and more lengthy longitudinal study is a significant and indispensable contribution in helping us discover the important developmental aspects of musical training.

Keywords: cortical thickness, music, neuroimaging, child development

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214 Reaching a Mobile and Dynamic Nose after Rhinoplasty: A Pilot Study

Authors: Guncel Ozturk

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Background: Rhinoplasty is the most commonly performed cosmetic operations in plastic surgery. Maneuvers used in rhinoplasty lead to a firm and stiff nasal tip in the early postoperative months. This unnatural stability of the nose may easily cause distortion in the reshaped nose after severe trauma. Moreover, a firm nasal tip may cause difficulties in performing activities such as touching, hugging, or kissing. Decreasing the stability and increasing the mobility of the nasal tip would help rhinoplasty patients to avoid these small but relatively important problems. Methods: We use delivery approach with closed rhinoplasty and changed positions of intranasal incisions to reach a dynamic and mobile nose. A total of 203 patients who had undergone primary closed rhinoplasty in private practice were inspected retrospectively. Posterior strut flap that was connected with connective tissues in the caudal of septum and the medial crurals were formed. Cartilage of the posterior strut graft was left 2 mm thick in the distal part of septum, it was cut vertically, and the connective tissue in the distal part was preserved. Results: The median patient age was 24 (range 17-42) years. The median follow-up period was15.2 (range12-26) months. Patient satisfaction was assessed with the 'Rhinoplasty Outcome Evaluation' (ROE) questionnaire. Twelve months after surgeries, 87.5% of patients reported excellent outcomes, according to ROE. Conclusion: The soft tissue connections between that segment and surrounding structures should be preserved to save the support of the tip while having a mobile tip at the same time with this method. These modifications would access to a mobile, non-stiff, and dynamic nasal tip in the early postoperative months. Further and prospective studies should be performed for supporting this method.

Keywords: closed rhinoplasty, dynamic, mobile, tip

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213 Special Features Of Phacoemulsification Technique For Dense Cataracts

Authors: Shilkin A.G., Goncharov D.V., Rotanov D.A., Voitecha M.A., Kulyagina Y.I., Mochalova U.E.

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Context: Phacoemulsification is a surgical technique used to remove cataracts, but it has a higher number of complications when dense cataracts are present. The risk factors include thin posterior capsule, dense nucleus fragments, and prolonged exposure to high-power ultrasound. To minimize these complications, various methods are used. Research aim: The aim of this study is to develop and implement optimal methods of ultrasound phacoemulsification for dense cataracts in order to minimize postoperative complications. Methodology: The study involved 36 eyes of dogs with dense cataracts over a period of 5 years. The surgeries were performed using a LEICA 844 surgical microscope and an Oertli Faros phacoemulsifier. The surgical techniques included the optimal technique for breaking the nucleus, bimanual surgery, and the use of Akahoshi prechoppers. Findings: The complications observed during the surgery included rupture of the posterior capsule and the need for anterior vitrectomy. Complications in the postoperative period included corneal edema and uveitis. Theoretical importance: This study contributes to the field by providing insights into the special features of phacoemulsification for dense cataracts. It highlights the importance of using specific techniques and settings to minimize complications. Data collection and analysis procedures: The data for the study were collected from surgeries performed on dogs with dense cataracts. The complications were documented and analyzed. Question addressed: The study addressed the question of how to minimize complications during phacoemulsification surgery for dense cataracts. Conclusion: By following the optimal techniques, settings, and using prechoppers, the surgery for dense cataracts can be made safer and faster, minimizing the risks and complications.

Keywords: dense cataracts, phacoemulsification, phacoemulsification of cataracts in elderly dogs, осложнения факоэмульсификации

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212 Elite Child Athletes Are Our Future: Cardiac Adaptation to Monofin Training in Prepubertal Egyptian Athletes

Authors: Magdy Abouzeid, Nancy Abouzeid, Afaf Salem

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Background: The elite child athletes are one who has superior athletic talent. Monofin (a single surface swim fin) swimming already proved to be the most efficient method of swimming for human being. This is a novel descriptive study examining myocardial function indices in prepubertal monofin children. The aim of the present study was to determine the influence of long-term monofin training (LTMT), 36 weeks, 6 times per week, 90 min per unit on Myocardial function adaptation in elite child monofin athletes. Methods: 14 elite monofin children aged 11.95 years (± 1.09 yr) took part for (LTMT). All subjects underwent two-dimension, M-mode, and Doppler echocardiography before and after training to evaluate cardiac dimensions and function; septal and posterior wall thickness. Statistical methods of SPSS, means ± SD and paired t test, % of improvement were used. Findings: There was significant difference (p<0.01) and % improvement for all echocardiography parameter after (LTMT). Inter ventricular septal thickness in diastole and in systole increased by 27.9 % and 42.75 %. Left ventricular end systolic dimension and diastole increased by 16.81 % and 42.7 % respectively. Posterior wall thickness in systole very highly increased by 283.3 % and in diastole increased by 51.78 %. Left ventricular mass in diastole and in systole increased by 44.8 % and 40.1 % respectively. Stroke volume (SV) and resting heart rate (HR) significant changed (sv) 25 %, (HR) 14.7 %. Interpretation: the unique swim fin tool and create propulsion and overcome resistance. Further researches are needed to determine the effects of monofin training on right ventricular in child athletes.

Keywords: prepubertal, monofin training, heart athlete's, elite child athlete, echocardiography

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211 Humeral Head and Scapula Detection in Proton Density Weighted Magnetic Resonance Images Using YOLOv8

Authors: Aysun Sezer

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Magnetic Resonance Imaging (MRI) is one of the advanced diagnostic tools for evaluating shoulder pathologies. Proton Density (PD)-weighted MRI sequences prove highly effective in detecting edema. However, they are deficient in the anatomical identification of bones due to a trauma-induced decrease in signal-to-noise ratio and blur in the traumatized cortices. Computer-based diagnostic systems require precise segmentation, identification, and localization of anatomical regions in medical imagery. Deep learning-based object detection algorithms exhibit remarkable proficiency in real-time object identification and localization. In this study, the YOLOv8 model was employed to detect humeral head and scapular regions in 665 axial PD-weighted MR images. The YOLOv8 configuration achieved an overall success rate of 99.60% and 89.90% for detecting the humeral head and scapula, respectively, with an intersection over union (IoU) of 0.5. Our findings indicate a significant promise of employing YOLOv8-based detection for the humerus and scapula regions, particularly in the context of PD-weighted images affected by both noise and intensity inhomogeneity.

Keywords: YOLOv8, object detection, humerus, scapula, IRM

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210 Effects of Axial Loads and Soil Density on Pile Group Subjected to Triangular Soil Movement

Authors: Ihsan Al-Abboodi, Tahsin Toma-Sabbagh

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Laboratory tests have been carried out to investigate the response of 2x2 pile group subjected to triangular soil movement. The pile group was instrumented with displacement and tilting devices at the pile cap and strain gauges on two piles of the group. In this paper, results from four model tests were presented to study the effects of axial loads and soil density on the lateral behavior of piles. The responses in terms of bending moment, shear force, soil pressure, deflection, and rotation of piles were compared. Test results indicate that increasing the soil strength could increase the measured moment, shear, soil pressure, and pile deformations. Most importantly, adding loads to the pile cap induces additional moment to the head of front-pile row unlike the back-pile row which was influenced insignificantly.

Keywords: pile group, passive piles, lateral soil movement, soil density, axial loads

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209 Lateral Retroperitoneal Transpsoas Approach: A Practical Minimal Invasive Surgery Option for Treating Pyogenic Spondylitis of the Lumbar Vertebra

Authors: Sundaresan Soundararajan, Chor Ngee Tan

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Introduction: Pyogenic spondylitis, otherwise treated conservatively with long term antibiotics, would require surgical debridement and reconstruction in about 10% to 20% of cases. The classical approach adopted many surgeons have always been anterior approach in ensuring thorough and complete debridement. This, however, comes with high rates of morbidity due to the nature of its access. Direct lateral retroperitoneal approach, which has been growing in usage in degenerative lumbar diseases, has the potential in treating pyogenic spondylitis with its ease of approach and relatively low risk of complications. Aims/Objectives: The objective of this study was to evaluate the effectiveness and clinical outcome of using lateral approach surgery in the surgical management of pyogenic spondylitis of the lumbar spine. Methods: Retrospective chart analysis was done on all patients who presented with pyogenic spondylitis (lumbar discitis/vertebral osteomyelitis) and had undergone direct lateral retroperitoneal lumbar vertebral debridement and posterior instrumentation between 2014 and 2016. Data on blood loss, surgical operating time, surgical complications, clinical outcomes and fusion rates were recorded. Results: A total of 6 patients (3 male and 3 female) underwent this procedure at a single institution by a single surgeon during the defined period. One patient presented with infected implant (PLIF) and vertebral osteomyelitis while the other five presented with single level spondylodiscitis. All patients underwent lumbar debridement, iliac strut grafting and posterior instrumentation (revision of screws for infected PLIF case). The mean operating time was 308.3 mins for all 6 cases. Mean blood loss was reported at 341cc (range from 200cc to 600cc). Presenting symptom of back pain resolved in all 6 cases while 2 cases that presented with lower limb weakness had improvement of neurological deficits. One patient had dislodged strut graft while performing posterior instrumentation and needed graft revision intraoperatively. Infective markers normalized for all patients subsequently. All subjects also showed radiological evidence of fusion on 6 months follow up. Conclusions: Lateral approach in treating pyogenic spondylitis is a viable option as it allows debridement and reconstruction without the risk that comes with other anterior approaches. It allows efficient debridement, short surgical time, moderate blood loss and low risk of vascular injuries. Clinical outcomes and fusion rates by this approach also support its use as practical MIS option surgery for such infection cases.

Keywords: lateral approach, minimally invasive, pyogenic spondylitis, XLIF

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208 Cadaveric Study of Lung Anatomy: A Surgical Overview

Authors: Arthi Ganapathy, Rati Tandon, Saroj Kaler

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Introduction: A thorough knowledge of variations in lung anatomy is of prime significance during surgical procedures like lobectomy, pneumonectomy, and segmentectomy of lungs. The arrangement of structures in the lung hilum act as a guide in performing such procedures. The normal pattern of arrangement of hilar structures in the right lung is eparterial bronchus, pulmonary artery, hyparterial bronchus and pulmonary veins from above downwards. In the left lung, it is pulmonary artery, principal bronchus and pulmonary vein from above downwards. The arrangement of hilar structures from anterior to posterior in both the lungs is pulmonary vein, pulmonary artery, and principal bronchus. The bronchial arteries are very small and usually the posterior most structures in the hilum of lungs. Aim: The present study aims at reporting the variations in hilar anatomy (arrangement and number) of lungs. Methodology: 75 adult formalin fixed cadaveric lungs from the department of Anatomy AIIMS New Delhi were observed for variations in the lobar anatomy. Arrangement of pulmonary hilar structures was meticulously observed, and any deviation in the pattern of presentation was recorded. Results: Among the 75 adult lung specimens observed 36 specimens were of right lung and the rest of left lung. Seven right lung specimens showed only 2 lobes with an oblique fissure dividing them and one left lung showed 3 lobes. The normal pattern of arrangement of hilar structures was seen in 22 right lungs and 23 left lungs. Rest of the lung specimens (14 right and 16 left) showed a varied pattern of arrangement of hilar structures. Some of them showed alterations in the sequence of arrangement of pulmonary artery, pulmonary veins, bronchus, and others in the number of these structures. Conclusion: Alterations in the pattern of arrangement of structures in the lung hilum are quite frequent. A compromise in knowledge of such variations will result in inadvertent complications like intraoperative bleeding during surgical procedures.

Keywords: fissures, hilum, lobes, pulmonary

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207 Study of Effect of Steering Column Orientation and Operator Platform Position on the Hand Vibration in Compactors

Authors: Sunil Bandaru, Suresh Yv, Srinivas Vanapalli

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Heavy machinery especially compactors has more vibrations induced from the compactor mechanism than the engines. Since the operator’s comfort is most important in any of the machines, this paper shows interest in studying the vibrations on the steering wheel for a double drum compactor. As there are no standard procedures available for testing vibrations on the steering wheel of double drum compactors, this paper tries to evaluate the vibrations on the steering wheel by considering most of the possibilities. In addition to the feasibility for the operator to adjust the steering wheel tilt as in the case of automotive, there is an option for the operator to change the orientation of the operator platform for the complete view of the road’s edge on both the ends of the front and rear drums. When the orientation is either +/-180°, the operator will be closer to the compactor mechanism; also there is a possibility for the shuffle in the modes with respect to the operator. Hence it is mandatory to evaluate the vibrations levels in both cases. This paper attempts to evaluate the vibrations on the steering wheel by considering the two operator platform positions and three steering wheel tilting angles.

Keywords: FEA, CAE, steering column, steering column orientation position

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206 Evaluation of the Risk Factors on the Incidence of Adjacent Segment Degeneration After Anterior Neck Discectomy and Fusion

Authors: Sayyed Mostafa Ahmadi, Neda Raeesi

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Background and Objectives: Cervical spondylosis is a common problem that affects the adult spine and is the most common cause of radiculopathy and myelopathy in older patients. Anterior discectomy and fusion is a well-known technique in degenerative cervical disc disease. However, one of the late undesirable complications is adjacent disc degeneration, which affects about 91% of patients in ten years. Many factors can be effective in causing this complication, but some are still debatable. Discovering these risk factors and eliminating them can improve the quality of life. Methods: This is a retrospective cohort study. All patients who underwent anterior discectomy and fusion surgery in the neurosurgery ward of Imam Khomeini Hospital between 2013 and 2016 were evaluated. Their demographic information was collected. All patients were visited and examined for radiculopathy, myelopathy, and muscular force. At the same visit, all patients were asked to have a facelift, and neck profile, as well as a neck MRI(General Tesla 3). Preoperative graphs were used to measure the diameter of the cervical canal(Pavlov ratio) and to evaluate sagittal alignment(Cobb Angle). Preoperative MRI of patients was reviewed for anterior and posterior longitudinal ligament calcification. Result: In this study, 57 patients were studied. The mean age of patients was 50.63 years, and 49.1% were male. Only 3.5% of patients had anterior and posterior longitudinal ligament calcification. Symptomatic ASD was observed in 26.6%. The X-rays and MRIs showed evidence of 80.7% radiological ASD. Among patients who underwent one-level surgery, 20% had symptomatic ASD, but among patients who underwent two-level surgery, the rate of ASD was 50%.In other words, the higher the number of surfaces that are operated and fused, the higher the probability of symptomatic ASD(P-value <0.05). The X-rays and MRIs showed 80.7% of radiological ASD. Among patients who underwent surgery at one level, 78% had radiological ASD, and this number was 92% among patients who underwent two-level surgery(P-value> 0.05). Demographic variables such as age, sex, height, weight, and BMI did not have a significant effect on the incidence of radiological ASD(P-value> 0.05), but sex and height were two influential factors on symptomatic ASD(P-value <0.05). Other related variables such as family history, smoking and exercise also have no significant effect(P-value> 0.05). Radiographic variables such as Pavlov ratio and sagittal alignment were also unaffected by the incidence of radiological and symptomatic ASD(P-value> 0.05). The number of surgical surfaces and the incidence of anterior and posterior longitudinal ligament calcification before surgery also had no statistically significant effect(P-value> 0.05). In the study of the ability of the neck to move in different directions, none of these variables are statistically significant in the two groups with radiological and symptomatic ASD and the non-affected group(P-value> 0.05). Conclusion: According to the findings of this study, this disease is considered to be a multifactorial disease. The incidence of radiological ASD is much higher than symptomatic ASD (80.7% vs. 26.3%) and sex, height and number of fused surfaces are the only factors influencing the incidence of symptomatic ASD and no variable influences radiological ASD.

Keywords: risk factors, anterior neck disectomy and fusion, adjucent segment degeneration, complication

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205 Gross Morphological Study on Heart of Yellow Bellied Sea Snake

Authors: Jonnalagadda Naveen, M. P. S. Tomar, Putluru Satish, Palanisamy Dharani

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Present investigation was carried out on a single specimen of the heart of yellow-bellied sea snake, which accidentally came to the seashore with the fisherman’s net. After the death, these specimens was preserved in 10% neutral buffered formalin and observe for its morphology. The literature cited revealed that meager information was available on the anatomy of the heart of this species of snake thus present study was planned on the gross anatomy of the heart of yellow-bellied sea snake. The heart of yellow-bellied sea snake was located between 28-35th rib in an oblique direction in the pericardial sac. It was three chambered with the complete division of atria but the ventricular cavity was incompletely divided. The apex did not show any gubernaculum cordis. The sinus venosus was the common cavity for confluence of anterior and posterior vana cava and the jugular vein was opened with anterior vena cava. The opening of posterior vena cava was slit-like and it was guarded by membranous valves whereas no valve could be observed at the opening of anterior vana cava and the jugular vein. Both the caval veins ran along the right border of the heart. Pulmonary vein was single which later divided into two branches. The length-width index for the atria was 1.33 whereas it was 1.67 for the ventricle. The atrioventricular canal was situated slightly towards the left of the midline of the heart and was divided into a right cavum pulmonale and left cavum arteriosum of which the right one was slightly larger and longer than the left. The cavum venosum was present in between the cavum pulmonale and the cavum arteriosum. The Ventricle was elongated triangle muscular compartment with ventrally located apex. Internally the cavity of ventricle was divided into two partial chambers dorsally by a muscular ridge and ventrally by an incomplete inter ventricular septum.

Keywords: aorta, atrium, heart, sea snake, sinus venosus, ventricle

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204 Long-Term Follow-Up of Dynamic Balance, Pain and Functional Performance in Cruciate Retaining, Posterior Stabilized Total Knee Arthroplasty

Authors: Ahmed R. Z. Baghdadi,  Mona H. Gamal Eldein

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Background: With the perceived pain and poor function experienced following knee arthroplasty, patients usually feel unsatisfied. Yet, a controversy still persists on the appropriate operative technique that doesn’t affect proprioception much. Purpose: This study compared the effects of Cruciate Retaining (CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on dynamic balance, pain and functional performance following rehabilitation. Methods: Thirty patients with CRTKA (group I), thirty with PSTKA (group II) and fifteen indicated for arthroplasty but weren’t operated on yet (group III) participated in the study. The mean age was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI 35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for group I, II, and III respectively. The Berg Balance Scale (BBS), WOMAC pain subscale and Timed-Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four weeks pre- and post-operatively, three, six and twelve months post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks) programs, follow-up to all groups for twelve months. Results: The Mixed design MANOVA revealed that group I had significantly lower pain scores and SC time compared with group II three, six and twelve months post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly six months post-operatively compared with four weeks pre- and post-operatively and three months post-operatively in group I and II with the opposite being true four weeks post-operatively. But no significant differences in BBS scores, pain scores and TUG and SC time between six and twelve months post-operatively in group I and II. Interpretation/Conclusion: CRTKA is preferable to PSTKA, possibly due to the preserved human proprioceptors in the un-excised PCL.

Keywords: dynamic balance, functional performance, knee arthroplasty, long-term

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203 Clinical and Etiological Particularities of Infectious Uveitis in HIV+ and HIV- Patients in the Internal Medicine Department

Authors: N. Jait, M. Maamar, H. Khibri, H. Harmouche, N. Mouatssim, W. Ammouri, Z. Tazimezaelek, M. Adnaoui

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Introduction: Uveitis presents with inflammation of the uvea, intraocular, of heterogeneous etiology and presentation. The objective of our study is to describe the clinical and therapeutic characteristics of infectious uveitis in HIV+ and HIV- patients. Patients and Methods: This is a retrospective study conducted at the internal medicine department of CHU Ibn Sina in Rabat over a period of 12 years (2010–2021), collecting 42 cases of infectious uveitis. Results: 42 patients were identified. 34% (14 cases) had acquired immunosuppression (9 cases: 22% had HIV infection and 12% were on chemotherapy), and 66% were immunocompetent. The M/F sex ratio was 1.1. The average age was 39 years old. Uveitis revealed HIV in a single case; 8/9 patients have already been followed, their average viral load is 3.4 log and an average CD4 count is 356/mm³. The revealing functional signs were: ocular redness (27%), decreased visual acuity (63%), visual blurring (40%), ocular pain (18%), scotoma (13%), and headaches (4%). The uveitis was site: anterior (30%), intermediate (6%), posterior (32%), and pan-uveitis (32%); unilateral in 80% of patients and bilateral in 20%. The etiologies of uveitis in HIV+ were: 3 cases of CMV, 2 cases of toxoplasmosis, 1 case of tuberculosis, 1 case of HSV, 1 case of VZV, and 1 case of syphilis. Etiologies of immunocompetent patients: tuberculosis (41%), toxoplasmosis (18%), syphilis (15%), CMV infection (4 cases: 10%), HSV infection (4 cases: 10%) , lepromatous uveitis (1 case: 2%), VZV infection (1 case: 2%), a locoregional infectious cause such as dental abscess (1 case: 2%), and one case of borreliosis (3% ). 50% of tuberculous uveitis was of the pan-uveitis type, 75% of the uveitis by toxoplasmosis was of the posterior type. Uveitis was associated with other pathologies in 2 seropositive cases (cerebral vasculitis, multifocal tuberculosis). A specific treatment was prescribed in all patients. The initial evolution was favorable in 67%, including 12% HIV+. 11% presented relapses of the same seat during uveitis of the toxoplasmic, tuberculous and herpetic type. 47% presented complications, of which 4 patients were HIV+: 3 retinal detachments; 7 Retinal hemorrhages. 6 unilateral blindness (including 2 HIV+ patients). Conclusion: In our series, the etiologies of infectious uveitis differ between HIV+ and HIV- patients. In HIV+ patients most often had toxoplasmosis and CMV, while HIV - patients mainly presented with tuberculosis and toxoplasmosis. The association between HIV and uveitis is undetermined, but HIV infection was an independent risk factor for uveitis.

Keywords: uveitis, HIV, immunosuppression, infection

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202 Glenoid Osteotomy with Various Tendon Transfers for Brachial Plexus Birth Palsy: Clinical Outcomes

Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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201 Working Memory and Audio-Motor Synchronization in Children with Different Degrees of Central Nervous System's Lesions

Authors: Anastasia V. Kovaleva, Alena A. Ryabova, Vladimir N. Kasatkin

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Background: The most simple form of entrainment to a sensory (typically auditory) rhythmic stimulus involves perceiving and synchronizing movements with an isochronous beat with one level of periodicity, such as that produced by a metronome. Children with pediatric cancer usually treated with chemo- and radiotherapy. Because of such treatment, psychologists and health professionals declare cognitive and motor abilities decline in cancer patients. The purpose of our study was to measure working memory characteristics with association with audio-motor synchronization tasks, also involved some memory resources, in children with different degrees of central nervous system lesions: posterior fossa tumors, acute lymphoblastic leukemia, and healthy controls. Methods: Our sample consisted of three groups of children: children treated for posterior fossa tumors (PFT-group, n=42, mean age 12.23), children treated for acute lymphoblastic leukemia (ALL-group, n=11, mean age 11.57) and neurologically healthy children (control group, n=36, mean age 11.67). Participants were tested for working memory characteristics with Cambridge Neuropsychological Test Automated Battery (CANTAB). Pattern recognition memory (PRM) and spatial working memory (SWM) tests were applied. Outcome measures of PRM test include the number and percentage of correct trials and latency (speed of participant’s response), and measures of SWM include errors, strategy, and latency. In the synchronization tests, the instruction was to tap out a regular beat (40, 60, 90 and 120 beats per minute) in synchrony with the rhythmic sequences that were played. This meant that for the sequences with an isochronous beat, participants were required to tap into every auditory event. Variations of inter-tap-intervals and deviations of children’s taps from the metronome were assessed. Results: Analysis of variance revealed the significant effect of group (ALL, PFT and control) on such parameters as short-term PRM, SWM strategy and errors. Healthy controls demonstrated more correctly retained elements, better working memory strategy, compared to cancer patients. Interestingly that ALL patients chose the bad strategy, but committed significantly less errors in SWM test then PFT and controls did. As to rhythmic ability, significant associations of working memory were found out only with 40 bpm rhythm: the less variable were inter-tap-intervals of the child, the more elements in memory he/she could retain. The ability to audio-motor synchronization may be related to working memory processes mediated by the prefrontal cortex whereby each sensory event is actively retrieved and monitored during rhythmic sequencing. Conclusion: Our results suggest that working memory, tested with appropriate cognitive methods, is associated with the ability to synchronize movements with rhythmic sounds, especially in sub-second intervals (40 per minute).

Keywords: acute lymphoblastic leukemia (ALL), audio-motor synchronization, posterior fossa tumor, working memory

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200 Significance of Archetypal Sounds: Exploring Mystical Practices of Uttarakhand Himalayas

Authors: Vineet Gairola

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In many cultures, ethnographers have tried to set up a tight link between music and possession. However, they rarely informed us about the psychology of interactions between music and the possessed. Ancient myths and the archetypal find expression through the rituals practiced in Uttarakhand. In Uttarakhand (a part of the Central Himalayan region), an intriguing archetypal healing mechanism takes place. Some people get 'possessed' by a deity and shower blessings onto people gathered for a puja in a temple, where invocation of deity takes place through two archetypal drumming instruments played together named dhol-damaun. There is devi-doli (palanquin of the goddess) worship, which is carried on the shoulders of two people and is said to be tilting and shaking on its own. Archetypal in the modern mind survives effortlessly. The 'oceanic' of religious feelings are explored through an oral text of Dholsagar. The method of ethnography along with case-studies has been used. A substantial part of fieldwork was carried out in Rudraprayag, Uttarakhand. The research suggests that the collective unconscious is also sonic in nature, which is characterized by sounds and rhythms—not only symbols and images, as Dr. Jung suggested.

Keywords: archetypal, music, myth, mysticism, possession, sonic collective unconscious

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199 Microseismics: Application in Hydrocarbon Reservoir Management

Authors: Rahul Kumar Singh, Apurva Sharma, Dilip Kumar Srivastava

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Tilting of our interest towards unconventional exploitation of hydrocarbons has raised a serious concern to environmentalists. Emerging technologies like horizontal/multi-lateral drilling with subsequent hydraulic fracturing or fracking etc., for exploitation of different conventional/unconventional hydrocarbon reservoirs, are related to creating micro-level seismic events below the surface of the earth. Monitoring of these micro-level seismic events is not possible by the conventional methodology of the seismic method. So, to tackle this issue, a new technology that is microseismic is very much in discussions around the globe. Multiple researches are being carried out these days around the globe in order to prove microseismic as a new essential in the E & P industry, especially for unconventional reservoir management. Microseismic monitoring is now used for reservoir surveillance, and the best application is checking the integrity of the caprock and containment of fluid in it. In general, in whatever terms we want to use micro-seismic related events monitoring and understanding the effectiveness of stimulation, this technology offers a lot of value in terms of insight into the subsurface characteristics and processes, and this makes it really a good geophysical method to be used in future.

Keywords: microseismic, monitoring, hydraulic fracturing or fracking, reservoir surveillance, seismic hazards

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198 Efficacy of Transcranial Magnetic Therapy on Balance in Patients with Vestibular Dysfunction

Authors: Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed, Nawal A. Abu-Shady

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Background: Most of patients with vestibular dysfunction suffering from balance disorders, Abnormality in balance increase effort and exertion which affect the independency, so this study might be a guide in managing balance problem and consequently improve walking with less exertion and maximum function. Purpose: to analyze and discuss the effect of transcranial magnetic therapy on balance in patients with vestibular dysfunction. Methods: forty subjects from both sexes were classified to divided randomly into two equal groups; Group I study group: this group received transcranial magnetic therapy, with a selected physical therapy program for improving balance and vestibular disorders (Balance training, Cawthorne-Cooksey Exercises) and group II (control group): this group received a selected physical therapy program as group I without transcranial magnetic therapy. This treatment procedure will be applied three times weekly for three months. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and II respectively. The Biodex Balance System, Berge balances scale (BBS) and brain MRI were used for assessment. Assessments were conducted before and after treatment. The treatment program for group I included balance training, Cawthorne-Cooksey Exercises and pulsed magnetic therapy (Parameters used in the program of 20 minutes, Intensity 2 gausses, Frequency 1 Hz). This selected program was done in approximately one hour every other day for three month. The treatment program group II Patients received the same program as group A without transcranial magnetic therapy. Results: The One-way ANOVA revealed that there were no significant differences in BBS scores, overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability between both groups. Moreover, the BBS scores increased and overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability decreased significantly after treatment in group I and II compared with before treatment. Interpretation/Conclusion: Adding pulsed magnetic therapy to balance training, Cawthorne-Cooksey Exercises has no effect on static and dynamic balance in patients with balance problems due to benign positional paroxysmal vertigo.

Keywords: balance, transcranial magnetic therapy, vestibular dysfunction, biomechanic

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197 The Use of Orthodontic Pacifiers to Prevent Pacifier Induced Malocclusion - A Literature Review

Authors: Maliha Ahmed Suleman, Sidra Ahmed Suleman

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Introduction: The use of pacifiers is common amongst infants and young children as a comforting behavior. These non-nutritive sucking habits can be detrimental to the developing occlusion should they persist while the permanent dentition is established. Orthodontic pacifiers have been recommended as an alternative to conventional pacifiers as they are considered to have less interference with orofacial development. However, there is a lack of consensus on whether this is true. Aim and objectives: To review the prevalence of malocclusion associated with the use of orthodontic pacifiers. Methodology: Literature was identified through a rigorous search of the Embase, Pubmed, CINAHL, and Cochrane Library databases. Articles published from 2000 onwards were included. In total, 5 suitable papers were identified. Results: One study showed that the use of orthodontic pacifiers increased the risk of malocclusion, as seen through a greater prevalence of accentuated overjet, posterior crossbites, and anterior open bites in comparison to individuals who did not use pacifiers. However, this study found that there was a clinically significant reduction in the prevalence of anterior open bites amongst orthodontic pacifier users in comparison to conventional pacifier users. Another study found that both types of pacifiers lead to malocclusion; however, they found no difference in the mean overjet and prevalence of anterior open bites amongst conventional and orthodontic pacifier users. In contrast, one study suggested that orthodontic pacifiers do not seem to be related to the development of malocclusions in the primary dentitions, and using them between the ages of 0-3 months was actually beneficial as it prevents thumb-sucking habits. One of the systemic reviews concluded that orthodontic pacifiers do not seem to reduce the occurrence of posterior crossbites; however, they could reduce the development of open bites by virtue of their thin neck design. Whereas another systematic review concluded that there were no differences as to the effects on the stomatognathic system when comparing conventional and orthodontic pacifiers. Conclusion: There is limited and conflicting evidence to support the notion that orthodontic pacifiers can reduce the prevalence of malocclusion when compared to conventional pacifiers. Well-designed randomized controlled trials are required in the future in order to thoroughly assess the effects of orthodontic pacifiers on the developing occlusion and orofacial structures.

Keywords: orthodontics, pacifier, malocclusion, review

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196 The Efficacy of Class IV Diode Laser in the Treatment of Patients with Chronic Neck Pain: A Randomized Controlled Trial

Authors: Mohamed Salaheldien Mohamed Alayat, Ahmed Mohamed Elsoudany, Roaa Abdulghani Sroge, Bayan Muteb Aldhahwani

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Background: Neck pain is a common illness that could affect individual’s daily activities. Class IV laser with longer wavelength can stimulate tissues and penetrate more than the classic low-level laser therapy. Objectives: The aim of the study was to investigate the efficacy of class IV diode laser in the treatment of patients with chronic neck pain (CNP). Methods: Fifty-two patients participated and completed the study. Their mean age (SD) was 50.7 (6.2). Patients were randomized into two groups and treated with laser plus exercise (laser + EX) group and placebo laser plus exercise (PL+EX) group. Treatment was performed by Class IV laser in two phases; scanning and trigger point phases. Scanning to the posterior neck and shoulder girdle region with 4 J/cm2 with a total energy of 300 J applied to 75 cm2 in 4 minutes and 16 seconds. Eight trigger points on the posterior neck area were treated by 4 J/cm2 and the time of application was in 30 seconds. Both groups received exercise two times per week for 4 weeks. Exercises included range of motion, isometric, stretching, isotonic resisted exercises to the cervical extensors, lateral bending and rotators muscles with postural correction exercises. The measured variables were pain level using visual analogue scale (VAS), and neck functional activity using neck disability index (NDI) score. Measurements were taken at baseline and after 4 weeks of treatment. The level of statistical significance was set as p < 0.05. Results: There were significant decreases in post-treatment VAS and NDI in both groups as compared to baseline values. Laser + EX effectively decreased VAS (mean difference -6.5, p = 0.01) and NDI scores after (mean difference -41.3, p = 0.01) 4 weeks of treatment compared to PL + EX. Conclusion: Class IV laser combined with exercise is effective treatment for patients with CNP as compared to PL + EX therapy. The combination of laser + EX effectively increased functional activity and reduced pain after 4 weeks of treatment.

Keywords: chronic neck pain, class IV laser, exercises, neck disability index, visual analogue scale

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195 Finite Element Simulation of an Offshore Monopile Subjected to Cyclic Loading Using Hypoplasticity with Intergranular Strain Anisotropy (ISA) for the Soil

Authors: William Fuentes, Melany Gil

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Numerical simulations of offshore wind turbines (OWTs) in shallow waters demand sophisticated models considering the cyclic nature of the environmental loads. For the case of an OWT founded on sands, rapid loading may cause a reduction of the effective stress of the soil surrounding the structure. This eventually leads to its settlement, tilting, or other issues affecting its serviceability. In this work, a 3D FE model of an OWT founded on sand is constructed and analyzed. Cyclic loading with different histories is applied at certain points of the tower to simulate some environmental forces. The mechanical behavior of the soil is simulated through the recently proposed ISA-hypoplastic model for sands. The Intergranular Strain Anisotropy ISA can be interpreted as an enhancement of the intergranular strain theory, often used to extend hypoplastic formulations for the simulation of cyclic loading. In contrast to previous formulations, the proposed constitutive model introduces an elastic range for small strain amplitudes, includes the cyclic mobility effect and is able to capture the cyclic behavior of sands under a larger number of cycles. The model performance is carefully evaluated on the FE dynamic analysis of the OWT.

Keywords: offshore wind turbine, monopile, ISA, hypoplasticity

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