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The Journal of the American Osteopathic... Jan 2020To observe the changes of the retinal nerve fiber layer (RNFL) thickness and the optic disc vessel density (VD) in preclinical diabetic retinopathy (DR) and the...
PURPOSE
To observe the changes of the retinal nerve fiber layer (RNFL) thickness and the optic disc vessel density (VD) in preclinical diabetic retinopathy (DR) and the relationship between RNFL changes and VD, as well as to investigate the influencing factors on peripapillary vessel density.
METHODS
This was a cross-sectional study. Thirty-four eyes of 34 type 2 diabetes mellitus (T2DM) patients diagnosed with preclinical diabetic retinopathy (DR) were included in our study, with twenty-three eyes of 23 healthy subjects set up as normal controls. History of diabetes, hypertension, and dyslipidemia was recorded in detail. All participants underwent color fundus photography (CFP), RNFL around the optic disc, and OCT angiography (OCTA) over the optic disc. The 4.5 mm × 4.5 mm Angio Disc scan mode was performed with all participants by using the OCTA instrument. The relationship between changes of RNFL in the four quadrants (superior, inferior, temporal, and nasal) and VD changes was analyzed.
RESULTS
Vessel density was significantly lower in the superior ( = −2.27) and temporal ( = −2.02) peripapillary sectors of diabetic eyes compared to normal eyes ( < 0.05). The retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant ( < 0.001) of diabetic eyes compared to normal eyes. Pearson correlation coefficient analysis showed a significant positive correlation between vessel density and RNFL thickness in the peripapillary region in the temporal ( = 0.468, < 0.01) and superior ( = 0.612, < 0.01) sectors. Multiple linear regression analysis showed that glycated hemoglobin (HbA1c) ( = −1.50, < 0.01) and the duration of diabetes ( = −0.33, =0.03) were associated with peripapillary vessel density.
CONCLUSIONS
Preclinical DR presented optic disc microcirculation changes. Temporal RNFL thinning is an early sign of retinal neurodegeneration and is associated with temporal peripapillary vessel density reduction. The duration of diabetes and HbA1c are risk factors for peripapillary vessel density reduction in patients with preclinical DR.
Topics: Manipulation, Orthopedic; Manipulation, Osteopathic; Occipital Bone
PubMed: 31904776
DOI: 10.7556/jaoa.2020.001 -
BMC Musculoskeletal Disorders Mar 2021A novel implant for occipitocervical fusion consisting of a median plate with an additional hook inserting in the foramen magnum was tested. Aim of this study was to...
BACKGROUND
A novel implant for occipitocervical fusion consisting of a median plate with an additional hook inserting in the foramen magnum was tested. Aim of this study was to test the stability of a new implant for occipitocervical fusion against the already available and employed median plate implant without hook.
MATERIAL AND METHOD
36 rigid polyurethane foams occipital artificial bones were used. The two occipital implants, namely the occipital plate with hook (Group 1) and the one without hook (Group 2), were applied to the artificial occiput trough three occipital screws and ensured into the experimental setup trough a crossbar. The test parameters were set using the testing machine software as follows: (1) test speed: 10 mm/ min, with 25 mm/ min maximum; (2) preload: 5 N; (3) force switch-off threshold: 90% force drop from F_max. Failure force and path were recorded. Failure force is defined as the maximum reaction force under which failure occurs (F_max), while failure path is the travel path during which failure occurs (dL).
RESULTS
Group 1 (plate with hook) showed a mean failure force of 459.3 ± 35.9 N and a mean failure path of 5.8 ± 0.3 mm Group 2 (plate without hook) showed a mean failure force of 323.9 ± 20.2 N and a mean failure path of 7.2 ± 0.4 mm. The Shapiro-Wilk test score was not significant (P > 0.1), assuming that data were normally distributed. Group 1 had a statistically significant greater F_max (+ 135.37; P > 0.0001) and less dL (- 1.52; P > 0.0001) compared to group 2.
CONCLUSIONS
Medial plates with foramen magnum hooks showed to be more stable that plates without a hook. These new implants may represent a new tool in OCJ fixation, but further studies are required to investigate their behavior in an anatomical setting.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Humans; Occipital Bone; Spinal Fusion
PubMed: 33676483
DOI: 10.1186/s12891-021-04112-z -
Journal of Ayub Medical College,... 2022Giant Cell Tumours (GCT) are usually found at the extremities of the long bones and their presence in the skull being less than 1%. In the skull, sphenoidal bone and...
Giant Cell Tumours (GCT) are usually found at the extremities of the long bones and their presence in the skull being less than 1%. In the skull, sphenoidal bone and temporal bone are the commonest sites. There have been very few reports of GCTs of the occipital bone. Total excision surgery is the ideal treatment of choice. If surgery poses a problem, then adjuvant radiotherapy can be administered too. We present a case of 13-year-old male child who was diagnosed with GCT of the occipital bone. He was successfully operated and is symptom free 6 months post his surgery till now.
Topics: Adolescent; Bone Neoplasms; Giant Cell Tumor of Bone; Giant Cell Tumors; Humans; Male; Occipital Bone; Temporal Bone
PubMed: 35576308
DOI: 10.55519/JAMC-02-9383 -
Annals of Neurology Feb 2022A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper... (Observational Study)
Observational Study
OBJECTIVE
A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS).
METHODS
From a single-center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12-year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion.
RESULTS
Patients who developed SPMS showed faster cord atrophy rates (-2.19%/yr) at least 4 years before conversion compared to their RRMS matches (-0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (-1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (-1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively.
INTERPRETATION
Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268-281.
Topics: Adult; Atrophy; Brain; Disease Progression; Female; Foramen Magnum; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Sclerosis, Relapsing-Remitting; Predictive Value of Tests; Prognosis; Prospective Studies; Spinal Cord
PubMed: 34878197
DOI: 10.1002/ana.26281 -
BMJ Case Reports Jan 2017
Topics: Anti-Bacterial Agents; Child, Preschool; Drainage; Female; Humans; Neck Pain; Occipital Bone; Osteomyelitis; Retropharyngeal Abscess; Tomography, X-Ray Computed
PubMed: 28100572
DOI: 10.1136/bcr-2016-217479 -
The Neuroradiology Journal Aug 2022Isolated occipital condyle lesions are commonly treated with empirical radiation, with the sole aim of relieving symptoms. Patients rarely undergo surgical biopsy,... (Review)
Review
Isolated occipital condyle lesions are commonly treated with empirical radiation, with the sole aim of relieving symptoms. Patients rarely undergo surgical biopsy, considering the morbidity associated with open surgery approaches and the importance of surrounding structures limiting the application of computed tomography (CT) scan or fluoroscopic percutaneous needle biopsies. We describe the case of a 66-year-old woman who was admitted on an emergency basis. Her clinical presentation included unilateral occipital headache and ipsilateral hypoglossal nerve palsy. Imaging revealed findings consistent with an isolated right occipital condyle lesion. In order to pursue a tissue diagnosis, essential to dictate medical management accurately, a minimally invasive biopsy of the occipital condyle through the trans-oral route was performed. Combined fluoroscopy, cone-bean CT and angiography allowed safe access to the lesion.
Topics: Aged; Biopsy; Female; Headache; Humans; Hypoglossal Nerve Diseases; Occipital Bone; Tomography, X-Ray Computed
PubMed: 34550830
DOI: 10.1177/19714009211044705 -
Scientific Reports Oct 2023The study of sexual dimorphism in human crania has important applications in the fields of human evolution and human osteology. Current, the identification of sex from...
The study of sexual dimorphism in human crania has important applications in the fields of human evolution and human osteology. Current, the identification of sex from cranial morphology relies on manual visual inspection of identifiable anatomical features, which can lead to bias due to user's expertise. We developed a landmark-based approach to automatically map the sexual dimorphism signal on the human cranium. We used a sex-known sample of 228 individuals from different geographical locations to identify which cranial regions are most sexually dimorphic taking into account shape, form and size. Our results, which align with standard protocols, show that glabellar and supraciliary regions, the mastoid process and the nasal region are the most sexually dimorphic traits (with an accuracy of 73%). The accuracy increased to 77% if they were considered together. Surprisingly the occipital external protuberance resulted to be not sexually dimorphic but mainly related to variations in size. Our approach here applied could be expanded to map other variable signals on skeletal morphology.
Topics: Humans; Sex Characteristics; Skull; Mastoid; Nose; Sexual Behavior; Occipital Bone
PubMed: 37803023
DOI: 10.1038/s41598-023-43007-y -
BMC Musculoskeletal Disorders Jun 2020The aim of the present study was to describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects,...
BACKGROUND
The aim of the present study was to describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects, as a proposed tool to guide restoration of vertical dislocations of the occipitocervical region in patients with basilar invaginations and for performing standardized testing of occipitocervical constructs.
METHODS
We analyzed neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) that were judged to be normal. The mean age of the included asymptomatic subjects was 48.0 ± 8.4 years old (range 20-69 years old; 48.4 ± 10.2 years old for males and 47.6 ± 6.4 years old for females). The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor's line. Occipitocervical distances (OCDs) were measured and analyzed its correlation with OC4Ds. Two spine surgeons each performed three measurements of the OC4D and OCD from each asymptomatic subject, from which our reported average values were derived. The height, weight, and body mass index (BMI) of each subject were recorded and analyzed for their correlations with the OC4D and OCD.
RESULTS
The OC4Ds from neutral, flexion, and extension lateral cervical spine radiographs were 69.0 ± 6.9, 68.9 ± 6.8, and 68.1 ± 6.9 mm, respectively. There was no significant difference in the OC4D values among neutral, flexion, and extension lateral cervical spine radiographs (P > 0.05). The neutral, flexion, and extension OCDs were 23.0 ± 4.8, 27.6 ± 6.0, and 13.8 ± 4.7 mm, respectively. In particular, the neutral OCD was significantly different from those in flexion and extension lateral cervical spine radiographs (P < 0.001). There was no significant correlation between OC4D and OCD in neutral, flexion, and extension (P > 0.05 for all). There were positive correlations between OC4D and height, as well as OC4D and weight, in neutral, flexion, and extension lateral cervical spine radiographs (P < 0.001 for all). Furthermore, the intra-class correlation coefficients for inter- and intra-observer reliabilities of OC4Ds in neutral, flexion, and extension lateral cervical spine radiographs were significantly higher than those for OCDs (P < 0.001).
CONCLUSIONS
The OC4D represents a novel measurement for estimating the occipital-cervical distance that is not affected by changes in neutral, flexion, and extension positions. Hence, the OC4D may serve as a valuable parameter and intra-operative tool to guide vertical restoration during occipitocervical fusion (OCF) for patients with altered occiput-cervical anatomy.
Topics: Adult; Aged; Cervical Vertebrae; Female; Humans; Lordosis; Male; Middle Aged; Observer Variation; Occipital Bone; Patient Positioning; Radiography; Range of Motion, Articular; Reproducibility of Results; Sex Factors; Spinal Fusion; Young Adult
PubMed: 32539760
DOI: 10.1186/s12891-020-03398-9 -
Folia Morphologica 2021Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of...
BACKGROUND
Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of occipital neuralgia. This study proposed to investigate the location of GON subcutaneous (Sc) and semispinalis capitis (SSC) piercing points related to the intermastoid and external occipital protuberance (EOP) to mastoid process (MP) lines.
MATERIALS AND METHODS
The Sc piercing point, relation to SSC and obliquus capitis inferior (OCI) muscles of 100 GONs from 50 cadaveric heads (23 males, 27 females) were dissected. Distances from EOP to MP (EM line) on both sides and between MPs (MM line) were measured. Perpendicular lines from Sc and SSC piercing points to EM and MM lines were created and measured. Distances from EOP to the perpendicular lines of SSC piercing point and from MP to the perpendicular lines of Sc piercing point were measured and calculated into percentage of EM and MM length, respectively.
RESULTS
Three types of Sc piercing points (I, II and III) were obtained. The percentage of GON piercing trapezius muscle (TP) (type I), aponeurosis of TP (type II) and aponeurosis between TP and sternocleidomastoid muscle (SCM) (type III) were 2, 67 and 31, respectively. In addition, 95% of GON pierced SSC, 2% pierced its tendinous band and 3% travelled between its medial fibres and the nuchal ligament. 94% of the GON turned around the lower edge of the OCI, while 6% pierced the lower edge of this muscle. Sc piercing point was always located above the MM line, but it could be above, below or on the EM line. In contrast, all of the SSC piercing points were located below the EM line except in one specimen, but it could be above, below or on the MM line. Therefore, the MM and EM lines were used as reference lines for locating the Sc and SSC piercing points, respectively. The mean EM line length was 81.26 ± 5.26 mm with statistically significant differences between genders and sides in female. The mean MM line length was 121.77 ± 8.54 mm with a statistically significant difference between genders. Sc piercing point could be located at 44% of MM line length from ipsilateral MP with a mean vertical distance of 18 mm. No statistically significant difference was found between genders and sides in these parameters, but a statistically significant difference was found in the percentage of MB to MM line between type III and type I (p = 0.02). SSC piercing point of all types could be located at the point of 25% of EM line length from EOP with a vertical distance of 18 mm below EM line. No statistically significant difference was found between genders, sides and types of both piercing points.
CONCLUSIONS
MM and EM lines are potential reference lines for locating the Sc and SSC piercing points of GON, respectively.
Topics: Female; Head; Humans; Male; Mastoid; Neck; Neck Muscles; Occipital Bone
PubMed: 32844388
DOI: 10.5603/FM.a2020.0099 -
Archives of Disease in Childhood Feb 1970This paper describes a follow-up of 74 consecutive cases of occipital cranium bifidum born and treated between 1948 and 1965, and the surgical technique used in their...
This paper describes a follow-up of 74 consecutive cases of occipital cranium bifidum born and treated between 1948 and 1965, and the surgical technique used in their repair. When no hydrocephalus developed, 86% of the cases of cranial meningocele, but only 40% of those of encephalocele, showed normal mental development. Even when hydrocephalus complicating cranium bifidum was controlled surgically, many of the children were mentally and some also physically handicapped. Hydrocephalus was more frequent when the sac had contained brain tissue than in cases of meningocele. There were certain cases of massive posterior protrusion of brain tissue combined with an abnormally small cranial cavity in which reduction of the cerebral hernia was impossible: they showed no sign of intelligence for so long as they survived. In such circumstances operation is contraindicated. Associated development anomalies were frequently encountered, the majority of these involving the neuraxis.
Topics: Adolescent; Child; Child, Preschool; Encephalocele; Female; Humans; Hydrocephalus; Intelligence; Male; Meningocele; Mental Disorders; Occipital Bone; Postoperative Complications
PubMed: 5440176
DOI: 10.1136/adc.45.239.104