Background
Sleep disturbance is a systemic symptom and at the same time a major modulating factor of temporomandibular disorders (TMD). Inflammation is known as a underlying mechanism involved in ...both poor sleep and increased pain.
Objective
The relationship between long‐term clinical characteristics and hematologic biomarkers of hypothalamic–pituitary–adrenal axis activity and inflammation in TMD patients according to sleep duration was investigated to verify the possible role of sleep disturbance and systemic inflammation in TMD.
Materials and methods
Inflammatory and stress mediator levels of venous blood samples were investigated in 63 female TMD patients along with comorbidity levels including stress, somatization, autonomic symptoms and sleep quality based on structured questionnaires. Differences in long‐term clinical characteristics and hematologic variables following conservative treatment were analysed according to total sleep time as normal, short and long sleep groups. Also, clinical and hematologic indices related to favourable treatment response were sought out.
Results
Significantly less patients in the long sleep group reported pain on voluntary mandibular movement (p = .042) while depression (p = .043) and somatization levels (p = .002) were significantly higher in the short sleep group. Norepinephrine levels of the long sleep group were significantly lower than other groups. Decrease in pain intensity with treatment was smallest in the short sleep group. Erythrocyte sedimentation rate was associated with significant pain improvement at 3 months post‐treatment and interleukin‐1β, ‐4, and ‐8 levels could predict favourable treatment response.
Conclusion
Short sleep is associated with more comorbidities and unfavourable long‐term treatment response in TMD which may be mediated by systemic inflammation. Effective management of sleep is necessary for successful TMD management.
ROC curves of haematological indices and sleep time for significant pain improvement at 6 months post‐treatment. ACTH, adrenocorticotropic hormone; AUC, area under the curve; ESR, erythrocyte sedimentation rate; hs‐CRP, high sensitivity C‐reactive protein; IL, interleukin; ROC, Receiver operating characteristic.
•Core-shell structured agglomerates are found in the bottom ash discharging chute.•Both the core and the shell comprise a significant amount of mullite.•Massive amorphous SiO2 is found in the shell ...of the agglomerates.•Agglomerates are initially formed due to burning char at bottom of the furnace.•The core–shell structure is due to the temperature gradient of the burning char.
Cylindrical agglomerates with cross-sectional diameters over 200 mm are found in the bottom ash discharging chute of a 550 MWe large-scale circulating fluidized bed (CFB) boiler, which results in disfunction of the bottom ash discharging system due to the blockage of the bottom ash discharging chute. The agglomerates with core–shell structure are found to be significant to understand the mechanisms of the agglomeration, and agglomerates with similar structure are also found inside the furnace. The X-ray diffraction analysis on the core–shell structured agglomerate particle shows both the core and the shell comprise a significant amount of mullite; meanwhile, cristobalite is found in the shell, which is supposed to be formed at temperature higher than the bed temperature. The results of the transmission electron microscopy analysis show that mullite crystal in the shell is distributed inside the amorphous SiO2. Sintering experiments show that the formation temperature for mullite and cristobalite is ca. 1050 ℃, while the transformation temperature of quartz to amorphous silica is ca. 1150 ℃, which is much higher than the bed temperature. Thus, the agglomeration is supposed to be resulted from the high-temperature condition caused by the burning char inside the furnace, and the core–shell structure of the agglomerates is supposed to be formed due to the temperature gradient along the particle diameter of the burning char.
Abstract
This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait ...analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm,
P
= 0.003), stride length (105.2 cm vs. 109.1 cm,
P
= 0.015), and double-limb support duration (13.4% vs. 11.7%,
P
= 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°,
P
= 0.001) and ankle plantarflexion angle at push-off (− 12.2° vs. − 6.5°,
P
= 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°,
P
= 0.004) and ankle plantarflexion angle at push-off (− 12.8° vs. − 8.3°,
P
= 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group (
P
= 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.
Retrospective comparative study.
To investigate the consequences and appropriate management of pseudarthrosis after anterior cervical discectomy and fusion (ACDF).
Pseudarthrosis is a frequent ...complication of ACDF and causes unsatisfactory results. Little is known about long-term prognosis of detecting pseudarthrosis 1 year after ACDF.
Eighty-nine patients with a minimum 2-year follow-up were included. ACDF surgery using allograft and plating was performed: single-level in 51 patients, two-level in 26 patients, and three-level in 12 patients. Presence of pseudarthrosis was evaluated 1 year postoperatively and then the nonunion segments were re-evaluated 2 years postoperatively. Demographic data were assessed to identify the risk factors associated with pseudarthrosis. A visual analogue scale for neck/arm pain and the Neck Disability Index were analyzed preoperatively and at 1 and 2 years postoperatively.
Pseudarthrosis was detected in 29 patients (32.6%) 1 year postoperatively: 15of 51 patients after single-level surgery, 9 of 26 patients after two-level surgery, and 5 of 12 patients after three-level surgery. Only eight patients showed persistent nonunion at 2 years: 3 of 15 patients after single-level surgery, 3 of 9 after two-level surgery, and 2 of 5 after three-level surgery. The remaining 21 patients (72.4%) achieved bony fusion 2 years postoperatively without any intervention. Patients who underwent two-level or three-level ACDF had a significantly higher pseudarthrosis rate than those who underwent single-level ACDF, with odds ratios of 1.844 and 3.147, respectively. The improvements in visual analogue scale for neck pain and Neck Disability Index scores in the persistent nonunion group were significantly lower than those in the final union group at 2 years.
Patients with pseudarthrosis detected 1 year postoperatively may be observed without any intervention because approximately 70% of them will eventually fuse by the 2-year point. Early revision could, however, be considered if the pseudarthrosis is associated with considerable neck pain after multilevel ACDF.
3.
Objectives
Investigate the presence of widespread pain in a well‐defined TMD group and analyze its interrelationship with various comorbidities. Also, longitudinally seek the difference in treatment ...response according to the presence of widespread pain.
Subjects and Methods
The observational study involved 45 female TMD patients in their 20s. Patients were grouped into localized and widespread pain groups based on the widespread pain index (WPI ≥ 4). Clinical characteristics and levels of comorbidities were analyzed through physical examination and validated questionnaires. Differences between the groups and the power of pre‐treatment WPI in predicting pre‐treatment comorbidities and post‐treatment pain level improvement were statistically analyzed.
Results
Patients with widespread pain showed higher somatization and anxiety levels. SF‐36 scores were significantly lower and more patients complained of gastrointestinal symptoms. Conventional treatment significantly reduced pain intensity in both groups but less in the widespread pain group. WPI showed significant chances to predict patients showing improvement in pain levels with treatment with a cutoff value of 4. WPI was also effective in differentiating patients that showed a higher level of somatization.
Conclusion
Widespread pain index could be effectively applied in differentiating those with a higher level of psychological distress and predicting TMD treatment response with further investigations into its reliability.
Conventional laminoplasty is useful for expanding a stenotic spinal canal. However, it has limited use for the decompression of accompanying neural foraminal stenosis. As such, an additional ...posterior foraminotomy could be simultaneously applied, although this procedure carries a risk of segmental kyphosis and instability.
The aim of this study was to elucidate the long-term surgical outcomes of additional posterior foraminotomy with laminoplasty (LF) for cervical spondylotic myelopathy (CSM) with radiculopathy.
A retrospective comparative study was carried out.
Ninety-eight consecutive patients who underwent laminoplasty for CSM with radiculopathy between January 2006 and December 2012 were screened for eligibility. This study included 66 patients, who were treated with a laminoplasty of two or more levels and followed up for more than 2 years after surgery.
The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores, JOA recovery rates, and visual analog scale (VAS) were used to evaluate clinical outcomes. The C2–C7 sagittal vertical axis distance, cervical lordosis, range of motion (ROM), and angulation and vertebral slippage at the foraminotomy level were used to measure radiological outcomes using the whole spine anterioposterior or lateral and dynamic lateral radiographs.
Sixty-six patients with CSM with radiculopathy involving two or more levels were consecutively treated with laminoplasty and followed up for more than 2 years after surgery. The first 26 patients underwent laminoplasty alone (LA group), whereas the next 40 patients underwent an additional posterior foraminotomy at stenotic neural foramens with radiating symptoms in addition to laminoplasty (LF group). In the LF group, the foraminotomy with less resection than 50% of facet joint to avoid segmental kyphosis and instability was performed at 78 segments (unilateral-to-bilateral ratio=57:21) and 99 sites. Clinical and radiographic data were assessed preoperatively and at 2-year follow-up and compared between the groups.
The NDI, JOA scores, JOA recovery rates, and VAS for neck and arm pain were improved significantly in both groups after surgery. The improvement in the VAS for arm pain was significantly greater in the LF group (from 5.55±2.52 to 1.85±2.39) than the LA group (from 5.48±2.42 to 3.40±2.68) (p<.001). Although cervical lordosis and ROM decreased postoperatively in both groups, there were no significant differences in the degree of reduction between the LF and LA groups. Although the postoperative focal angulation and slippage were slightly increased in the LF group, this was not to a significant degree. Furthermore, segmental kyphosis and instability were not observed in the LF group, regardless of whether the patient underwent a unilateral or bilateral foraminotomy.
Additional posterior foraminotomy with laminoplasty is likely to improve arm pain more significantly than laminoplasty alone by decompressing nerve roots. Also, performing posterior foraminotomy via multiple levels or bilaterally did not significantly affect segmental malalignment and instability. Therefore, when a laminoplasty is performed for CSM with radiculopathy, an additional posterior foraminotomy could be an efficient and safe treatment that improves both myelopathy symptoms and radicular arm pain.
Power differences among optical network unit (ONU) channels received at an optical line terminal (OLT) of ethernet passive optical network systems are minimized to increase burst-mode receiver ...performance and acquire reliable ONU operation. The OLT measures each ONU power and sends control messages back to ONUs during registration stage. The ONU is designed to change its modulation depth using received control bits. A digital automatic power control circuit is used at the ONU site to help this process. Proposed schemes are implemented and test results are provided.
Objective We wanted to investigate the relationship between the magnetic resonance (MR) findings and the clinical outcome after treatment with non-surgical transforaminal epidural steroid injections ...(ESI) for lumbar herniated intervertebral disc (HIVD) patients. Materials and Methods Transforaminal ESI were performed in 91 patients (50 males and 41 females, age range: 13-78 yrs) because of lumbosacral HIVD from March 2001 to August 2002. Sixty eight patients whose MRIs and clinical follow-ups were available were included in this study. The medical charts were retrospectively reviewed and the patients were divided into two groups; the successful (responders, n = 41) and unsatisfactory (non-responders, n = 27) outcome groups. A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%. The MR findings were retrospectively analyzed and compared between the two groups with regard to the type (protrusion, extrusion or sequestration), hydration (the T2 signal intensity), location (central, right/left central, subarticular, foraminal or extraforaminal), and size (volume) of the HIVD, the grade of nerve root compression (grade 1 abutment, 2 displacement and 3 entrapment), and an association with spinal stenosis. Results There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p> 0.05). However, the location of the HIVD and the grade of nerve root compression were different between the two groups (p Conclusion MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.
We wanted to investigate the relationship between the magnetic resonance (MR) findings and the clinical outcome after treatment with non-surgical transforaminal epidural steroid injections (ESI) for ...lumbar herniated intervertebral disc (HIVD) patients.
Transforaminal ESI were performed in 91 patients (50 males and 41 females, age range: 13-78 yrs) because of lumbosacral HIVD from March 2001 to August 2002. Sixty eight patients whose MRIs and clinical follow-ups were available were included in this study. The medical charts were retrospectively reviewed and the patients were divided into two groups; the successful (responders, n = 41) and unsatisfactory (non-responders, n = 27) outcome groups. A successful outcome required a patient satisfaction score greater than two and a pain reduction score greater than 50%. The MR findings were retrospectively analyzed and compared between the two groups with regard to the type (protrusion, extrusion or sequestration), hydration (the T2 signal intensity), location (central, right/left central, subarticular, foraminal or extraforaminal), and size (volume) of the HIVD, the grade of nerve root compression (grade 1 abutment, 2 displacement and 3 entrapment), and an association with spinal stenosis.
There was no significant difference between the responders and non-responders in terms of the type, hydration and size of the HIVD, or an association with spinal stenosis (p > 0.05). However, the location of the HIVD and the grade of nerve root compression were different between the two groups (p < 0.05).
MRI could play an important role in predicting the clinical outcome of non-surgical transforaminal ESI treatment for patients with lumbar HIVD.
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