OBJECTIVE: We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity.MATERIALS AND METHODS: We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity.RESULTS: Disease duration was significantly shorter in active TAOs than in inactive ones (p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs (p < 0.001), but not the AD value of lateral EOMs (p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs (p < 0.005), whereas only FA differed significantly in the lateral EOMs (p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs (p < 0.05), except for FA (p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%).CONCLUSION: rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.
Anisotropy ; Diffusion Tensor Imaging ; Diffusion ; Echo-Planar Imaging ; Humans ; Logistic Models ; Multivariate Analysis ; Muscles ; Negotiating ; Optic Nerve ; Orbit ; Sensitivity and Specificity ; Smoke ; Smoking ; Troleandomycin

PURPOSE: Stress distribution and mandible distortion during lateral movements are known to be closely linked to bruxism, dental implant placement, and temporomandibular joint disorder. The present study was performed to determine stress distribution and distortion patterns of the mandible during lateral movements in Class I, II, and III relationships. METHODS: Five Korean volunteers (one normal, two Class II, and two Class III occlusion cases) were selected. Finite element (FE) modeling was performed using information from cone-beam computed tomographic (CBCT) scans of the subjects' skulls, scanned images of dental casts, and incisor movement captured by an optical motion-capture system. RESULTS: In the Class I and II cases, maximum stress load occurred at the condyle of the balancing side, but, in the Class III cases, the maximum stress was loaded on the condyle of the working side. Maximum distortion was observed on the menton at the midline in every case, regardless of loading force. The distortion was greatest in Class III cases and smallest in Class II cases. CONCLUSIONS: The stress distribution along and accompanying distortion of a mandible seems to be affected by the anteroposterior position of the mandible. Additionally, 3-D modeling of the craniofacial skeleton using CBCT and an optical laser scanner and reproduction of mandibular movement by way of the optical motion-capture technique used in this study are reliable techniques for investigating the masticatory system.
Bruxism ; Cone-Beam Computed Tomography* ; Dental Implants ; Finite Element Analysis* ; Incisor ; Malocclusion* ; Mandible ; Mastication* ; Masticatory Muscles ; Reproduction ; Skeleton ; Skull ; Stomatognathic System ; Temporomandibular Joint Disorders ; Volunteers

PURPOSE: To examine the usefulness of various receptor tyrosine kinase expressions as prognostic markers and therapeutic targets in muscle invasive urothelial cancer (UC) patients. MATERIALS AND METHODS: We retrospectively analyzed the data of 98 patients with muscle invasive UC who underwent radical cystectomy between 2005 and 2010 in Yonsei Cancer Center. Using formalin fixed paraffin embedded tissues of primary tumors, immunohistochemical staining was done for human epidermal growth factor receptor 2 (HER2), fibroblast growth factor receptor 1 (FGFR1), and fibroblast growth factor receptor 3 (FGFR3). RESULTS: There were 41 (41.8%), 44 (44.9%), and 14 (14.2%) patients who have over-expressed HER2, FGFR1, and FGFR3, respectively. In univariate analysis, significantly shorter median time to recurrence (TTR) (12.9 months vs. 49.0 months; p=0.008) and overall survival (OS) (22.3 months vs. 52.7 months; p=0.006) was found in patients with FGFR1 overexpression. By contrast, there was no difference in TTR or OS according to the HER2 and FGFR3 expression status. FGFR1 remained as a significant prognostic factor for OS with hazard ratio of 2.23 (95% confidence interval: 1.27-3.90, p=0.006) in multivariate analysis. CONCLUSION: Our result showed that FGFR1 expression, but not FGFR3, is an adverse prognostic factor in muscle invasive UC patients after radical cystectomy. FGFR1 might be feasible for prognosis prediction and a potential therapeutic target after thorough validation in muscle invasive UC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma/*metabolism/*mortality/surgery ; Cystectomy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Muscles/pathology ; Neoplasm Invasiveness ; Prognosis ; Proportional Hazards Models ; Receptor, ErbB-2/metabolism ; Receptor, Fibroblast Growth Factor, Type 1/*metabolism ; Receptor, Fibroblast Growth Factor, Type 3/metabolism ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms/*metabolism/*mortality/surgery ; Urothelium/pathology

OBJECTIVE: Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. METHODS: A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. RESULTS: Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. CONCLUSION: For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.
Adult ; Back Muscles ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Multivariate Analysis ; Muscles* ; Paraspinal Muscles ; Spinal Fusion ; Spine

OBJECTIVETo determine whether there are in vivo differences of metabolites levels in bilateral cortical masticatory area(CMA) of patients with sleep bruxism, compared with healthy controls using proton magnetic resonance spectroscopy(1H-MRS). Accordingly to explore if cortical control of the central jaw motor system is abnormal in sleep bruxism patients.

METHODSFifteen sleep bruxism patients and fifteen age- and gender-matched healthy controls underwent 1H-MRS of bilateral CMA using J-difference edited point-resolved spectroscopy sequence(MEGA-PRESS) technique. Levels of metabolites were quantified from the ratio of the metabolite integral to the unsuppressed water signal. Differences of levels of γ-aminobutyric acid(GABA), glutmate(Glu) and N-acetyl aspartate(NAA) in bilateral CMA between sleep bruxism patients and healthy controls were tested using two-way ANOVA.

RESULTSEdited spectra were successfully obtained from the bilateral CMA in all of the participants. Levels of GABA+, glutmate and NAA in right and left CMA in sleep bruxism patients were (2.45±0.48)×10(-3), (2.35±0.62)×10(-3), (10.65±1.84)×10(-3), (10.49±2.37)×10(-3), (10.70±3.61)×10(-3), and (11.26±4.01)×10(-3) respectively. In contrast, levels of GABA+, glutmate and NAA in right and left CMA in healthy controls were (2.63±0.68)×10(-3), (2.65±0.97)×10(-3), (11.19± 1.34)×10(-3), (10.58±3.14)×10(-3), (11.82±1.80)×10(-3), and (11.95±3.23)×10(-3). There were no differences in levels of GABA+(P=0.196), Glu(P=0.590), and NAA(P=0.292) between sleep bruxism patients and healthy controls, nor in inbilateral CMA(GABA+: P=0.837; Glu: P=0.510; NAA: P=0.628).

CONCLUSIONSThe results indicate the absence of any alteration of the cortical control of the central jaw motor system in the levels of GABA, Glu and NAA in patients with sleep bruxism.

Analysis of Variance ; Aspartic Acid ; analogs & derivatives ; analysis ; metabolism ; Case-Control Studies ; Glutamic Acid ; analysis ; metabolism ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; methods ; Masticatory Muscles ; metabolism ; physiopathology ; Motor Neurons ; metabolism ; Sleep Bruxism ; metabolism ; physiopathology ; gamma-Aminobutyric Acid ; analysis ; metabolism

BACKGROUND: Total oxygen consumption has been found to be reduced under deep neuromuscular blockade due to a lower rate of metabolism of skeletal muscles. However, the magnitude of this effect in individual muscles has not been investigated. Thus the aim of this study was to compare the oxygenation of paralyzed versus non-paralyzed forearm muscle under tourniquet-provoked ischemia. METHODS: After ethics approval and written informed consent, 30 patients scheduled for elective hand and wrist surgery were included. Ischemia was provoked by inflation of bilateral upper arm tourniquets and muscle relaxation was achieved via intravenous administration of rocuronium 0.9 mg/kg. Bilateral tourniquets were applied to both upper arms before induction of anesthesia and near infrared spectrometry (NIRS) electrodes applied on both forearms. Muscular ischemia in an isolated (= non-paralyzed, NP) as well as a paralyzed forearm (P) was created by sequential inflation of both tourniquets before and after intravenous administration of rocuronium. Muscle oxygen saturations (SmO2) of NIRS in both forearms and their changes were determined and compared. RESULTS: Data of 30 patients (15 male, 15 female; 41.8 +/- 14.7 years) were analyzed. The speed of SmO2 decrease (50% decrease of SmO2 from baseline (median [percentiles]: NP 210 s [180/480s] vs. P 180 [180/300]) as well as the maximum decrease in SmO2 (minimum SmO2 in % (median [percentiles]: NP 20 [19/24] vs. P 21 [19/28]) were not significantly affected by neuromuscular paralysis. CONCLUSIONS: No significant effect of muscle relaxation on NIRS-assessed muscle oxygenation under tourniquet-induced ischemia was found in human forearm muscles.
Administration, Intravenous ; Anesthesia ; Arm ; Electrodes ; Ethics ; Female ; Forearm* ; Hand ; Humans ; Inflation, Economic ; Informed Consent ; Ischemia ; Male ; Metabolism ; Muscle Relaxation* ; Muscle, Skeletal* ; Muscles ; Neuromuscular Blockade ; Oxygen Consumption ; Oxygen* ; Paralysis ; Prospective Studies* ; Spectroscopy, Near-Infrared ; Spectrum Analysis ; Tourniquets ; Wrist

PURPOSE: The aim of this study was to evaluate the transfer of different occlusal forces in various skeletal malocclusions using finite element analysis (FEA). METHODS: Three representative human cone-beam computed tomography (CBCT) images of three skeletal malocclusions were obtained from the Department of Orthodontics, Yonsei University Dental Hospital, Seoul, South Korea. The CBCT scans were read into the visualization software after separating bones and muscles by uploading the CBCT images into Mimics (Materialise). Two separate three-dimensional (3D) files were exported to visualize the solid morphology of skeletal outlines without considering the inner structures. Individual dental impressions were taken and stone models were scanned with a 3D scanner. These images were integrated and occlusal motions were simulated. Displacement and Von Mises stress were measured at the nodes of the FEA models. The displacement and stress distribution were analyzed. FEA was performed to obtain the 3D deformation of the mandibles under loads of 100, 150, 200, and 225 kg. RESULTS: The distortion in all three skeletal malocclusions was comparable. Greater forces resulted in observing more distortion in FEA. CONCLUSIONS: Further studies are warranted to fully evaluate the impact of skeletal malocclusion on masticatory performance using information on muscle attachment and 3D temporomandibular joint movements.
Bite Force ; Computer Simulation ; Cone-Beam Computed Tomography ; Finite Element Analysis* ; Humans ; Korea ; Malocclusion* ; Mandible ; Muscles ; Orthodontics ; Seoul ; Temporomandibular Joint

BACKGROUND: Central core disease (CCD) is a congenital myopathy characterized by distinctive cores in muscle fibers. Mutations in the gene encoding ryanodine receptor 1 (RYR1) have been identified in most CCD patients. CASE REPORT: Two unrelated patients presented with slowly progressive or nonprogressive proximal muscle weakness since childhood. Their family history revealed some members with the same clinical problem. Histological analysis of muscle biopsy samples revealed numerous peripheral cores in the muscle fibers. RYR1 sequence analysis disclosed a novel mutation in exon 101 (c.14590T>C) and confirmed a previously reported mutation in exon 102 (c.14678G>A). CONCLUSIONS: We report herein two families with CCD in whom missense mutations at the C-terminal of RYR1 were identified. Although it has been accepted that such mutations are usually associated with a severe clinical phenotype and clearly demarcated central cores, our patients exhibited a mild clinical phenotype without facial muscle involvement and skeletal deformities, and atypical cores in their muscle biopsy specimens.
Biopsy ; Congenital Abnormalities ; Exons ; Facial Muscles ; Humans ; Muscle Weakness ; Muscular Diseases ; Mutation, Missense ; Myopathy, Central Core* ; Phenotype ; Ryanodine Receptor Calcium Release Channel* ; Sequence Analysis

Intramedullary screw fixation and bicortical screw fixation are widely used operation methods in the surgical treatment of Jones fractures. The purpose of this study is to evaluate of mechnical stability in two kind of Jones fracture. Using Mimics, three-dimensional models of the fifth metatarsal were reconstructed form computed tomography images of a 23-year-old Korean healthy male. Normal and osteoporotic bone models were made by changing bone density or thickness of cortical and cancellous bone. Two kinds of fixation techniques, i.e., intramedullary and bicortical screw fixation models, were simulated and muscles forces related to the fifth metatarsal base were applied. Maximum contact pressure difference were measured as 20,818 MPa, 12,155 MPa in normal bone, 23,371 MPa, 13,765 MPa in 85% cancellous osteoporotic bone, 24,310 MPa and 14,264 MPa in 75% cancellos osteoporotic model, 21,337 MPa, 20,971 MPa in -0.5 mm cortical osteoporotic bone, 26,322 MPa and 36,153 MPa in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Displacements on fracture interface were 0.208 mm, 0.126 mm in normal bone while 0.229 mm, 0.127 mm in 85% cancellos osteoporotic model, 0.241 mm, 0.127 mm in 75% cancellos osteoporotic model, 0.223 mm, 0.271 mm in -0.5 mm cortical osteoporotic model, 0.292 mm, 0.480 mm in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Bicortical screw fixation is superior in mechanical stability than intramedullary screw fixation for normal bone quality Jones fractures. For cortical osteoporotic bone Jones fractures, however, intramedullary screw fixation can give a better mechanical stability than bicortical screw fixation.
Bone Density ; Finite Element Analysis* ; Fracture Fixation ; Humans ; Male ; Metatarsal Bones ; Muscles ; Young Adult

OBJECTIVE: To investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients. METHODS: A cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs. RESULTS: Comparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025). CONCLUSION: RCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients.
Hemiplegia ; Humans ; Multivariate Analysis ; Muscle Strength ; Muscle Weakness ; Muscles ; Paralysis ; Paresis ; Prevalence ; Range of Motion, Articular ; Risk Factors ; Rotator Cuff ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Tendon Injuries ; Upper Extremity