• Journal of Cardiovascular Imaging
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• v.30 no.1
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• pp.50-58
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• 2022

BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and -15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), -0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = -0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.

• Physical Therapy Rehabilitation Science
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• v.13 no.3
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• pp.274-284
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• 2024

Background: Mild pain can affect movement leading to disability, and impaired neck proprioception. Transcutaneous electrical nerve stimulation (TENS) has been recommended as an intervention for chronic and subacute neck pain with mobility deficits. Objective: The purpose was to investigate the effects of transcutaneous electrical nerve stimulation (TENS) for improving cervical spine proprioception and reducing pain, anxiety, and disability in young adults with mild neck pain. Methods: Twenty-two participants were recruited between the ages of 20-40 years old and randomized into control and intervention groups. Participants had chronic mild neck pain and not receiving pain treatment or medication, and did not have electrotherapy contraindications. The intervention group received a 30-minute TENS intervention and were instructed in a 2-week daily home-based TENS intervention. Outcome measures were visual analog scale, neck disability index, state-trait anxiety inventory, active range of motion (AROM) and joint position error (JPE). Results: Participants reported reduction in pain, disability, and anxiety post 30-minute intervention. Increase in right lateral flexion AROM and decrease in mean JPE extension post 30-minute intervention. Post 2-week intervention, reduction in pain, an increase in right lateral flexion AROM, and a reduction in mean JPE extension were also detected. Conclusion: People with chronic mild neck pain had a reduction in pain, anxiety, and disability post 30-minutes TENS treatment. Reduction in anxiety and disability with TENS treatment suggests that TENS may be beneficial in reducing pain, anxiety, and improving neck proprioception in young adults with mild neck pain.

• Anatomy and Cell Biology
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• v.57 no.3
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• pp.363-369
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• 2024

Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were -24.6 mm, -24.9 mm, and -22.9 mm respectively on the right and -21.4 mm, -19.9 mm, and -18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation.

• Journal of Radiation Protection and Research
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• v.39 no.4
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• pp.168-175
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• 2014

This study was designed to assess whether the conventional tangential technique, using a multileaf collimator (MLC), allows a reduced dose to the organs at risk (OAR) in breast radiation therapy. A total of forty right and left 20 for each breast cancer patients that underwent radiation therapy after breast conserving surgery were included in this study. For each patient, the planning target volume (PTV) and OAR (heart, left anterior descending artery (LAD), liver and lung) were defined and dose distribution were produced for conventional tangential beams using 6 MV photons. The treatment plans were made using the following two techniques for all patients. For the first plan (P1), MLC was designed to shield as much of OAR as possible without compromising the coverage of PTV. In the second plan (P2), the treatment plan was created without using MLC. Dose-volume histograms for OARs were calculated for all plans. For left breast cancer, the percentage of maximum dose ($D_{max%}$) and mean dose ($D_{mean%}$) of OARs (heart and LAD) were calculated, and for right breast cancer, the percentage of the mean dose ($D_{mean%}$) of the liver was calculated. The $D_{mean%}$ of the lung was calculated in all patients. The mean values of $D_{max%}$ of the heart ($86.9{\pm}19.5%$ range, 35.1-100.6%) in P1 were significantly lower than in P2 ($98.3{\pm}3.4%$ range, 91.7-105.2%) (p=0.001). The mean values of $D_{max%}$ of LAD ($78.4{\pm}22.5%$ range, 26.5-99.7%) in P1 was significantly lower than in P2 ($93.3{\pm}8.1%$ range, 67.9-102.1%) (p<0.001). In P1, the mean values of $D_{mean%}$ of the liver ($4.8{\pm}2.0%$) were significantly lower than in P2 ($6.2{\pm}2.5%$) (p<0.001). The mean values of $D_{mean%}$ of the lung were significantly lower in P1 ($9.3{\pm}2.3%$) than in P2 ($9.7{\pm}2.4%$) (p<0.001). P1, by using MLC, allows a significantly reduced dose to OAR compared with P2. We can suggest that it is reasonable to routinely use MLC in the conventional tangential technique for breast radiation therapy considering the primary tumor location.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.193-199
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• 2007

Background: Reoperation is usually required for a right ventricle to pulmonary artery conduit obstruction caused by valve degeneration, conduit peel formation or somatic growth of the patient. An autologous tissue reconstruction (peel operation), where a prosthetic roof is placed over the fibrotic tissue bed of the explanted conduit, has been used to manage conduit obstructions at our institute since May 2002. Herein, the early and midterm results are evaluated. Material and Method: Between May 2002 and July 2006, 9 patients underwent obstructed extracardiac conduit replacement with an autologous tissue reconstruction, at a mean of 5.1 years after a Rastelli operation. The mean age at reoperation was $7.5{\pm}2.4$ years, ranging from 2.9 to 10.1 years. The diagnoses included 6 pulmonary atresia with VSD, 2 truncus arteriosus and 1 transposition of the great arteries. The preoperative mean systolic gradient was $88.3{\pm}22.2mmHg$, ranging from 58 to 125 mmHg. The explanted conduits were all Polystan valved pulmonary conduit (Polystan, Denmark). A bioprosthetic valve was inserted in 8 patients, and a monocusp ventricular outflow patch (MVOP) was used in 1 patient. The anterior wall was constructed with a Gore-Tex patch (n=7), MVOP (n=1) and bovine pericardium (n=1). Pulmonary artery angioplasty was required in 5 patients and anterior aortopexy in 2. The mean cardiopulmonary bypass time . was 154 minutes, ranging from 133 to 181 minutes; an aortic crossclamp was not performed in all patients. The mean follow-up duration was 20 months, ranging from 1 to 51 months. All patients were evaluated for their right ventricular outflow pathway using a 3-D CT scan. Resuit: There was no operative mortality or late death. The mean pressure gradient, assessed by echocardiography through the right ventricular outflow tract, was 20.4 mmHg, ranging from 0 to 29.6 mmMg, at discharge and 26 mmHg, ranging from 13 to 36 mmHg, at the latest follow-up (n=7, follow-up duration >1 year). There were no pseudoaneurysms, strictures or thrombotic occlusions. Conclusion: A peel operation was concluded to be a safe and effective re-operative option for an obstructed extracardiac conduit following a Rastelli operation.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.253-253
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• 1997

Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l0℃. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52±42.46 and 103.48± 15.96 mmHg in group I versus 247.78±36.19 and 147.91 ± 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95± 12.84 and 437.31 14.26 mmHg in group I versus 310.88±3).47 and )90.93± 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56± 18.66 and 87. 2± 17.22 mmHg in group I versus 31.22±6.84 and 65.78± 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69±0.85 and 4.36±0.86 mmHg/ml/min in group I versus 1.99±0.39 and 3.29±0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l0℃ was superior to preservation at 4℃.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.270-274
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• 1997

In recent years, the use of allograft conduits in repair of congenital cardiac disease is widely accepted. However, the supply of homograft. is currently limiting their increased clinical application, especially small cryopreserved homografts for use in neonates and inf'ants. We used a technique to surgically reduce the size of the more readily available large-diameter allografts, making them suitable for right ventricular outflow tract reconstruction in small infants and children. From December 1994 to March 1996, a total of 11 patients ranging in age from 10 months to 6 years (mean age, 27.3 months) and ranging in weight from 5.6 to 18.5 kg (mean 11.5 kg) underwent reconstruction of the right ventricular outflow tract using this surgical technique (pulmo ary atresia with ventricular septal defect, 9 cases ; tetralogy of Falloff, 2 cases). The diameter after downsizing ranged from 14 to 19 mm with a mean of 16.8 mm. There was one operative death due to rupture of the infected homograft. Evaluation of these patients between 2 and 15 months (mean 6.9 months) after homograft implantation reveals excellent clinical and echocardiographic results. There were no significant homograft insufficiency and RVOT obstructions. Although a longer follow-up is certainly required to evaluate the long term fate of the surgically modified bicuspid homografts, we believe that this technique may represent a valuable therapeutic alternative, at least in the short term, to the use of synthetic grafts when an appropriately sized homograft is not available.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.1
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• pp.49-53
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• 2011

Introduction: This study compared the strength of osseointegration as determined by the resistance to reverse torque rotation of three different hydroxyapatite coated implants in the rabbit femur model. Materials and Methods: Three hydroxyapatite coated implants (HAPTITE), Tapered Screw-Vent (TSV) and BioTite-H - were used. A total of 40 implants were placed in the femur of 20 adult male rabbits. The animals were divided into two groups. In group A (n=10); one HAPTITE was placed into each right femur and one TSV was placed into each left femur. In group B (n=10); one HAPTITE was placed into each right femur and one BioTite-H was placed into each left femur. Five rabbits of each group were sacrificed at 4 and 8 weeks. The implants were removed by reverse torque rotation using a digital torque-measuring device. A total of 40 implants in 20 rabbits were used for the removal torque measurements. Results: In the Group A, 4 weeks after implant placement, the mean removal torque for the HAPTITE and TSV was $70.7{\pm}31.6$ N cm and $28.9{\pm}15.1$ N cm, respectively. Eight weeks after implant placement, the mean removal torque for the HAPTITE and TSV was $87.9{\pm}26.2$ N cm and $54.9{\pm}22.4$ N cm, respectively. In the Group B, 4 weeks after implant placement, the mean removal torque for the HAPTITE and BioTite-H was $58.0{\pm}29.6$ N cm and $37.7{\pm}14.1$ N cm, respectively. Eight weeks after implant placement, the mean removal torque for the HAPTITE and BioTite-H was $91.4{\pm}47.1$ N cm and $30.8{\pm}9.8$ N cm. HAPTITE showed a higher removal torque than the other implants. Conclusion: These results suggest that HAPTITE increases the strength of osseointegration significantly as determined by the resistance to reverse torque rotation.

• Journal of Veterinary Clinics
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• v.32 no.3
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• pp.231-234
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• 2015

This study measured the tibial plateau angle (TPA), a value that predicts cranial cruciate ligament rupture (CCLR) and a prerequisite for dynamic stabilization, in small breed dogs. The cadavers of 32 skeletally mature small breed dogs without CCLR were used to measure TPA. Differences were evaluated between males and females, left and right limbs, and among breeds. The mean TPA of all dogs was $26.13^{\circ}{\pm}2.33^{\circ}$. The mean TPAs of left and right limbs were $26.00^{\circ}{\pm}2.23^{\circ}$ and $26.26^{\circ}{\pm}2.45^{\circ}$, respectively, which was not a significant difference. The mean TPAs of male and female dogs were $26.01^{\circ}{\pm}1.57^{\circ}$ and $26^{\circ}.22{\pm}2.80^{\circ}$, respectively, which was also not significant difference. The mean TPAs in Maltese, Poodle, Shih Tzu, and Yorkshire terrier were $26.06^{\circ}{\pm}2.96^{\circ}$, $25.21^{\circ}{\pm}1.38^{\circ}$, $26.65^{\circ}{\pm}2.96^{\circ}$, and $26.27^{\circ}{\pm}1.61^{\circ}$, respectively. Differences in these means were not statistically significant. The TPA measured from this study could provide important information for further investigation of the pathogenesis of and surgical techniques for CCLR in small breed dogs.

• Journal of Gifted/Talented Education
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• v.22 no.2
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• pp.317-332
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• 2012

We investigated brain activity during the performance of the intelligence task by a science high school student group (n=8) and a foreign language high school student group (n=5). Both groups scored in the top 1% on intelligence tests (science high school group: RAPM mean score=34.0, WAIS mean IQ=139.6; foreign language high school group: RAPM mean score=33.8, WAIS mean IQ=147.2). Analysis of brain activity during the performance of the intelligence task showed that both groups had brain activity in certain areas, including the left and right prefrontal cortex, parietal cortex, and anterior cingulate. The science high school group showed the highest activity in the right parietal cortex, which is related to visuo-spatial working memory, whereas the foreign language high school group showed the highest activity in the left prefrontal cortex, which is related to verbal working memory. The foreign language high school group showed higher brain activity than the science high school group in the left precentral gyrus which is related to the motion of the tongue and lips. These results show that the science high school group utilized the visuo-spatial area, whereas the foreign language high school group utilized the verbal area during the performance of the intelligence task. This suggests that the major thinking process differs depending on the gifted students' primary field of study, although they are doing the same task.