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PubMed2004

Image of a line is not shrunk but neglected. Absence of crossover in unilateral spatial neglect.

Patients with left unilateral spatial neglect following right hemisphere lesions usually err rightward when bisecting a horizontal line. For very short lines (e.g. 25 mm), however, leftward errors or seemingly 'right' neglect is often observed. To explain this paradox of crossover in the direction of errors, rather complicated models have been introduced as to the distribution of attention. Neglect may be hypothesized to occur in representational process of a line or estimation of the midpoint on the formed image, or both. We devised a line image task using a computer display with a touch panel and approached the representational image of a line to be bisected. Three patients with typical left neglect were presented with a line and forced to see its whole extent with cueing to the left endpoint. After disappearance of the line, they pointed to the right endpoint, the left endpoint, or the subjective midpoint according to their representational image. The line image between the reproduced right and left endpoints was appropriately formed for the 200 mm lines. However, the images for the shorter 25 and 100 mm lines were longer than the physical lengths with overextension to the left side. These results proved the context effect that short lines may be perceived longer when they are presented in combination with longer lines. One of our patients had an extensive lesion that involved the frontal, temporal, and parietal lobes, and the other two had a lesion restricted to the posterior right hemisphere. The image for a fully perceived line may be represented far enough into left space even when left neglect occurs after a lesion that involves the right parietal lobe. The patients with neglect placed the subjective midpoint rightward from the centre of the stimulus line for the 100 and 200 mm lines and leftward for the 25 mm lines. This crossover of bisection errors disappeared when the displacement of the subjective midpoint was measured from the centre of the representational line image. Left neglect may occur consistently in estimation of the subjective midpoint on the representational image, which may be explained by a simple rightward bias of attentional distribution.

Aged↗

PubMed1994

Three-dimensional echocardiography. In vivo validation for right ventricular volume and function.

BACKGROUND: Current two-dimensional echocardiographic measures of right ventricular volume are limited by the asymmetrical and crescentic shape of the ventricle and by difficulty in obtaining standardized views. Three-dimensional echocardiographic reconstruction, which does not require geometric assumptions or standardized views, may therefore have potential advantages for determining right ventricular volume. Three-dimensional techniques, however, have not been applied to the right ventricle in vivo, where cardiac motion and contraction could affect accuracy. The purpose of this study was to determine the feasibility and accuracy of three-dimensional echocardiographic reconstruction for quantifying right ventricular volume and function in vivo. In particular, it was designed to test the accuracy of a newly developed system that provides rapid, efficient, and automated three-dimensional data collection (minimizing motion effects) and takes advantage of the full three-dimensional data set to obtain volume. METHODS AND RESULTS: The three-dimensional system was applied to reconstruct the right ventricle and measure its volume and function during 20 hemodynamic stages created in five dogs. Actual instantaneous volumes were measured continuously by an intracavitary balloon connected to an external column. Hemodynamics were varied by volume loading and induction of ischemia. Three-dimensional reconstruction successfully reproduced right ventricular volume compared with actual values at end diastole (y = 1.0 chi-3.4, r = .99, SEE = 1.8 mL) and end systole (y = 1.0 chi+ 2.0, 4 = .98, SEE = 2.5 mL). The mean difference between calculated and actual volumes throughout the cycle was 2.1 mL, or 4.9% of the mean. Ejection fraction also correlated well with actual values (y = 0.96 chi-0.3, r = .98, SEE = 3.3%). CONCLUSIONS: Despite the irregular crescentic shape of the right ventricle, this newly developed three-dimensional system and surfacing algorithm can accurately reconstruct its shape and quantitate its volume and function in vivo without geometric assumptions. The increased efficiency of the system should increase applicability to issues of clinical and research interest.

Algorithms↗

PubMed1994

Three-dimensional echocardiography: in vivo validation for right ventricular free wall mass as an index of hypertrophy.

OBJECTIVES: This study tested the ability of three-dimensional echocardiography to reconstruct the right ventricular free wall and determine its mass in vivo using a system that automatically combines two-dimensional images with their spatial locations. BACKGROUND: Right ventricular free wall thickness is limited as an index of right ventricular hypertrophy because right ventricular mass may increase by dilation without increased thickness and because trabeculations and oblique views can exaggerate thickness in individual M-mode and two-dimensional scans. Three-dimensional echocardiography may have potential advantages because it can integrate the entire free wall mass, uninfluenced by oblique views or geometric assumptions. METHODS: The three-dimensional system was applied to 12 beating canine hearts to reconstruct the right ventricular free wall in intersecting views. The corresponding mass was compared with actual weights of the excised right ventricular free wall (15.5 to 78 g). For comparison, right ventricular sinus and outflow tract thickness were also measured by two-dimensional echocardiography, and the ability to predict mass from these values was determined. RESULTS: The three-dimensional algorithm successfully reproduced right ventricular free wall mass, which agreed well with actual values: y = 1.04x + 0.02, r = 0.985, SEE = 2.7 g (5.7% of the mean value). The two-dimensional predictions showed increased scatter: The variance of mass estimation, based on thickness, was 9.5 to 12.5 (average 11) times higher than the three-dimensional method (p < 0.02). CONCLUSIONS: Despite the irregular crescentic shape of the right ventricle, its free wall mass can be accurately measured by three-dimensional echocardiography in vivo, providing closer agreement with actual mass than predictions based on wall thickness. This method, with the increased efficiency of the three-dimensional system, can potentially improve our ability to evaluate the presence and progression of right ventricular hypertrophy.

Animals↗

PubMed2005

Hybrid test bench for evaluation of any device related to mechanical cardiac assistance.

Hydraulic mock circulatory systems have low flexibility to allow tests of different cardiovascular devices and low precision when a reference model must be reproduced. In this paper a new bench is described. It combines the computer model of the environment in which the device will operate and the electro-hydraulic interfaces by which device and computer are connected. A models library provided with basic functions allows implementing many layouts of the bench, which in turn depend both on the device properties and the desired experiment. In case of an apical LVAD evaluation, the bench can reproduce right and left ventricles, pulmonary and systemic circulations, inlet and outlet LVAD cannulas. An interface forces the instantaneous calculated flow at the VAD input and feeds back the measured pressure to the computer; another interface works in a similar -but complementary- way at the VAD output. The paper focuses on the operating principle of the electro hydraulic interfaces which represent a relevant component of the bench, on the RT-Linux-based software architecture, on the models of the basic elements of the bench. A patent is under preparation. At the moment, only a portion of the bench has been developed. It consists of a piston-cylinder mechanism, which mimics the elastance-based mechanism of a natural ventricle, and a hydraulic circuit representing the arterial load according to a modified windkessel model and the venous return according to the Guyton's model. The pump is driven by a real-time simulation of the cardiovascular system. This preliminary layout allowed testing the piston-cylinder mechanism, its control, and the software. This electro-hydraulic interface has been used to reproduce a pulsatile pump working in different modes. The hybrid model approach can support the development of new cardiac assist devices from their computer model to their manufacture.

Computer Simulation↗

PubMed1999

Volumetric MRI measurements of the tree shrew hippocampus.

Protocols suitable for repeated magnetic resonance imaging (MRI) studies of the tree shrew's brain were established. This included the development of (i) a technique for prolonged inhalation anesthesia by endotracheal intubation; (ii) a reproducible fixation of the animal's head in a stereotaxic frame and finally (iii) the set-up of the hardware (rf coil) and software (MRI sequences) of the MRI system. The endotracheal intubation as well as the repeated and prolonged anesthesia showed no complications. The in vivo measurements of the tree shrew's hippocampal formation revealed a high reproducibility. Right and left hippocampal volume was determined as 85.2 mm3 +/- 8% and 87.4 mm3 +/- 10%, respectively. The utility of MRI in delineating alterations in brain anatomy was demonstrated in three animals receiving cortisol via the drinking water (5 mg/animal/day). After a 4-week treatment, in two of the three tree shrews a reduction in hippocampal volume was observed. Thus, the MRI protocols used here allow for repeated and non-invasive measurements of changes in hippocampal anatomy within the same animal and to monitor the temporal dynamics of structural alterations within this brain structure.

Animals↗

PubMed1995

A philosopher looks at assisted reproduction.

The article first examines the various objections to IVF: religious, health and safety and feminist. It is argued that none of these objections provides good reasons for banning IVF, though certain controls and procedures to protect individuals from harm and exploitation may be appropriate. Next, the article critiques John Robertson's strong conception of procreative liberty, which entails a right to be a surrogate mother or serve as a sperm donor. Roberton's interpretation misconceives the nature and value of the right to reproduce. The righ to reproduce is best interpreted as a right to have one's own children to rear. Where there is no intent or ability to rear, there is no fundamental moral right to reproduce. However, since assisted reproduction is used to enable individuals to have their own children to rear, it should be available to infertile individuals who cannot otherwise reproduce.

Bioethics↗

PubMed1985

Day-to-day reproducibility of responses to right ventricular programmed electrical stimulation: implications for serial drug testing.

The day-to-day reproducibility of responses to right ventricular programmed electrical stimulation was analyzed in 77 patients studied in the baseline state twice within 72 hours. Of 66 in whom ventricular tachycardia (VT) was inducible at the first study (C1), VT was reproduced in 53 (80%) at the second control study (C2). Among 41 patients in whom VT was inducible using 1 or 2 programmed electrical stimuli (PES) at C1, VT remained inducible in 39 (95%) at C2, whereas only 14 of 25 patients (56%) who required 3 or more PES for VT induction at C1 had VT reproduced at C2. The difference in the reproducibility of VT induction in these 2 patient groups was highly significant (p less than 0.001). Although VT was inducible in 50% of patients using the identical stimulation mode at each study, 35% required a more intense mode for VT induction at C2; this included 11 of 35 patients (31%) in whom VT was initially inducible with 1 or 2 PES who required 3 or more PES for induction of VT at C2. Thus, patients in whom VT is initially inducible with 1 or 2 PES demonstrate reproducible day-to-day responses to programmed electrical stimulation and appear to be excellent candidates for electrophysiologically guided antiarrhythmic drug therapy. Because VT induction was significantly less reproducible in patients who required 3 or more PES at C1, day-to-day reproducibility of VT induction should be confirmed in such patients if electropharmacologic therapy is attempted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study.

Right ventricular (RV) dysfunction is a predictor of poor outcome in patients with heart disease. Conventional imaging modalities fail to assess RV volumes accurately. We sought to assess the accuracy and reproducibility of routine breath-hold gradient echo magnetic resonance imaging (MRI)-derived RV mass, volumes and function. We assessed: (1) The accuracy of in vivo MRI-derived RV mass in comparison to the RV weight in 9 minipigs. (2) Intra- and inter-observer reproducibility of RV mass, end-diastolic (EDV) and end-systolic (ESV) volumes and ejection fraction (EF) in 15 normal volunteers and 10 patients with heart disease. (3) Inter-study reproducibility of the former parameters in 25 coronary artery disease patients. (4) The correlation between right and left ventricular stroke volumes in the total population. Strong statistically significant correlations were found between: (1) MRI-derived RV mass and RV weight (r = 0.98, bias = 2.5 g), (2) Intra-observer measurements of RV mass (r = 0.96, bias = 0.5 g), EDV (r = 0.99, bias = -1.5 ml), ESV (r = 0.98, bias = 0.1 ml) and EF (r = 0.92, bias = -1.4%), (3) Inter-observer measurements of RV mass (r = 0.95, bias = 1.1 g), EDV (r = 0.98, bias = -1.1 ml), ESV (r = 0.98, bias = 1.2 ml) and EF (r = 0.87, bias = -1.9%), (4) Inter-study measurements of RV mass (r = 0.91, bias = -0.1 g), EDV (r = 0.96, bias = 3.8 ml), ESV (r = 0.98, bias = 0.3 ml) and EF (r = 0.90, bias = 0.9%), (5) MRI-derived right and left ventricular stroke volumes (r = 0.87). The assessment of the RV mass, volumes and function by routine breath-hold gradient echo MRI is accurate and highly reproducible. The correlation between left and RV MRI-derived stroke volumes indicates excellent coherence of simultaneous bi-ventricular volume measurements.

Adult↗

PubMed2006

Infertility, assisted reproduction and rights.

The rights to reproduce and found a family are recognized as basic human rights. Infertile couples should enjoy the same right to reproduce as those who have the ability to do so without assistance. Both positive and negative rights to access to assisted reproductive technologies are required in order to fully realize the reproductive rights. However, there is a limit to such a claim. The positive right of individuals to have state-funded assisted reproductive treatments has to be balanced against the provision of other societal goods and healthcare rationing. The negative right to acquire access to assisted reproductive technologies by individuals' own resources is also restrained. The barrier to such access is often of a moral nature, the standard of which depends on the values of the society.

Female↗

PubMed1999

Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Reproducibility, comparison of 2 agents, and distribution of microemboli.

BACKGROUND AND PURPOSE: Cardiac right-to-left shunts can be identified by transcranial Doppler ultrasound (TCD) with the use of different contrast agents and by transesophageal echocardiography (TEE). Systematic data are available on neither the reproducibility of contrast TCD, the comparison of different contrast agents, nor the comparison of simultaneous bilateral to unilateral recordings. Furthermore, we assessed the side distribution of thus provoked artificial cardiac emboli. METHODS: Fifty-four patients were investigated by TEE and by bilateral TCD of the middle cerebral artery. The following protocol was performed twice: injection of 9 mL of agitated saline without Valsalva maneuver, injection of 9 mL of agitated saline with Valsalva maneuver, injection of 5 mL of a commercial galactose-based contrast agent without Valsalva maneuver, and injection of 5 mL of the galactose-based contrast agent with Valsalva maneuver. RESULTS: In 18 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-nine patients were negative in both investigations, 1 was positive on TEE and negative on TCD, and 6 patients were only positive on TCD. Both bilateral and repeated recordings increased the sensitivity of contrast TCD. There was a symmetrical distribution of microembolic signals in the right and left middle cerebral artery. CONCLUSIONS: TCD performed twice and with the use of saline or a galactose-based contrast agent is a sensitive method in the identification of cardiac right-to-left shunts also identified by TEE. The cardiac microemboli in this study did not show any side preference for one of the middle cerebral arteries.

Adult↗

PubMed1992

Thermodilution right ventricular ejection fraction measurement reproducibility--a study in patients undergoing coronary artery bypass graft surgery.

OBJECTIVE: To assess the effects of heart rate, right ventricular systolic performance (ejection fraction), chamber dimensions, and flow rate (cardiac index) on the reproducibility of algorithm-derived triplicate thermodilution right ventricular ejection fraction measurements. DESIGN: Prospective study; combined hemodynamic and echocardiographic clinical evaluation. SETTING: Operating room in a university hospital. PATIENTS: Twenty-one coronary artery bypass graft patients. MEASUREMENTS AND MAIN RESULTS: The right atrial delivery site was positioned by analysis of transduced pressure waveform and echocardiographic imaging of tracer agitated saline cavitations. Measurement reproducibility was quantified by determining the variation (standard deviation) within 101 triplicate thermodilution measurement sets. There was no significant relationship between measurement reproducibility and estimates of right atrial area (21.6 +/- 6.9 cm2), diameter (5.1 +/- 0.8 cm) and supero-inferior length (5.1 +/- 0.9 cm) and right ventricular maximal minor axis diastolic diameter (4.21 +/- 1.05 cm). Reproducibility was also unrelated to right ventricular end-diastolic volume index (97.9 +/- 32.7 mL/m2) and cardiac index (2.9 +/- 0.9 L/min/m2). Measurement reproducibility was directly related to mean right ventricular ejection fraction (0.39 +/- 0.14) and inversely related to heart rate (80.8 +/- 18.6 beats/min) (p < .01 and < .001, respectively). CONCLUSIONS: Thermodilution-derived right ventricular ejection fraction measurement reproducibility was unrelated to estimates of right atrial and ventricular dimensions and cardiac index. Measurement reproducibility was a direct function of right ventricular systolic performance and an indirect function of heart rate. Measurement should be interpreted with these constraints in mind.

Adult↗

PubMed1992

Short-term reproducibility over time of right ventricular pulse pressure as a potential hemodynamic sensor for ventricular tachyarrhythmias.

The implantable cardioverter defibrillator (ICD) has been shown to effectively terminate episodes of ventricular tachyarrhythmias. Multiple investigators have suggested that the incorporation of hemodynamic sensors may allow ICDs to differentiate between hemodynamically unstable and stable ventricular tachyarrhythmias (VT), as well as differentiate ventricular from supraventricular tachycardias. Right ventricular (RV) pulse pressure has been shown to possess acceptable characteristics as a sensor for incorporation in ICDs. We sought to determine the short-term reproducibility of RV pulse pressure measurements by comparing RV pulse pressure measured during two separate episodes of VT in each of ten study patients. The mean VT cycle length for VT episode 1 was 293 +/- 15 msec, and was 298 +/- 15 msec for VT episode 2 (P = NS). The decrease in mean arterial pressure was 40 +/- 7 mmHg in episode 1 and 37 +/- 7 mmHg in episode 2 (P = NS). The decrease in RV pulse pressure during episode 1 was -13 +/- 2 mmHg, and -12 +/- 2 during episode 2 (P = NS). The decrease in RV pulse pressure during episodes of VT at two different times during a single electrophysiology study is highly reproducible, suggesting that RV pulse pressure may be a reliable sensor over time.

Aged↗

PubMed1991

Body surface isopotential mapping of the entire QRST complex in the Wolff-Parkinson-White syndrome. Correlation with the location of the accessory pathway.

Body surface potential maps were recorded during sinus rhythm and during atrial pacing at the time of electrophysiologic studies in 42 patients with Wolff-Parkinson-White syndrome. The locations of the accessory pathways were determined by epicardial mapping during surgery in 34 patients and by multicatheter endocavitary electrophysiologic studies in eight additional patients. During delta wave inscription, the shape and extension of areas of the negative and positive potentials on the thorax correlated better with the preexcitation site (69% of patients) than with the localization of the minimum potential alone (45.2% of patients). Typical potential distributions were present from the beginning of the delta wave and remained stationary during the first half of the QRS complex. During marked preexcitation, the superposition of atrial activity on the delta wave produced a mixed pattern in the earliest maps. However, these alterations of early delta thoracic potential distribution did not persist longer than 30 msec. The spread of the negative potentials during the last half of the QRS complex also characterized each localization: right-sided preexcitation reproduced the depolarization sequence of left bundle branch block, left-sided preexcitation reproduced that of right bundle branch block, and posterior pathways resembled left anterior fascicular block. Anterior left ventricular and more anterior left lateral ventricular preexcitations mimicked a right bundle branch block-left posterior fascicular block pattern. There was good correlation between the body surface potential map obtained during the ST segment and the site of the right-sided preexcitation. However, in left-sided preexcitations, ST patterns concordant with delta wave patterns were found less frequently than in right-sided preexcitations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[Quality control in epicutaneous testing--reproducibility in the right-left comparison].

In 121 patients, 26 substances of a standard test battery were applied symmetrically on both sides of the upper back. The Finn chamber on Scanpor was the test system used, the final reading being taken on day 3 or 4. Of 166 tests, 131 were positive on both sides. Test substances and patients age had no influence. In comparison with the results in the literature, ours show a good reproducibility of 78.9%. Doubtful reactions (?+) were difficult to evaluate. These reactions deserve future research.

Adolescent↗

PubMed1994

The reproducibility of measurement of right ventricular ejection fraction and cardiac output by the thermodilution technique in patients on mechanical ventilation.

Thermodilution determined right ventricular ejection fraction (RVEF) and cardiac output (CO) were measured in 48 critically ill patients requiring mechanical ventilation and inotropic and/or vasoactive drugs. The coefficient of variation on CO and RVEF were calculated from triple determinations. The average coefficient of variation based on 551 triple determinations was 12.6% for RVEF (range 2-51%) and 4.9% for CO (range 0-24%). If a 10% coefficient of variation was chosen as acceptable, 95% of the CO measurements were acceptable. The coefficient of variation on RVEF only fulfilled the 10% criteria in 46% of the measurements, but if the accepted level was raised to a 20% coefficient of variation, 90% of the measurements were acceptable. The measurement of RVEF and CO are used for calculation of e.g. right ventricular end diastolic volume (RVEDV). By applying the average coefficient of variation of RVEF and CO, the accumulated error on calculation of RVEDV was found to be divided by 15%- +20% at worst. Before derived parameters such as RVEDV are interpreted or compared with previously obtained values, the accumulated error should be calculated. To ensure the quality of the measurements, our recommendation is always to calculate the coefficient of variation for each triple determination of RVEF and CO.

Blood Pressure↗

PubMed1987

Reproducibility of determination of right ventricular ejection fraction by radionuclide imaging: assessment by the statistical method of variance components.

Confidence limits for single and repeat measurements of right ventricular ejection fraction (RVEF) were established by means of a model based on the statistical method of variance components. A total of 80 subjects (age 23 to 74 years) were examined by two radionuclide methods 1) gated first-pass (fp) technique performed in a standard 30 degrees right anterior oblique projection, and 2) multigated equilibrium imaging (muga) in an individual left anterior oblique view, applying with both methods separate end-diastolic and end-systolic ventricular regions of interest. Values obtained by fp technique were clearly higher than those measured by the muga approach, and the correlation between them was only fair: RVEFmuga = 0.48 RVEFfp + 0.13; r = 0.73; SEE = 0.08. The 95% confidence limits for a single measurement were with the fp technique: 'true' RVEF = measured RVEF +/- 6 EF-units compared to +/- 16 units with the muga method. At repeat determination within an interval of four weeks, the minimal changes in measured RVEF that were statistically significant at the 5% level were with the fp technique +/- 8 units with the same observer on both occasions and +/- 9 units with different observers. Corresponding figures with the muga method were +/- 16 and +/- 22 units, respectively. The minimal changes in a subject's 'true' RVEF necessary to produce a significant change in measured RVEF were with fp technique +/- 14 units for the same observer and +/- 17 units for different observers, compared to +/- 30 and +/- 41 units with the muga method. In conclusion, the variability with the muga approach was far greater than with the fp technique and the consequent reproducibility so poor as to preclude meaningful measurement of RVEF by the muga method.

Adult↗

PubMed1996

Accuracy of reproducing angles: is a right angle special?

The ability to set the angle of a 'V' to a designated value in the following three conditions was compared: (1) verbal designation of V angle; (2) initial 30 s visual demonstration of the designated V angle; (3) verbal designation of V angle plus feedback after every setting. The designated angles were 90 degrees and 45 degrees plus three arbitrary angles (65 degrees, 125 degrees, and 145 degrees). Each run comprised thirty consecutive settings. To ensure that our observers based their settings entirely on V angle it was arranged that line orientation did not provide a reliable cue to V angle. In condition (1), accuracy of setting V angle was significantly worse when the designated angle was other than 90 degrees or 45 degrees. This was not the case in condition (2), indicating that observers maintained a memory of the initial demonstration throughout a run of thirty settings. Setting error was not significant in condition (3) for any of the five angles. However, even in condition (3), setting-to-setting variability was significantly lower for the 90 degrees angle than for the other angles.

Adult↗

PubMed1994

Effects of pretwist on biomechanical properties of canine patellar tendon.

The purpose of this study was to measure the effect produced on canine patellar tendon of a 90 degree pretwist on the following mechanical properties: failure stress, failure strain, average elastic modulus, and strain energy density. Forty adult mongrel dog cadavers, killed for other studies, were used. Paired patellar tendons were isolated with patellar and tibial bone and the central 4.0-4.6 mm of tendon used for testing. Specimens were elongated to failure using a Materials Testing System (MTS). Only those paired specimens both failing in substance were analyzed. Eight paired specimens were analyzed, both with 0 degree twist, for right-left reproducibility. Thirty-two paired specimens were randomly assigned to four groups: right 0 degree/left 90 degree clockwise pretwist; right 0 degree/left 90 degree counterclockwise; left 0 degree/right 90 degree clockwise; left 0 degree/right 90 degree counterclockwise. No statistically significant differences were present between the paired untwisted specimens in any mechanical property. In the pretwisted specimens, there were statistically significant differences between the group left/clockwise and right/counterclockwise and the group left/counterclockwise and right/clockwise with respect to the mechanical properties failure stress, average elastic modulus, and strain energy density. No statistically significant differences were observed between the two groups for failure strain. For the canine patella-patellar tendon-tibia complex (PPTTC), the mechanical properties failure stress, average elastic modulus, and strain energy density are sensitive to both side (left/right) of PPTTC and direction (clockwise/counterclockwise) of pretwist. Pretwist of patellar tendon grafts in anterior cruciate ligament reconstruction may produce significant changes in their mechanical properties that vary with the direction of twist.

Animals↗