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Determination of the kinematic axis point of the temporomandibular joint regardless of cyclic mandibular movement data.

The term 'kinematic axis' refers to a theoretical intercondylar axis of the mandible, any point on it nearly reciprocating on a single surface during all sagittal movements. Thus the axis can simplify kinematic features of the temporomandibular joint. In order to locate the axis point on a desired sagittal plane kinematically, a cyclic mandibular movement along the sagittal border has been employed, due primarily to its locational efficiency. For purposes of extracting entire features of condylar movements, however, not only the border movement, but as many other types of movements as possible should be employed. Location methodology applicable to such a wide variety of movement data has yet to be established. To surmount this restriction, this paper presents a technique applicable to any sagittal movement data. The axis point can be obtained as a condylar point, the motion range of which is the narrowest. This range has been provided as the region surrounded by a closed trajectory, whereas it is here defined by the region lying between the superior and inferior trajectories, thereby achieving a discarding of kinetic cyclicity. A condylar point minimizing the area of this region was verified to be a valid estimate of the kinematic axis point, through experiments employing actual mandibular movement data.

Biomedical Engineering↗

A computer simulation of the hypothalamic-pituitary-adrenal axis.

This paper describes the construction of a computer model that simulates the hypothalamic-pituitary-adrenal axis (HPA axis) regulation of cortisol production. It is presented to illustrate the process of physiological modeling using standard "off the shelf" technologies. The model simulates components of the HPA axis involved in the continuous secretion and elimination of cortisol, adrenocorticotropin (ACTH), and corticotropin releasing hormone (CRH). The physiological relations of these component pieces were modeled based on the current knowledge of their functioning. Rate constants, half lives, and receptor affinities were assigned values derived from the experimental literature. At its current level of development the model is able to accurately simulate the timing, magnitude and decay of the ACTH and cortisol concentration peaks resulting from the ovine-CRH stimulation test in normal and hypercortisolemic patients. The model will be used to predict the effects of lesions in different components of the HPA axis on the time course of cortisol and ACTH levels. We plan to use the model to explore the experimental conditions required to distinguish mechanisms underlying various disorders of the HPA axis, particularly depression. Efforts are currently underway to validate the model for a large variety of normal and pathological perturbations of the HPA axis.

Adrenocorticotropic Hormone↗

The relationship of the interosseous membrane to the axis of rotation of the forearm.

Fresh anatomic specimen forearms were studied using a mechanical device, the axis finder, to locate the axis of rotation. The relationship of the axis to the membrane was demonstrated directly using a small jig. The axis of rotation of the forearm is constant and independent of elbow flexion or extension. It runs from the center of the radial head to the center of the distal ulna. All fibers of the interosseous membrane cross the axis of rotation near their distal insertion into bone. This relationship of the ligaments to the axis of rotation is similar to those of the ankle, knee, and thumb joints. The membrane does not limit forearm rotation and can provide little stability if the bony ring is disrupted.

Forearm↗

The effects of motion direction, body axis, and posture on motion sickness induced by low frequency linear oscillation.

BACKGROUND: A recent experiment demonstrated that low frequency linear oscillation through the Z-axis of the body was more nauseogenic when applied in the vertical direction, with subjects seated upright, than in the horizontal direction, with subjects supine. HYPOTHESIS: The nauseogenicity of low frequency linear oscillatory motion is dependent on direction of motion with respect to the gravity vector, orientation of body axis with respect to motion, and body posture. METHODS: The following conditions were compared: A) seated upright, with horizontal motion, X-axis; B) seated upright, with vertical motion, Z-axis; and C) supine, with vertical motion, X-axis. Sinusoidal motion at 0.35 Hz, 3.6 m.s-2 peak was used in all conditions. Two experiments were performed. In Experiment 1 subjects (n = 28) were exposed to conditions A and B. In Experiment 2 subjects (n = 12) were exposed to conditions A, B and C. RESULTS: Horizontal motion (condition A) was found to be twice as nauseogenic (p < 0.05 to p < 0.0001) as vertical motion (condition B), but there was no difference in nauseogenicity between upright and supine postures for vertical motion (condition B vs. C). Mean motion exposure times to achieve moderate nausea were: Experiment 1: A) 9.0 min.; B) 22.4 min.; Experiment 2: A) 15.3 min.; B) 27.1 min.; C) 22.5 min. CONCLUSIONS: These results, taken together with those of the previous experiment, suggest that upright vs. supine body posture and stimulation through X- vs. Z-axis, both enhance the nauseogenicity of low frequency linear oscillation, these effects are additive, but that motion direction with respect to the gravity vector (horizontal vs. vertical) is a less important factor.

Adult↗

New modalities for understanding dynamic regulation of the somatotropic (GH) axis: explication of gender differences in GH neuroregulation in the human.

BACKGROUND: Neuroendocrine regulation of the somatotropic (GH) axis is under the direction of hypothalamic signals, intrapituitary mechanisms, and multi-level feedback control. Consequently, understanding the regulation of the physiologically pulsatile mode of GH release in vivo is a substantial challenge. OBJECTIVES: To present and review several new modalities designed to unmask novel features of physiological regulation of the GH axis. To this end, I emphasize gender differences in the control of pulsatile GH release, while highlighting the new approaches to uncovering such differences. SUBJECTS: Human volunteers. METHODS: Novel investigative modalities include: (1) a high-sensitivity chemiluminescence GH assay capable of measuring 0.002 microgram/l of GH when utilized with a new discrete variance model for assay data reduction; (2) the technique of standardized linear regression to compare GH measures in men versus women; (3) the application of so-called deconvolution analysis, which is designed to estimate underlying rates of pulsatile hormone (GH) secretion as well as hormone half-life from a given plasma GH concentration profile; (4) an approximate entropy (ApEn) statistic to quantify the regularity or orderliness of hormone release, by assigning a single non-negative number that is a measure of the pattern reproducibility in the data; and (5) the evolution of network models to represent the physiological connections and feedback activities of the GH axis. RESULTS: The foregoing new methodologies have collectively uncovered prominent gender differences in the regulation of the GH axis, which encompass: (i) higher mean serum GH concentrations due to greater GH secretory burst mass in women than men; (ii) relatively reduced suppressibility of GH by oral glucose administration due to greater GH secretory burst mass in women compared to men, with no apparent gender differences in the frequency of GH secretory bursts or the GH half-life in plasma; (iv) a remarkably higher degree of irregularity or disorder in the GH release process in women or female rats compared to male counterparts, indicating significantly reduced pattern reproducibility in the female; (v) an approximately two-fold greater sensitivity of men compared to women to the negative effects of age and increased percentage body fat and the positive impact of physical fitness on mean serum GH concentrations; and (vi) the ability of a multinodal network to capture the feedback relationships observed in vivo among GHRH, somatostatin, GH secretion, and GH and IGF-I negative feedback. CONCLUSIONS: New analytical modalities for understanding dynamic regulation of the GH axis disclose a wide array of specific, prominent, and quantifiable gender differences in the physiological control mechanisms that direct this important neuroendocrine axis.

Female↗

Hip axis length measurement using dual-energy X-ray absorptiometry.

Hip axis length (HAL) has been reported, in the United States, to influence the risk of hip fractures independently from age and proximal femoral bone mineral density. Last-generation dual-energy X-ray absorptiometry units can perform automatic hip axis length measurements. The present study was designed to evaluate the feasibility of this measurement in clinical practice and to establish the range of normal values obtained in French women using single- and fan-beam absorptiometry. Short-term reproducibility determined by performing two measurements with repositioning in 50 women was 1.67%. Long-term reproducibility calculated based on five measurements taken at six-month intervals in 60 women was 1.5%. No statistically significant differences were found between hip axis length on the right and left sides in 50 women. Mean values calculated based on measurements in 190 women aged 54 +/- 12 years (single-beam absorptiometry) and in 50 women aged 80 +/- 5 years (fan-beam absorptiometry) were 10.4 +/- 0.6 cm and 11.5 +/- 0.7 cm, respectively. Hip axis length was correlated with height but not with age or femoral neck bone mineral density. Our data are consistent with studies conducted in the United States. The interpretation of hip axis length measurements requires knowledge of the type of X-ray beam used (single or fan-shaped). Whether hip axis length predicts the hip fracture risk in Europeans remains to be demonstrated.

Absorptiometry, Photon↗

Off-axis output factors for 6MV and 18MV photons.

A series of in-air measurements showed that collimator scatter (Sc) did not change significantly for 6MV photons when the centre of the field was moved away from the central axis. This result enabled a model to be developed for the off-axis Effective Output Factor (EOF) which was then verified for 6MV and 18MV photons on a Varian 2100c accelerator and for 6MV photons on a Varian 600c accelerator. Thus off-axis output factors may be predicted, for a range of rectangular asymmetric fields, using only the Primary Off-Centre Ratio (POCR) in air and the on-axis output factor. Depth doses were also investigated off-axis and found to have no clinically significant differences compared with on-axis depth doses, for depths less than 7.5 cm for 6MV and 12.5 cm for 18MV photons. The model is simple to implement and avoids the need for a measurement for each patient, thus saving accelerator time.

Biophysical Phenomena↗

[Long-term follow up of QRS axis deviation].

It has been already described that the average axis of QRS complex is deviated by aging as well as various diseases, such as ventricular overload or bundle branch block. In this study, we first tested the hypothesis that the extra-cardiac factor changes with aging, such as the body shape or diaphragm position, which are represented by body weight (WT) and/or cardiac-thoracic ratio (CTR), are the main cause of QRS axis deviation. In 28 cases including 1 right (RAD) and 27 left axis deviation (LAD) patients whose QRS axis have been deviated during observed periods, WT and X-ray CTR were compared to the degree of axis deviation. Unfortunately no clear relationship was found among these parameters. On the other hand, in 8 cases out of 27 LAD patients, confirmed or suspected left anterior hemiblock (LAH) was found by vector electrocardiogram. Pathological studies showed that the degeneration of the stimulation pathway occurred with aging and it caused the bundle branch block. Therefore, we conclude that the degenerative change in left anterior stimulation pathway by aging should be, at least, one of the cause of the QRS axis deviation.

Aged↗

Acute injuries of the axis vertebra.

A retrospective analysis of 165 patients admitted to Hermann Hospital with acute injuries of the axis vertebra revealed 68 (41%) dens fractures, 62 (38%) cases of traumatic spondylolisthesis ("hangman's" fracture), 21 (13%) extension teardrop fractures, 10 (6%) hyperextension dislocations, and 2 (1.0%) fractures each of the laminae and spinous processes. Of the 68 dens fractures, none (0%) were of the Anderson and D'Alonzo Type I; 21 (31%) were Type II ("high"); and 47 (69%) were Type III ("low"). The 62 traumatic spondylolistheses included 13 (21%) Effendi type I, 35 (56%) type II and 3 (5%) type III. This review disclosed an additional 11 (18%) patients with an atypical variety of traumatic spondylolisthesis, not previously reported, in which one or both fractures involved the posterior cortex of the axis body. Of the axis injuries 31 (18%) were limited to the axis body alone. Of these, 21 (61%) were hyperextension teardrop fractures and 10 (32%) were hyperextension dislocations. Axis injuries were associated with acute injuries of other cervical vertebrae in 14 (8%) of the patients.

Axis, Cervical Vertebra↗

Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment.

Measurements of joint angles during motion analysis are subject to error caused by kinematic crosstalk, that is, one joint rotation (e. g., flexion) being interpreted as another (e.g., abduction). Kinematic crosstalk results from the chosen joint coordinate system being misaligned with the axes about which rotations are assumed to occur. The aim of this paper is to demonstrate that measurement of the so-called "screw-home" motion of the human knee, in which axial rotation and extension are coupled, is especially prone to errors due to crosstalk. The motions of two different two-segment mechanical linkages were examined to study the effects of crosstalk. The segments of the first linkage (NSH) were connected by a revolute joint, but the second linkage (SH) incorporated gearing that caused 15 degrees of screw-home rotation to occur with 90 degrees knee flexion. It was found that rotating the flexion axis (inducing crosstalk) could make linkage NSH appear to exhibit a screw-home motion and that a different rotation of the flexion axis could make linkage SH apparently exhibit pure flexion. These findings suggest that the measurement of screw-home rotation may be strongly influenced by errors in the location of the flexion axis. The magnitudes of these displacements of the flexion axis were consistent with the inter-observer variability seen when five experienced observers defined the flexion axis by palpating the medial and lateral femoral epicondyles. Care should be taken when interpreting small internal-external rotations and abduction-adduction angles to ensure that they are not the products of kinematic crosstalk.

Adult↗

Estimation of fetal age from dimensions of atlas and axis ossification centers.

The atlas and axis ossification centers of 106 human fetal and neonate skeletons were measured. The skeletons belong to the collection in the Department of Forensic Medicine of the Albert Szent-Györgyi Medical University, Szeged, Hungary. The age of the skeletons ranged from 4 to 10 lunar months. Nine linear measurements on the atlas, seven on the axis neural arches ossification centers and three on each one of the axis centra ossification centers were taken. We did simple and multiple linear regression analysis to estimate the age of fetuses. The results show that it is possible to use regression equations to estimate the fetal body length and age from atlas and axis ossification centers measurements during the whole period of development studied. The study of size and shape of the ossification centers using factorial analysis (principal component analysis) shows that the shape of the dens of the axis might be useful to estimate fetal viability.

Age Determination by Skeleton↗

Locked facets with fracture of the neural arch of the axis.

This report describes a rare variant represented by the association of locked facets at C2-3 with a fracture of the neural arch of the axis. Fracture of the neural arch of the axis is a broad term including the Hangman fracture, traumatic spondylolisthesis of the axis, fractures of the arch of the axis, or the more recently described fractures of the ring of the axis.

Axis, Cervical Vertebra↗

Acute axis fractures. Analysis of management and outcome in 340 consecutive cases.

STUDY DESIGN: Retrospective review of acute axis fractures treated at a tertiary referral center. OBJECTIVE: To determine the optimal treatment of axis fractures based on 340 cases from a single institution. SUMMARY OF BACKGROUND DATA: Axis fractures account for almost 20% of acute cervical spine fractures. However, their management and the clinical criteria predictive of nonoperative failure remain unclear. METHODS: Admission imaging studies and clinical variables were obtained for 340 consecutive axis fracture patients. Fractures were classified as as odontoid Type I, II, or III with dena displacement on admission roentgenograms; hangman's fractures of Francis grade and Effendi type; and miscellaneous fractures. Treatment methods were documented, and outcomes were based on dynamic lateral roentgenograms, clinical examination, or telephone interviews at last follow-up. RESULTS: Follow-up data were available in 92% of cases. Type II odontoid fractures comprised 35% of all axis fractures, were the most difficult to treat, and had the highest nonunion rate (28.4%). Odontoid displacement of 6 mm or more was associated with Type II nonunion (chi-square = 33.74, P < 0.0001). Patients underwent surgical fusion if fracture alignment could not be maintained by an external orthosis, or if they had odontoid fractures with transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm, or hangman's fractures of severe Francis grade or Effendi type. CONCLUSIONS: Type II odontoid fractures have the highest nonunion rate and were associated with dens displacement of 6 mm or greater. Early surgical fusion is recommended for acute fracture instability despite external immobilization, transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm on admission, or severe Francis grade or Effendi-type hangman's fractures. Otherwise, nonoperative management is sufficient.

Adolescent↗

Structural heterogeneity within the axis: the main cause in the etiology of dens fractures. A histomorphometric analysis of 37 normal and osteoporotic autopsy cases.

Fractures of the odontoid process are potentially serious injuries; Type II and III fractures, as described by Anderson and D'Alonzo, are seen in the emergency room especially in young adolescents and individuals over 60 years of age. The etiology of these fractures is still controversial. Malunion and nonunion in both types of fractures are presumed to be due to insufficient external or internal fixation, but this theory has not been fully explained. To examine these issues, the authors expanded their prior studies of the anatomy of the axis. For histomorphometric analysis of cancellous and cortical bone, the axis was removed in 37 autopsies (26 normal and 11 osteoporotic cases) and sectioned in the sagittal plane to a thickness of 1 mm using a surface-stained block-grinding technique. The base of the dens is the region of least resistance for fractures because of its reduced trabecular bone volume, a poorer trabecular interconnection, and a cortical thickness one-third that of the axis. In all cases, trabeculae were disconnected from the trabecular lattice, and in 30%, microcallus formations were demonstrated in the base of the dens. A special filigree type of trabeculae in the base of the dens is often seen in patients with osteoporosis; microarchitectural differences of cancellous bone between the base of the dens and the other regions of the axis are also markedly increased. The authors infer from the data that the bone structure of the axis is responsible for the location, distribution, and frequency of fractures of the odontoid process in normal healthy bone and this frequency is greatly increased in individuals with osteoporosis. The deficiency of bone mass within the base also suggests a new explanation for the occurrence of nonunions, even after treatment of fractures of the base of the dens.

Adolescent↗

Quantitative anatomy of the lateral masses of the atlas and axis vertebrae.

The study was carried out to determine the safe site of entry and the appropriate trajectory of the screw implantation in the lateral masses of atlas (Cl) and axis (C2) during their fixation using the plate and screw technique. Fifty dried specimens of atlas and axis vertebrae were studied. Various dimensions of the lateral masses were quantitatively measured, laying stress on their relationship with the vertebral artery foramen. As the vertebral artery foramen was present entirely in the transverse process in all specimens, screw implantation in the facet of atlas was relatively safe. Best direction of screw implantation in the facet of atlas was observed to be 15 degrees medial to sagittal plane and 15 degrees superior to axial plane. It should be implanted from the middle of the posterior surface of facet. Vertebral artery foramen formed a deep groove in the undersurface of a majority of superior facets of axis. In 15% facets, vertebral artery foramen occupied the entire undersurface of the superior facet. Safe angle for screw implantation in the facet of axis through its pedicle was seen to be 40 degrees medial to sagittal plane and 20 degrees superior to axial plane. Safe site of screw entry in the axis was superior and medial third of the posterior surface of the pedicle. Quality of cancellous bone in the lateral masses in the proposed trajectory of screw in Cl and C2 was good, providing an excellent purchase of the screw.

Axis, Cervical Vertebra↗

[Atlanto-axial subluxation posssibly due to eosinophilic granuloma of the axis: a case report].

A 29-year-old male presented with symptoms of acute severe neck pain with no other neurological symptoms. He had noticed lymph node swelling with pain in his neck about 2 months before admission and had been treated by the transoral administration of antibiotics for about 10 days. His neck was protected with a neck collar and an evaluation of any possible neck lesion was performed. Plain X-ray film and CT scans of the cervical spine showed an anterior subluxation of the atlas and an anterior declination and erosion of the dens. The MRI findings showed long T1 and T2 values in many parts of the bone marrow of the body of the axis and the dens, and both the bone marrow and thickend soft tissue between the pharynx and the axis were slightly enhanced. Inflammatory disease, tuberculosis, rheumatoid arthritis, malignant lymphoma, and leukemia were all ruled out based on the laboratory data, Ga schintigrams and other examinations. Almost no changes in the lesion were observed on MRI at about 6 weeks after admission. As a result, we presumed that this lesion was not likely to be malignant, but might be some kind of granuloma, especially an eosinophilic granuloma. A laminectomy of the atlas and a resection of the posterior margin of the foramen magnum and upper portion of the lamina of the axis was performed to achieve decompression of the craniovertebral junction, and posterior fusion was performed with a rod betweeen the occipital bone and the C4 lamina. The rod was fixed with screws and wires to the occipital bone and with lamina hooks to the axis and C4 laminas. At 14 months postoperatively, the patient is doing well and the axis and the dens have been reconstructed without any need to resect the lesion, or perform either chemothrapy or radiotherapy. Our clinical findings of this case correlate with the opinion that an immobilization of the lesion is a sufficient treatment for many cases of eosinophilic granuloma. Although a biopsy or histological examination of the lesion was not performed, the clinical course of this case strongly suggests that this lesion was indeed an eosinophilic granuloma.

Adult↗

[Forms of fracture of the dens axis in the application of ventral flexion force].

In fracture experiments in 220 cast models of the axis and atlas, an attempt was made to separate two different factors influencing the position of the dens fracture (superior and inferior type): the direction of the force application and the inclination of the dens axis. For this purpose, two extreme forms of dens inclination in the sagittal plane were used, namely a form with a ventrally inclined axis (kyphotic form) and a dorsally oriented axis (lordotic form). The force was applied in ventral flexion in 11 single steps between 10 and 75 degrees. The fracture types occurring under natural conditions could be reproduced with this experimental paradigm. Depending on the direction of the force application, both types of dens fracture occurred in ventral flexing traction alone. Independent of the inclination of the dens axis, this ventral flexion led to an inferior fracture type with a shallow angle, and a superior fraction type with a steep angle. With 75 degrees flexion, no longer the dens fracture, but the Hangman's fracture was the usual fracture type in both dens forms. With fundamental agreement of both dens forms with regard to the direction-dependent genesis of the fracture pattern, the lordotic dens and kyphotic dens displayed differences in the details which are discussed exhaustively. In this connection, the differences in the size of the horizontal thrust component due to the primary form of the dens with the same direction of force application is pointed out. According to the present investigations, a classification of dens fractures should be made more precise by specification of the dens form.

Axis, Cervical Vertebra↗

[Radiologic description of the growth plates of the atlas and axis in foals].

Fractures of the first two cervical vertebrae, atlas and axis, may occur in foals for different reasons, e.g. in cases of a fall, going head over heels or when being hit by a hoof. The tentative clinical diagnosis can be confirmed by x-raying the standing animal, with aid of computed tomography in the anaesthetized foal respectively. The growth plates however, and their time of closure have to be considered when interpreting radiographs. In the atlas there are two ventrolateral plates and one dorsomedian cartilagineous plate. Only the dorsal plate, however, can be found in the dorsoventral projection up to an age of about 12 months. The ventrolateral growth plates which have closed at about six months of age cannot be seen in either ther dorsoventral or laterolateral projection. In transversely oriented CT-scans all of the three centres of ossification can easily be made visible in the atlas. In the axis the cartilagineous gaps between the dens axis and the cranial epiphysis as well as the cranial and caudal epiphyseal growth plate can be shown in normal x-radiographs in both planes of projection. Besides this there are growth plates between the corpus vertebrae and the arcus vertebrae in the axis which cannot be seen in either radiographic projection. They become clearly visible in transversal CT-scans and are ossified at the age of three to four months. At the end of the first year the growth plates between the dens axis and the cranial epiphysis have closed. The cranial and caudal epiphyseal plate are gone at an age of about four to five years.

Animals↗