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The use of computerized videokeratography as an aid in fitting rigid gas permeable contact lenses.

PURPOSE: To assess the efficacy of computerized corneal topography in (1) fitting cosmetic rigid gas permeable contact lenses on normal corneas and (2) patients who have keratoconus. METHODS: In study 1, 26 patients were fitted with cosmetic contact lenses. In 13 patients, the first rigid gas permeable lens was chosen on the basis of corneal topography using the EyeSys videokeratoscope and contact lens software version 2.11w. Thirteen control patients were fitted with rigid gas permeable contact lenses by means of diagnostic contact lenses. The number of parameter changes required in each group to reach the best fit were compared. In study 2, the records of 28 patients (41 eyes) with keratoconus who had been successfully fit with rigid gas permeable lenses were reviewed. Topographic analysis using the EyeSys videokeratoscope was conducted. The following 8 data points were analyzed: maximum dioptric curvature with respect to the central visual axis, the power at the visual axis (VK), the average keratometry readings within the 3-mm zone, the average flat K at 3-mm central and 5-mm paracentral regions, and the K reading at 1.5, 2.0, and 2.5 mm superior to the visual axis. RESULTS: Study 1: In 10 eyes (38%) fitted with cosmetic contact lenses utilizing corneal topography and the EyeSys contact lens program, the first lens chosen by the computer program was correct with no additional changes in lens parameters required. In the other 16 eyes, 21 parameter changes were required. In the control group, 14 eyes (53%) required no additional change in parameters from the original contact lens that was fitted using diagnostic lenses. In the other 12 eyes, 12 parameter changes were required. Study 2: In the keratoconus group, of the 9 measurements analyzed, the final base curve of patients' rigid gas permeable lenses was correlated most closely with the average flat corneal curvature at the 3-mm central zone. CONCLUSION: Study 1: In fitting cosmetic rigid gas permeable contact lenses, the videokeratoscope with the EyeSys software 2.11w contact lens program proved to be inferior to diagnostic lenses in selecting the final correct contact lens parameters. However, it may be useful in selecting an initial diagnostic lens with which to begin rigid gas permeable fitting. Study 2: In patients with irregular corneas such as keratoconus, corneal topography is helpful in determining the initial base curve of the contact lens. In patients with keratoconus, it appears to be the average flat corneal curvature at the 3.0-mm zone.

Contact Lenses↗

Stent-induced intimal hyperplasia: are there fundamental differences between flexible and rigid stent designs?

PURPOSE: To evaluate possible differences in neointimal development resulting from overdilation of rigid versus flexible vascular stents. MATERIALS AND METHODS: Twelve vascular sheaths were placed bilaterally through femoral arteries in six swine. After angiographic measurement, 12 stents (six flexible and six rigid) were balloon expanded to 8-mm diameters in 12 6-mm iliac arteries (approximately 30% overdilation). All stents were similar in surface area, gauge, and type of wire (tantalum). The primary difference was longitudinal flexibility (low hoop strength) versus rigidity (high hoop strength). Stents were studied with angiography and intravascular ultrasound 5 weeks after implantation. The animals were killed, and the stented segments were removed and examined histologically. RESULTS: Rigid stents maintained larger diameters than flexible stents: mean, 6.52 mm versus 5.82 mm (mean difference, 0.70; standard deviation [SD], 0.47; confidence interval [CI], +/- 0.49; P < .05). In addition, rigid stents developed a thicker, eccentric neointimal reaction relative to flexible stents: mean 1.08 mm versus 0.74 mm (mean difference, 0.338; SD, 0.315; CI, +/- 0.331; P < .05). CONCLUSION: Rigid stents maintain larger diameters over the long term relative to flexible stents when overdilated in normal swine arteries. However, a thicker neointima develops within the lumen of rigid stents at follow-up (greater late loss).

Animals↗

Transdermal delivery of pergolide from surfactant-based elastic and rigid vesicles: characterization and in vitro transport studies.

PURPOSE: The aim of this study was to investigate the effect of elastic and rigid vesicles on the penetration of pergolide across human skin. METHODS: Vesicles used consisted of the bilayer-forming surfactant L-595 (sucrose laurate ester) and the micelle-forming surfactant PEG-8-L (octaoxyethylene laurate ester), together with the stabilizer sulfosuccinate. A series of L-595/PEG-8-L/sulfosuccinate vesicles were investigated, ranging from very rigid to very elastic. Pergolide-loaded elastic and rigid vesicles were visualized using Cryo-TEM and characterized for size and stability. Transdermal penetration of pergolide from different vesicle compositions was studied in vitro using flow-through Franz diffusion cells. A saturated buffer solution served as the control. RESULTS: Vesicle composition had a major effect on the physicochemical characteristics, morphology and drug solubility of the vesicular system. L-595/PEG-8-L/sulfosuccinate (70/30/5) elastic vesicles gave the best balance between vesicle stability and elasticity, as well as the highest drug solubility. Transport studies clearly showed that elastic vesicles were superior to rigid vesicles. Elastic vesicles enhanced the drug transport compared to the buffer control, although rigid vesicles decreased the drug transport. The best drug transport was achieved from L-595/PEG-8-L/sulfosuccinate (70/30/5) elastic vesicles, resulting in a steady-state flux of 13.6 +/- 2.3 ng/ (h*cm2). This was a 6.2-fold increase compared to the most rigid vesicles. CONCLUSIONS: This study supports the hypothesis that elastic vesicles are superior to rigid vesicles as vehicles for transdermal drug delivery.

Administration, Cutaneous↗

Normal hemodynamic parameters do not always predict the presence of a rigid erection: a quantitative assessment of functional erectile impairment.

The purpose was to assess objectively and quantitatively the hemodynamic status and the degree of functional erectile impairment in a group of impotent patients. A clinical study was designed, incorporating pharmacocavernosometry (to evaluate arterial and veno-occlusive function) with axial buckling forces and penile geometry measurements in a group of impotent patients. The pressure gradient between the intracavernosal pressure associated with the presence of penile axial rigidity and the equilibrium intracavernosal pressure was calculated (axial rigidity gradient, ARG); such methodology allowed a quantitative characterization of functional impairment, as ARG expresses the intracavernosal pressure increase necessary to achieve axial rigidity and therefore potency. Penile geometry characteristics were also expressed by calculating the penile aspect ratio (diameter/length, D/L). In 83 consecutive patients tested (mean age 42.89+/-9.96), rigidity occurred at intracavernosal pressures between 50 and 100 mm Hg. A conversely proportional relation was noticed between penile aspect ratio values and the intracavernosal pressure associated with rigidity values, clearly demonstrating the important functional role of penile geometry. ARG demonstrated a wide range of values (3-69 mm Hg), reflective of the severity of the erectile dysfunction on each patient. Half (50.6%) of the patients had ARG values < or =20 mm Hg, indicative of minimal and minimal-to-moderate erectile impairment, while 20.48% had ARG between 21-30 and 28.92% >30 mm Hg, indicative of moderate and severe erectile dysfunction (ED) respectively. In all, 6% of the study group, all of them with primary ED, ARG <20 mm Hg had normal hemodynamics, but low penile aspect ratio values indicating that penile geometry may be the cause of insufficient rigidity. Hemodynamic integrity is the most critical, but not the only determinant of penile rigidity, as erectile impairment may be noticed in patients with normal arterial inflow and corporal veno-occlusive function. In such cases, unfavorable penile geometry should be considered as the possible etiological factor of impotence.

Adult↗

Skeletal stability after mandibular advancement with rigid versus wire fixation.

PURPOSE: This study examined the stability of skeletal changes after mandibular advancement surgery with rigid or wire fixation up to 2 years postoperatively. PATIENTS AND METHODS: Subjects for this multisite, prospective, clinical trial received rigid (n = 78) or wire (n = 49) fixation. The rigid cases were fixed with three 2-mm bicortical position screws and 1 to 2 weeks of skeletal maxillomandibular fixation with elastics, and the wire fixation subjects were fixed with inferior border wires and had 6 weeks of skeletal maxillomandibular fixation with 24-gauge wires. Cephalometric radiographs were obtained before orthodontics, immediately before surgery, and at 1 week, 8 weeks, 6 months, 1 year, and 2 years after surgery. Linear cephalometric changes were referenced to a cranial base coordinate system. RESULTS: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean anterior sagittal advancement of the mandibular symphysis was 4.92 +/3.01 mm in the rigid group and 5.11 +/- 3.09 mm in the wire group, and the inferior vertical displacement was 3.37 +/- 2.44 in the rigid group and 2.85 +/- 1.78 in the wire group. The vertical changes were similar in both groups. Two years postsurgery, the wire group had 30% sagittal relapse of the mandibular symphysis, whereas there was no change in the rigid group (P < .001). Both groups experienced changes in the orientation and configuration of the mandible. CONCLUSIONS: Rigid fixation is a more stable method than wire fixation for maintaining mandibular advancement after sagittal split ramus osteotomy.

Adult↗

Coherence and motion transparency in rigid and nonrigid plaids.

Under a wide range of conditions, stimuli composed of two superimposed grating components with unequal rotation velocities (differing in sign and/or magnitude) gave a striking percept of a single, coherent, nonrigidly deforming plaid surface. Conversely, component angular velocities of the same sign and magnitude yielded rigidly rotating plaids. Rigidity and motion coherence were shown to be independent percepts, and coherent plaids were categorised unambiguously as rigid or nonrigid. Coherence and motion transparency were found to depend upon the relative orientation of components, and polar plots showed two lobes of high coherence for narrow intercomponent angles. There was a slight tendency for plaids with unequal component rotations to appear less coherent, but this was nonsignificant, once the effect of intercomponent angle was taken into account. Changes in the relative spatial frequency of components, relative contrast of components, and repeated presentation produced equivalent effects on coherence for rigid and nonrigid types of plaid motion. Manipulation of the terminators in the display by making the aperture diameters for the two component gratings unequal reduced coherence and increased transparency. The effect was the same for rigid and nonrigid plaids. Coherence in rigid and nonrigid plaids thus depends primarily on local processes and there is no strong interaction between rigidity and coherence.

Humans↗

Flexural rigidity of microtubules and actin filaments measured from thermal fluctuations in shape.

Microtubules are long, proteinaceous filaments that perform structural functions in eukaryotic cells by defining cellular shape and serving as tracks for intracellular motor proteins. We report the first accurate measurements of the flexural rigidity of microtubules. By analyzing the thermally driven fluctuations in their shape, we estimated the mean flexural rigidity of taxol-stabilized microtubules to be 2.2 x 10(-23) Nm2 (with 6.4% uncertainty) for seven unlabeled microtubules and 2.1 x 10(-23) Nm2 (with 4.7% uncertainty) for eight rhodamine-labeled microtubules. These values are similar to earlier, less precise estimates of microtubule bending stiffness obtained by modeling flagellar motion. A similar analysis on seven rhodamine-phalloidin-labeled actin filaments gave a flexural rigidity of 7.3 x 10(-26) Nm2 (with 6% uncertainty), consistent with previously reported results. The flexural rigidity of these microtubules corresponds to a persistence length of 5,200 microns showing that a microtubule is rigid over cellular dimensions. By contrast, the persistence length of an actin filament is only approximately 17.7 microns, perhaps explaining why actin filaments within cells are usually cross-linked into bundles. The greater flexural rigidity of a microtubule compared to an actin filament mainly derives from the former's larger cross-section. If tubulin were homogeneous and isotropic, then the microtubule's Young's modulus would be approximately 1.2 GPa, similar to Plexiglas and rigid plastics. Microtubules are expected to be almost inextensible: the compliance of cells is due primarily to filament bending or sliding between filaments rather than the stretching of the filaments themselves.

Actin Cytoskeleton↗

Rigidity of microtubules is increased by stabilizing agents.

Microtubules are rigid polymers that contribute to the static mechanical properties of cells. Because microtubules are dynamic structures whose polymerization is regulated during changes in cell shape, we have asked whether the mechanical properties of microtubules might also be modulated. We measured the flexural rigidity, or bending stiffness, of individual microtubules under a number of different conditions that affect the stability of microtubules against depolymerization. The flexural rigidity of microtubules polymerized with the slowly hydrolyzable nucleotide analogue guanylyl-(alpha, beta)-methylene-diphosphonate was 62 +/- 9 x 10(-24) Nm2 (weighted mean +/- SEM); that of microtubules stabilized with tau protein was 34 +/- 3 x 10(-24) Nm2; and that of microtubules stabilized with the antimitotic drug taxol was 32 +/- 2 x 10(-24) Nm2. For comparison, microtubules that were capped to prevent depolymerization, but were not otherwise stabilized, had a flexural rigidity of 26 +/- 2 x 10(-24) Nm2. Decreasing the temperature from 37 degrees C to approximately 25 degrees C, a condition that makes microtubules less stable, decreased the stiffness of taxol-stabilized microtubules by one-third. We thus find that the more stable a microtubule, the higher its flexural rigidity. This raises the possibility that microtubule rigidity may be regulated in vivo. In addition, the high rigidity of an unstabilized, GDP-containing microtubule suggests that a large amount of energy could be stored as mechanical strain energy in the protein lattice for subsequent force generation during microtubule depolymerization.

Animals↗

The effect of rigidity, shape, unsaturation, and length on the anesthetic potency of hydrocarbons.

We previously hypothesized that anesthesia results from an action on two sites separated by 5 A. The hypothesis relied on the finding that fluorinated alkanes having active anesthetic sites at each end of the molecule produce anesthesia as long as the total number of carbon atoms in their structure does not exceed five (i.e., approximately 5 A), and on the sustaining of the 5-A separation by the rigidity produced by fluorination. In this study, we tested an alternative hypothesis: that the site of action cannot accommodate a rigid compound, particularly a rectilinear compound, having more than five carbon atoms, and that rigidity itself might limit the anesthetic potency of larger compounds. We tested the anesthetic potency of 11 hydrocarbons in which rigidity was increased by unsaturation. In 72 rats exposed to such compounds, we found that unsaturation, rigidity, or both produced by unsaturation either did not change (double bonds) or increased (triple bonds) potency for a given number of carbon atoms. For example, we found that the rectilinear, rigid 2,4-trans-trans-hexadiene was no less potent (minimum alveolar anesthetic concentration [MAC] 0.042 +/- 0.002 atm; mean +/- SD) than the flexible 1,5-hexadiene (0.047 +/- 0.005 atm) or n-hexane (0.0467 +/- 0.0055 atm) and that 3-hexyne was more potent (MAC 0.0146 +/- 0.0014 atm) than n-hexane (MAC 0.0467 +/- 0.0055 atm). We conclude that the site of anesthetic action can accommodate straight rigid structures of up to six carbons in length.

Anesthesia, Inhalation↗

Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants.

OBJECTIVE: To assess the occurrence of muscle rigidity after fentanyl administration in premature and term neonates. DESIGN: Prospective case series, observational study. SETTING: A university hospital neonatal intensive care unit. PATIENTS: 8/89 preterm and term infants (25-40 wks gestational age) who received fentanyl for perioperative analgesia and sedation or intensive care procedures. INTERVENTIONS: Mechanical or bag mask ventilation and antagonization with naloxone. MEASUREMENTS AND MAIN RESULTS: We observed chest wall rigidity in 8 patients after low dosage of fentanyl (3-5 microg/kg body weight). All patients presented with respiratory distress, hypercapnia, and hypoxemia leading to bradycardia. In two patients, laryngospasm was noted and associated with muscle rigidity, thus making intubation impossible. Naloxone (20-40 microg/kg body weight) reversed the laryngospasm and muscle rigidity immediately, allowing restitution within 1 min. In our patient population, we found fentanyl-induced chest wall rigidity in 4% of neonates after fentanyl administration. CONCLUSION: Even low doses of fentanyl can lead to thoracic rigidity in neonates. Additionally, we observed laryngospasm in two patients and speculate that it might be a variant of muscle rigidity.

Fentanyl↗

The effect of pin location on the rigidity of the halo pin-bone interface.

Optimal insertion of halo fixation pins to maximize the rigidity of the interface between the halo pins and the outer table of the skull is important in reducing the incidence of pin loosening. An in vitro biomechanical study was performed using cadaver skulls to investigate the effects of pin location on the rigidity of this pin-bone interface. Halo pins were inserted at nine positions within a recommended "safe zone" for pin insertion. It was found that the rigidity of the pin-bone interface progressively decreased as pins were inserted more superiorly on the calvaria. The rigidity of the interface did not change significantly when the location of the pins was varied in the horizontal axis. This reduction in interface rigidity associated with inserting pins more superiorly on the skull may be related to an increase in the angle of insertion of the pins with respect to the surface of the calvaria. Based on this study, a change in the technique of halo pin insertion is recommended. Pins should be placed as inferiorly as possible, close to the supraorbital ridge, to achieve the most perpendicular angle of insertion and thus the most rigid fixation. The improved rigidity obtained with perpendicular pin insertion may minimize the rate of pin loosening and other complications associated with use of the halo orthosis.

Biomechanical Phenomena↗

Effect of rigid gas permeable lens flexure on vision.

The flexure of spherical rigid lenses (various materials) and a soft lens was measured using automated over-keratometry on 6 adapted rigid lens wearers (12 eyes) whose corneal toricity ranged from 1.37 to 3.87 D. The results showed: (1) that there was no significant difference in flexure between polymethyl methacrylate (PMMA), silicone acrylate, and the fluorosilicone acrylate lenses (whose Dks ranged from 0 to 115). However, Advent (fluoropolymer) did flex significantly more than the other rigid lenses, and significantly less than the soft lens (Bausch & Lomb U4) and (2) that lens flexure of the rigid lenses did not alter over a 2-h period. We also measured high and low contrast visual acuity (HCVA and LCVA), and the results from subjects wearing Advent and the soft lens were significantly worse than with the other rigid lenses. Finally, the results of this study showed no correlation between rigid lens flexure and permeability and between rigid lens flexure and visual acuity when Advent was excluded from the linear regression analysis.

Adult↗

Patient preferences and comparative ocular responses to rigid and soft contact lenses.

Patient preferences and ocular responses were compared between rigid and soft contact lenses by randomly fitting 32 neophyte subjects with a rigid lens in 1 eye and a soft lens in the contralateral eye. Twenty-seven of 32 subjects completed the 3-month study and 16 subjects were willing to continue for an additional 3-month extension. Subjects preferred the comfort and handling of the soft lens but preferred the vision provided by the rigid lens and initially its ease of maintenance. There was also a marked preference for the soft lens when all aspects of lens wear were compared. Objectively, the rigid lenses were responsible for more ocular changes than the soft lenses. Palpebral aperture sizes of the rigid gas permeable (RGP) wearing eyes decreased significantly (0.5 mm; p < 0.05) compared to the soft lens wearing eyes. The incidence of corneal staining was significantly greater in the rigid lens wearing eye (50% RGP vs. 22% soft) but limbal injection was greater in the soft lens wearing eye (18% soft vs. 6% RGP). Refractive sphere, cylinder, and corneal astigmatism decreased in the rigid lens wearing eye after 3 months. This daily wear clinical trial has shown a marked subjective preference for wearing soft lenses with fewer short-term ocular effects.

Adult↗

Variables affecting rigid contact lens comfort in the collaborative longitudinal evaluation of keratoconus (CLEK) study.

PURPOSE: To identify factors associated with rigid contact lens comfort in keratoconus. METHODS: Baseline data from the 16 Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study clinical sites were analyzed for all patients wearing a rigid contact lens in their more severely keratoconic eye (as determined by steep keratometry). Corneal transplant patients, patients who did not wear a rigid contact lens in either eye, patients who did not wear a rigid lens in their worse eye, and patients with missing contact lens comfort data were excluded from the sample. A total of 751 eyes were included. Variables assessed included measures of disease severity, visual acuity through the patients' habitual rigid contact lenses, contact lens wearing time, the apical fitting relationship of the contact lens, the degree of peripheral clearance, and the presence of corneal scarring and staining. Comfort was measured by asking the patients "In general, how comfortable are your contact lenses?" (1 = very comfortable through 5 = very irritating). RESULTS: Measures of disease severity (steep keratometry and the first definite apical clearance lens) were not associated with lens comfort. There was no difference in self-reported contact lens comfort between patients fitted with apical touch vs. apical clearance. Patients with a peripheral clearance rating of "minimal unacceptable" (more common among patients with milder keratoconus) were approximately half as likely to report good contact lens comfort compared with patients with "average" peripheral clearance (unadjusted odds ratio, 0.39; 95% confidence interval, 0.19 to 0.79). There was no association between contact lens comfort and the other peripheral clearance ratings compared with ratings of average. CONCLUSIONS: There does not appear to be an association between decreasing patient-reported rigid lens comfort and increasing disease severity as measured by steep keratometry or first definite apical clearance lens in this sample. The apical fitting relationship (flat vs. steep) does not appear to be associated with patient-reported comfort. Minimal peripheral clearance may contribute to decreased rigid contact lens comfort in keratoconus.

Adult↗

Torsional rigidity of scoliosis constructs.

STUDY DESIGN: A biomechanical study of the rigidity of various scoliosis constructs instrumented with and without caudal pedicle screw anchors and with none, one, or two cross-link devices. OBJECTIVES: To determine whether the increased torsional rigidity provided by distal pedicle screw fixation might make cross-linking unnecessary. SUMMARY OF BACKGROUND DATA: Pedicle screws and cross-linking devices have been shown to increase the structural rigidity of spinal constructs. Their relative contributions to scoliosis construct rigidity has not been determined. METHODS: "Short" (T2-T11) and "long" (T2-L3) scoliosis constructs were mounted on an industrially fabricated spine model and tested in a hydraulic testing machine. Four different short and four different long constructs were tested: hooks only, hooks with concave side thoracic sublaminar wires, hooks with distal pedicle screw anchors, and hooks, distal pedicle screw anchors, and concave thoracic sublaminar wires. There were four iterations for each construct tested: no cross-links, one superior cross-link at T4-T5, one inferior cross-link at T9-T10, and two cross-links. Torsional rigidity was tested by applying a rotational torque at T2. Vertebral body motion was recorded with a three-dimensional video analysis system. RESULTS: Constructs with distal pedicle screws were statistically more rigid in torsion than those with hooks as distal anchors. The additional torsional rigidity from one or more cross-links was negligible compared with that provided by pedicle screws. CONCLUSIONS: With pedicle screws as distal anchors in scoliosis constructs, cross-linking with one or two devices adds very little additional rotational stiffness and may be unnecessary in many cases.

Bone Screws↗

Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation?

STUDY DESIGN: A review of 66 consecutive patients at a single institution who underwent one-level anterior cervical discectomy and fusion (ACDF) with rigid anterior plate fixation with allograft or autograft. OBJECTIVES: To address the efficacy of allograft to autograft with primary respect to fusion rate and secondary attention to risk factors and clinical outcome in patients undergoing one-level ACDF with rigid anterior plate fixation. SUMMARY OF BACKGROUND DATA: Although autograft is considered the gold standard in achieving optimal fusion, when compared with allograft in noninstrumented one-level ACDF and in plated and nonplated multilevel ACDF, the efficacy of allograft to autograft in one-level ACDF with rigid anterior plate fixation is not thoroughly understood. METHODS: Sixty-six consecutive patients (mean age, 45 years) at a single institution who underwent one-level ACDF with rigid anterior plate fixation with allograft (n = 35) or autograft (n = 31) were reviewed for radiographic fusion (mean, 12 months), risk factors, and clinical outcome (mean, 17 months). Smokers entailed 33.3% of the patients, and 45.5% of all patients presented with a work-related injury. An independent blinded observer reviewed at last follow-up lateral neutral and flexion/extension plain radiographs for radiographic fusion and instrumentation integrity. Clinical outcome was assessed on last follow-up and rated according to the Odom criteria. The threshold for statistical significance was established at P < 0.05. RESULTS: Solid fusion was achieved in 63 patients (95.5%). Fusion was noted in 100% of the allograft patients, whereas 90.3% of the autograft cases achieved fusion. No statistically significant difference was noted between allograft to autograft with regard to fusion rate (P > 0.05). Three patients developed nonunions (1 smoker; 2 nonsmokers) and entailed Orion instrumentation. In the one patient who was a nonsmoker with a nonunion, slight screw penetration into the involved and uninvolved interbody spaces was noted. No other intraoperative, postoperative, or radiographic complication was noted. All of the nonunions occurred early in the series. Postoperatively, excellent results were reported in 19.7%, good results in 71.2%, and fair results in 9.1% of the patients. Satisfactory clinical outcome was noted in all nonunion patients. A nonstatistically significant difference was noted with regard to clinical outcome of fused and nonfused patients, demographics, and the presence of a work-related injury (P > 0.05). The impact of smoking was not a factor influencing fusion or clinical outcome in this series (P > 0.05). A statistically significant difference was noted in plate-type on fusion rate (P < 0.05). CONCLUSION: A 100% and 90.3% radiographic fusion rate was obtained for allograft and autograft in one-level ACDF procedures with rigid anterior plate fixation, respectively. Although autograft achieved a higher incidence of nonunion than allograft, this may be attributed to the use of autograft early in the experience of plate application and fixation in this series. The effects of smoking were not found to be a significant factor influencing fusion in these plated patients. In 90.9% of the patients, excellent and good clinical outcome results were reported. The use of allograft in one-level ACDF with rigid plate fixation yields similar and high fusion rates as autograft. The use of allograft bone eliminates complications and pitfalls associated with autologous donor site harvesting. However, the use of autograft is a viable alternative to avoid the risk of infection, disease transmission, and histocompatibility differences associated with allograft. The use of allograft or autograft bone in properly selected patients for one-level ACDF with rigid anterior plate fixation can result in high fusion rates with excellent and good clinical outcomes.

Adult↗

Molecular Rigidity in Dry and Hydrated Onion Cell Walls.

Solid-state nuclear magnetic resonance relaxation experiments can provide information on the rigidity of individual molecules within a complex structure such as a cell wall, and thus show how each polymer can potentially contribute to the rigidity of the whole structure. We measured the proton magnetic relaxation parameters T2 (spin-spin) and T1p (spin-lattice) through the 13C-nuclear magnetic resonance spectra of dry and hydrated cell walls from onion (Allium cepa L.) bulbs. Dry cell walls behaved as rigid solids. The form of their T2 decay curves varied on a continuum between Gaussian, as in crystalline solids, and exponential, as in more mobile materials. The degree of molecular mobility that could be inferred from the T2 and T1p decay patterns was consistent with a crystalline state for cellulose and a glassy state for dry pectins. The theory of composite materials may be applied to explain the rigidity of dry onion cell walls in terms of their components. Hydration made little difference to the rigidity of cellulose and most of the xyloglucan shared this rigidity, but the pectic fraction became much more mobile. Therefore, the cellulose/xyloglucan microfibrils behaved as solid rods, and the most significant physical distinction within the hydrated cell wall was between the microfibrils and the predominantly pectic matrix. A minor xyloglucan fraction was much more mobile than the microfibrils and probably corresponded to cross-links between them. Away from the microfibrils, pectins expanded upon hydration into a nonhomogeneous, but much softer, almost-liquid gel. These data are consistent with a model for the stress-bearing hydrated cell wall in which pectins provide limited stiffness across the thickness of the wall, whereas the cross-linked microfibril network provides much greater rigidity in other directions.

Journal Article↗

Ocular rigidity and intraocular pressure in keratoconus.

Eighty-five patients with keratoconus and 20 normal controls were studied. Ocular rigidity, calculated using the Friedenwald nomogram, correlated with corneal thinning (p less than 0.001) and area of cone (p = 0.05). Schiøtz pressures with increasing weights fell more than normal in Grades 0 to 3 keratoconus, but returned to normal following corneal grafting, as did ocular rigidity. Goldmann applanation pressures were low over the apex of the cone, varying most in eyes with lowest ocular rigidity and with greatest corneal thinning, but also in large sagging cones which had only minimal corneal thinning. Pressures by Mackay-Marg tonometry were normal in keratoconus. The axial length of eyes with keratoconus even after corneal grafting was longer than normal and correlated with myopia. It is concluded that abnormalities of ocular rigidity, Schiøtz and Goldmann pressures in keratoconus are determined by abnormal corneal rigidity. If corneal rigidity is low or corneal thinning is present, Goldmann applanation pressures are falsely low and Mackay-Marg tonometry more closely approximates the true intraocular pressure. The cone develops by stretching with limited loss of tissue and the lower rigidity and reduced apical stress decrease the likelihood of rupture.

Adolescent↗