Newborns diagnosed with hip dysplasia face severe consequences when treatments fail. The Pavlik harness presents the most common worldwide treatment for correcting this medical hip abnormality in newborns, but becomes increasingly ineffective as subluxation increases. A dynamic finite element analysis on the hip joint would yield results that could provide insight to physicians as to how the Pavlik harness could be optimized to increase its success rate and develop patient-specific treatment plans. The study completes the first step in such an analysis by generating a three-dimensional model of an infant hip joint directly derived from computed tomography imaging in order to accurately represent the anatomical locations of muscle origins and insertions points as well as the unique cartilaginous characteristics of a neonate hip and femur. Such models will further enhance findings on the biomechanics of hip dysplasia that resulted from a preliminary study using computer-aided design to recreate the hip joint. In addition to the models, the orientation of the psoas tendon in a dysplastic hip through full range abduction and flexion was analyzed using a cadaveric dissection. It was determined that the psoas tendon was not an obstruction to reduction when the hip was in flexion so long as the tendon was not adherent to the hip capsule, and therefore can be disregarded in a finite element analysis or dynamic simulation that introduces flexion. The work of this thesis will lay the foundation for complex finite element analyses regarding the biomechanics of hip dysplasia in neonates as well as other hip abnormalities relevant to early child development.

This paper describes how a force response equation was created to model muscles, tendons, and ligaments of the hip joint to improve a biomechanical model of an infant hip to study Developmental Dysplasia of the Hip (DDH). DDH is the most common abnormality in newborn infants and is defined as any amount of instability in the hip including complete dislocation. Researchers at our institution are attempting to increase the success rate of treatment methods by creating computer models of the biomechanics of infant hip instability and dislocation. The computer model used a scaled adult pelvis, femur, tibia, fibula and foot to match the size of an infant for the bone geometry. The current infant muscle model is an undifferentiated model based on the area of a single infant muscle, for all muscles modeled. This muscle model was able to provide some insight into the nature of the biomechanics. To improve the infant muscle model, a set of equations differentiated by muscle area was developed. The new set of equations uses a ratio of infant over adult muscle area of a single muscle to create a ratio that can be used to scale all adult muscle areas to infant areas. This model will be more physiologically accurate because it will be differentiated based on muscle area.

Hip dysplasia, also known as congenital dysplasia of the hip (CDH) or Developmental Dysplasia of the Hip (DDH), is a mal-alignment of the hip joint. Left untreated within the first nine months, DDH could lead to permanent disability. Luckily however, this condition is diagnosed at an early age and is usually treated without surgery through the use of the Pavlik harness. In this thesis, a 3D computational model and dynamic finite element analysis of the muscles and tissues involved in hip dysplasia and the mechanics of the Pavlik harness, as rendered by Dr. Alain J. Kassab’s research group in the College of Mechanical and Aerospace Engineering in the University of Central Florida over the past 3 years, were reviewed and discussed to evaluate the accuracy of the hip reduction mechanism. I examine the group’s usage of CT-based images to create accurate models of the bony structures, muscle tensions and roles that were generated using biomechanical analyses of maximal and passive strain, and the usage of adult and infant hips. Results, as produced by the group indicated that the effects and force contribution of the muscles studied are functions of severity of hip dislocation. Therefore, I discussed complications with real world-to-computational modeling with regards to structural systems and data interpretations. Although this design could be applied to more anatomical models and mechanistic analyses, more research would have to be completed to create more accurate models and results.

Developmental dysplasia of the hip (DDH) is a condition that involves the dislocation of the head of the femur in the acetabulum of the pelvic bone. Although it may not interfere with a child's range of motion during infancy, DDH can cause various effects over time such as joint pain, abnormal gait, and even paralysis. It is crucial to catch this phenomenon early on so that permanent disability is not introduced to the patient. In this study, an excitation device was used to send a broadband frequency signal through a hip joint simulated by a 3D printed bone apparatus consisting of a left femur and left pelvic bone. Accelerometers were used to sense the transmission of this signal through the bones tested. Variability was induced through different experiments in order to determine where the optimal frequency for detection of DDH would be. After variability was quantified for all of the nonconsecutive and consecutive trials, the excitation device was tested on a raw chicken quarter through the knee joint since this was very similar to the hip joint. Coherence, phase, and transfer function graphs were used to demonstrate the degree of variability, optimal frequencies for detection, and degree of signal transmission through the joints tested. The results from the 3D printed bone model showed that the height of accelerometer suspension, loosened coupling of sensors, and vertical alignment of the bone model apparatus affected the transfer function and phase graphs of the experiments while coherence stayed relatively the same. On the other hand, the results from the raw chicken model displayed similarities between graphs for little to no joint dislocation but the complete dislocation of the bone yielded significantly different graphs.

No description available.

by Lam Kuo. / Year shown on spine: 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 107-121). / Acknowledgments / List of Abbreviations / Summary / List of Contents / List of Tables / List of Figures / Chapter Chapter 1 --- Introduction and the objectives of the study --- p.1-6 / Chapter Chapter 2 --- Overviews of Bronchopulmonary Dysplasia (BPD) and bronchodilator therapy -- a literature review --- p.7-29 / Chapter 2.1 --- Overview of Bronchopulmonary Dysplasia (BPD) --- p.7-9 / Chapter 2.2. --- Bronchodilator therapy --- p.10-18 / Chapter 2.2.1 --- Therapeutic value on infants with Bronchiolitis / Chapter 2.2.2. --- Therapeutic value on infants with Bronchopulmonary Dysplasia (BPD) / Chapter 2.3. --- "Three modes of aerosol delivery devices --jet nebuliser , ultrasonic nebuliser and metered dose inhaler" --- p.18-29 / Chapter 2.3.1. --- Jet nebuliser / Chapter 2.3.2. --- Ultrasonic nebuliser / Chapter 2.3.3. --- Metered dose inhaler / Chapter 2.3.4. --- Comparison of the therapeutic efficiency between jet nebuliser， ultrasonic nebuliser and Metered dose inhaler / Chapter 2.3.4.a. --- Comparison of particle size / Chapter 2.3.4.b. --- Comparison of aerosol deposition / Chapter 2.3.4.c. --- Comparison of pulmonary function / Chapter Chapter 3 --- Pulmonary function test in neonates --a literature review --- p.30-40 / Chapter 3.1. --- Overview of pulmonary function test in neonates --- p.30 / Chapter 3.2. --- Assessment of pulmonary function test in neonates --- p.31-40 / Chapter 3.2.1. --- Pulmonary mechanics / Chapter 3.2.1.a. --- Lung compliance / Chapter 3.2.1.b. --- Airway resistance / Chapter 3.2.1.c. --- Functional residual capacity (FRC) / Chapter Chapter 4 --- Subjects and methods --- p.41-48 / Chapter 4.1. --- Subjects --- p.41-42 / Chapter 4.2. --- Methods --- p.42-48 / Chapter 4.2.1. --- Delivery of Salbutamol aerosol / Chapter 4.2.1.1. --- Spontaneously breathing non-ventilated infants (group 1) / Chapter 4.2.1.2. --- Ventilator-dependent infants (group 2) / Chapter 4.2.2. --- Monitoring the clinical parameters / Chapter 4.2.3. --- Measurement of pulmonary function / Chapter 4.2.4. --- Statistics / Chapter Chapter 5 --- Results --- p.49-53 / Chapter 5.1. --- Clinical parameters --- p.50-51 / Chapter 5.2. --- Pulmonary function tests --- p.51-53 / Chapter Chapter 6 --- Discussion --- p.54-61 / Chapter 6.1. --- Non-ventilated group --- p.55-58 / Chapter 6.2. --- Ventilated group --- p.58-61 / Chapter Chapter 7 --- Conclusion --- p.62-63 / Tables and Figures / References

Magister Scientiae Dentium - MSc(Dent) / Oral epithelial dysplasia (OED) is a growth anomaly which occurs as a result of atypical, abnormal proliferation and a change in the architecture and cytological features of cells of epithelial origin, which ultimately results in the formation of a lesion with disturbed differentiation and maturation The purpose of this study was to describe the OED cases diagnosed at Tygerberg Oral health centre in a 7-year period between 2012 and 2019. The patients’ medical records from Tygerberg Oral Health Centre and National Health Laboratory Service (NHLS) were reviewed. All diagnosed cases of OED were identified and the data retrieved for further assessment and comparison. The individual medical records and follow up data were assessed. Seventy cases of OED were diagnosed in the period assessed. Of those 70 cases, the median age was 58 and the interquartile range was from 48 – 62. Thirty-six of the diagnosed patients were female and thirty-four were males. The majority of lesions diagnosed with OED were found on the tongue, floor of the mouth (FOM) and buccal mucosa. Majority of the lesions were found in non-smokers and non-alcohol consumers. These two categories both presented with mild cases of OED. From the results, it was derived that OED has no intra-oral location predilection. Moreover, OED is not directly associated with smoking.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21618号 / 医博第4424号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 大森 孝一, 教授 松田 秀一, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The most frequent sequelae following an obstetric brachial plexus lesion without complete functional recovery concern the impaired shoulder rotation movements and the associated structural changes of the growing glenohumeral joint. <p>This pathology is often unrecognized and may lead to a limitation in active movements, a pathologic and less efficient motion pattern in the affected limb, and the development of a severely incongruent and dysplastic glenohumeral joint prone to further arthrosis.<p><p>Hypothesis<p><p>Glenohumeral dysplasia after obstetric brachial plexus lesion has multiple etiologies: A hypothetic obstetric trauma may precede the motor imbalance, due to the initial palsy and prevalent recovery of the medial rotators of the shoulder.<p>The correction of the muscular imbalance, by neurotization of the lateral rotators (supra- and infraspinatus muscle) using a local nerve transfer or by a later muscle transfer surgery, improves function, seems to prevent the development of joint dysplasia and limits the articular deformities once they are present. <p>The early (peripartal) glenohumeral subluxation must be recognized and treated immediately to prevent the development of a severe joint contracture and dysplasia.<p> <p>Material and methods<p><p>Two retrospective and one prospective study evaluate how surgery may correct the muscular imbalance.<p>In a first series of 65 children, we analyse the recovery of the supra- and infraspinatus muscle after a nerve transfer onto the suprascapular nerve.<p>In a second retrospective analysis on 114 children, we study the outcome after secondary surgery (anterior joint release, modified Hoffer muscle transfer) dedicated to improve active and passive lateral rotation of the shoulder.<p>A prospective study of 50 magnetic resonance (MRI) scans of the glenohumeral joint describes the articular deformities.<p>Finally, 10 children presenting a very early glenohumeral subluxation have undergone a closed orthopaedic reposition and plaster immobilisation and were followed for a minimum of 2 years.<p><p>Results<p><p>In the first group, neurotization of the suprascapular nerve has been performed either by a dorsal or a ventral approach at a mean age of 14 months. The mean follow up is of 3 years and the improvement in aLR(ABD) is 68°and only 25°in aLR(ADD). None of these children with improved active lateral rotation of the shoulder developed clinical signs of a glenohumeral dysplasia within the follow up period.<p><p>Among the 114 children operated between 6 months and 44 years with a shoulder release, 74 had an isolated release procedure, 40 an associated tendon transfer or a suprascapular neurotization. The mean improvement in passive lateral rotation with the arm adducted (pLR (ADD)) was 60°. Active lateral rotation was possible in 63 % of children who underwent an isolated joint release.<p>The Hoffer muscle transfer was performed in 29 children and improved the aLR (ABD) by 60° (mean postoperative follow-up of 30 months). No signs of severe glenohumeral dysplasia developed in these children later on.<p><p>The prospective study of 50 consecutive MRI scans in children presenting at the consultation with a rotatory imbalance of their shoulder, as a sequel from obstetric brachial plexus palsy (Bahm et al. 2007) shows 37 congruent joints, 10 dorsal subluxations, 2 dorsal luxations and one complete dislocation associated with the formation of an independent neoglenoid. The humeral head was deformed in 12 cases; the glenoid in 34 children (flat in 23, biconcave 7 times, convex 3 times).<p><p>The follow up of 2 years in 10 children who underwent an immediate closed reposition shows evidence of joint congruence with a limited (30°) pLR (ADD), definitely lower than after a surgical release.<p><p>Conclusion<p><p>Some osteo-articular deformities secondary to neuromuscular diseases are well described ;those following an obstetric brachial plexus lesion are insufficiently recognized. Their etiology is unclear.<p>At the level of the shoulder joint, these sequels might be very important.<p>Our neuroorthopaedic hypothesis concerning a multifactorial etiology and treatment strategy raises the need of an early and precise screening of the deforming forces to render normal biomechanics and function.<p>The surgical strategy includes the reconstruction of the responsible motor nerve and the improvement of the passive and active range of motion of the shoulder in lateral rotation<p>It seems to be efficient to limit the progression to severe glenohumeral dysplasia and further arthrosis.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

O carcinoma epidermoide de lábio (CEL), que é causado pela exposição crônica e excessiva à radiação ultravioleta do sol, é precedido por uma desordem potencialmente maligna, a queilite actínica (QA). No entanto, ainda não é possível determinar quais casos de QA evoluirão para CEL. O método mais utilizado por patologistas para prever o prognóstico de desordens potencialmente malignas é a graduação histológica das displasias epiteliais. Entretanto, o sistema é subjetivo e ineficiente quanto ao seu valor preditivo. Acredita-se que o epitélio adjacente ao CEL tenha alterações genéticas semelhantes ao corpo da neoplasia. O objetivo deste estudo foi graduar as displasias epiteliais na margem do CEL e verificar a presença de proteína p53 mutada nessas áreas. Foram utilizados 40 casos de CEL com epitélio adjacente, no qual a displasia epitelial foi classificada pelo sistema proposto pela Organização Mundial da Saúde (OMS) e pelo sistema binário. Os casos foram, ainda, submetidos a reações de imuno-histoquímica com anticorpo anti-proteína p53 mutada. Entre os 40 casos estudados, 15 apresentaram displasia epitelial discreta, 18 moderada e 7 intensa. Pelo sistema binário, 36 casos foram classificados como de baixo risco e 4 como de alto risco. A marcação imuno-histoquímica para a proteína p53 mutada foi encontrada no epitélio adjacente de 32 casos (80%) dessa amostra. Considerando-se as duas graduações estudadas, a marcação foi detectada em 11/15 casos de displasia discreta, 16/18 de moderada e 5/7 de intensa pelo sistema da OMS e em 29/36 casos de baixo risco e 3/4 casos de alto risco. Concluiu-se, assim, que o epitélio adjacente ao CEL, mesmo exibindo poucas alterações morfológicas pode ter um comprometimento genético importante em genes que comandam a estabilidade genômica. / The lip squamous cell carcinoma (LSCC), which is caused by chronic and excessive exposure to solar ultraviolet radiation, is preceded by a potentially malignant disorder, the actinic cheilitis (AC). However, it is not possible to determine which AC cases will progress to LSCC. The method used by pathologists to predict the prognosis of potentially malignant disorders is the histologic grading of epithelial dysplasia. Nevertheless, this system is subjective and inefficient as to its predictive value. It is considered that the epithelium adjacent to LSCC has genetic alterations similar to the main tumor. The aim of this study was to grade the epithelial dysplasia on the LSCC border and also to verify the presence of mutated p53 protein in these areas. Forty LSCC cases with adjacent epithelium were retrieved from our files. The epithelial dysplasia was classified by the system proposed by the World Health Organization (WHO) as well as the binary system. Three m sections were submitted to the antibody against mutated p53 protein by means of immunohistochemistry. Among the 40 cases studied, 15 were classified as mild dysplasia, 18 moderate and 7 severe. When the binary system was considered, 36 cases were classified as low risk and four as high risk. Immunostaining revealed the presence of mutated p53 protein in the adjacent epithelium of 32 cases (80%). Analyzing the two grading systems separately, the staining was detected in 11/15 cases of mild dysplasia, 16/18 of moderate and 5/7 of intense; 29/36 of low-risk cases and 3/4 cases high-risk. In conclusion, even if it shows few morphological changes, the epithelium adjacent to LSCC may have a genetic involvement in important genes that control genomic stability.