Sacral agenesis (SA) is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH) and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side) in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip. Sacral agenesis (SA) is a rare condition consisting of the absence, failure of formation, or imperfect development of any part of the sacrum. There are various orthopedic problems associated with SA, including spinopelvic instability, scoliosis, myelomeningocele, a tethering cord, developmental dysplasia of the hip (DDH), knee contractures, and foot deformities –5. HowevWe herein report two cases of the rare cooccurrence of ipsilateral DDH in patients with sacral hemiagenesis who underwent periacetabular osteotomy under spinal anesthesia and analyze possible factors contributing to the development of SA and DDH.The patients and their family members were informed that data from their cases would be submitted for publication and provided their consent.A 16-year-old female presented with a one-year history of left hip pain and limping. She was the product of a normal pregnancy and delivery from a 28-year-old mother who had not been diabetic. The growth and development of the child had been normal, with the exception of treatment with a Pavlik harness due to left developmental dysplasia of the hip beginning three months after birth, followed by open reduction at 14 months of age. The results of a physical examination showed a 1 cm lower limb length discrepancy (left side) and left hip pain, without limitations of the range of motion of the left or neurological deficits. The initial radiographs demonstrated the left hip to be subluxed with associated acetabular dysplasia and partial left sacral agenesis .The dysplasia was concentrically reduced when the extremity was abducted. Pelvic three-dimensional CT reconstruction images clearly demonstrated partial left sacral agenesis, in which a rudimentary sacrum fused with the ilia below the sacroiliac joint  and magnThe patient was admitted to our hospital for periacetabular osteotomy which was performed using the insertion of a 27-gauge spinal needle for spinal anesthesia. The anesthesia and surgical procedures were uneventful, and she complained of no neurological deficits after the operation. Two years postoperatively, she underwent the removal of the internal fixation device, as bony fusion was demonstrated radiographically . CurrentA 13-year-old female visited our hospital for hip pain and limping. She had been born with a low birth weight of 1,400 g via caesarean section due to toxemia in the ninth month of pregnancy. She was the first child born to a 39-year-old mother who was not diabetic. The growth and development of the child had been normal, with the exception of treatment with a Pavlik harness for left developmental dysplasia of the hip beginning three months after birth, which resulted in poor repositioning. At 18 months of age, she underwent open reduction of the hip joint and surgical repair of the sacral dysraphism and lipomeningocele, without any consequent neurological deficits.The results of a pelvic radiograph showed left hip subluxation with associated acetabular dysplasia as well as partial left sacral agenesis . In addiThe patient underwent periacetabular osteotomy combined with allogeneic bone grafting with the insertion of a 27-gauge spinal needle for spinal anesthesia. The anesthesia and surgery were uneventful. At that time, a physical examination showed a 3 cm lower limb length discrepancy (left side), painless Trendelenburg gait, and mild limitation of the left hip range of motion, without any neurological deficits.One year after the surgery, the internal fixation device was removed . CurrentThe incidence of DDH in SA patients has been reported to range from 18% to 30% [Embryologically, in the eighth week of gestation, the primary ossification centers in the vertebrae become evident and the hip joint is differentiated from the circumstance musculoskeletal system . The devAnother theory, that a minor neurological abnormality caused by SA leads to hip dysplasia, may also explain the cooccurrence of SA and hip dysplasia on the ipsilateral side. However, both of our patients had a tethering cord associated with SA and there were no significant positive neurological findings or signs of muscle imbalance preoperatively or during the follow-up period. Furthermore, spasticity or imbalance of the lower extremity muscles due to cerebral palsy may result in progressive subluxation and dislocation of the hip. It has also been reported that more than half of patients with coexisting developmental dysplasia of the hip and spina bifida occulta display had abnormal somatosensory-evoked potentials . TherefoSome investigators have hypothesized that an abnormal glycemic state is a causative factor, based on the association between SA and a high incidence of maternal diabetes –5. HowevPang  reportedIt can be difficult to perform a normal periacetabular osteotomy for DDH associated with SA due to the possibility of spinopelvic instability . RichardIn conclusion, the cooccurrence of SA and DDH provides a plausible hypothesis to explain the embryogenic relationship between sacral and hip malformation. Due to the high incidence of dural abnormalities in patients with SA, it is important to perform MRI to check for caudal anomalies and administer general anesthesia  in SA patients in order to avoid the potential for direct injury to the spinal cord. The clinical and radiographic results of our cases were excellent; however, a further long-term follow-up study on the hip and sacroiliac joints is needed.


Brain dynamics is at the basis of top performance accomplishment in sports. The search for neural biomarkers of performance remains a challenge in movement science and sport psychology. The non-invasive nature of high-density electroencephalography (EEG) recording has made it a most promising avenue for providing quantitative feedback to practitioners and coaches. Here, we review the current relevance of the main types of EEG oscillations in order to trace a perspective for future practical applications of EEG and event-related potentials (ERP) in sport. In this context, the hypotheses of unified brain rhythms and continuity between wake and sleep states should provide a functional template for EEG biomarkers in sport. The oscillations in the thalamo-cortical and hippocampal circuitry including the physiology of the place cells and the grid cells provide a frame of reference for the analysis of delta, theta, beta, alpha (incl.mu), and gamma oscillations recorded in the space field of human performance. Based on recent neuronal models facilitating the distinction between the different dynamic regimes (selective gating and binding) in these different oscillations we suggest an integrated approach articulating together the classical biomechanical factors (3D movements and EMG) and the high-density EEG and ERP signals to allow finer mathematical analysis to optimize sport performance, such as microstates, coherency/directionality analysis and neural generators. For top performance accomplishment in sports, the brain dynamics needs to be taken into account because it determines both motor control and crucial psychological factors, such as intrinsic motivation  dynamics biomarkers of sport performance analogous to those proposed in mental health , local field potentials (LFP) and dual whole-cell recording in the primary somatosensory barrel cortex in behaving mice Figure  Poulet  have revAlthough whisking movement of mouse is not directly related to sport movement in human these results shed a new light on the mechanism underlying the event related spectral perturbation (ERSP) analysis applied on the EEG recorded in sport. In particular, it highlights the significance of event related desynchronization (ERD) and event related synchronization (ERS) episodes of the EEG signals with respect to selected inhibitory or excitatory neuronal populations.Self-emerging oscillation occupy a central position because they represent the brain's fundamental organizer of neuronal information  occurring during the non-rapid eye movement (NREM) state Figure  is relatthe price the brain pays for plasticity. According to this hypothesis, the oscillatory activity of normal sleep allows the brain to reestablish synaptic and cellular homeostasis which has been confronted to environmental demands implicating energetic supplies and plastic changes occurring during wake. In the same vein, the restorative function of sleep also consists of removing potentially neurotoxic waste products that accumulate in relation to awake brain activity  corresponding to sleep spindle activity remains stable during all the NREM episodes Figure . The stuThe SPW-R is another crucial oscillation in the memory consolidation process  applied over the left dorsolateral prefrontal cotex (PFC) facilitates implicit motor learning in a golf putting task  reciprocally connected to the supramamillary nucleus plays the role of “theta pacemaker” for the hippocampal theta oscillation  in human  in the contralateral motor area during the onset of fast ballistic movements  as the peak value resulting from the subtraction of the power spectrum recorded in the eyes-closed state from that recorded in the eyes-opened state  have lower brain activation than less bright individuals when functioning on the same cognitive tasks  occupies a central position in the treatment of sensorimotor information and serves as a functional link between different brain regions recorded in the monkey such as the pre-motor  was reported for contour compared to non-contour conditions during a visual contour detection task , all the rest of non-targeted teammates corresponding to “no-go signals” already moving during a delay period during which distractor cues may occurred (black birds) . Only when the targeted teammate is recognized in a profitable situation the pass must be accomplished .The delayed match to sample (DMS) with distractors task  avoiding loading or maintenance of memory facilitating the memory cleaning and task completion.Dipoppa and Gutkin  realized Figures . During This model includes two stimulus-selective neural population units (R representing red or B for blue) that are independently activated from a resting state to a persistent state by a sensory stimulus Figure . Althougper se, two types of ERP studies have been conducted, one about the effect of chronic physical activity and the other about the effect of acute physical exercise.As the majority of EEG studies devoted to sports have been included in the previous description of the different EEG rhythms, a review of the event related potentials (ERP) studies in sport is accomplished in the last part of the present review. Independently of the analysis of EEG content The first set, which makes up the majority of the studies, focused on the relationship between neuroelectric modulations associated with cognitive functioning and engagement in chronic physical activity through the life span. Studies using tasks involving stimulus discrimination and attention processes found that chronic engagement in exercise and aerobic fitness are linked to higher capacities, as reflected for the most part by larger P3 amplitudes, themselves indexing increased attentional resources during stimulus encoding  on ERPs measurements. In this category, two types of work have been conducted. While some explored the effects of activity right following exercise, others studied the modulations of ERPs during exercise.The studies that have concentrated on the after-effects of a single acute bout of exercise on neuroelectric indices of cognition have focused mainly on the ones reflecting inhibition  intensity exercise appears to be advantageous for ERPs components associated with cognition  it from the real EEG signal. Another already developed option uses a miniaturized wireless EEG system composed of a ring of 8 electrodes embedded in flexprint biocompatible polyamide placed around the ears  project for natural cognition  and sensori-physical environment. In this context, a new open source tool-box called MoBILAB  biomechanical recordings , (2) multiple EMG, (3) high density wireless EEG, (4) eye movement, and (5) signals coming from the autonomous nervous system. Based on the initial feedback of the trainer's team, the targeted movement priorities will be defined and recorded in a first explorative way. The best performance of the best performers will be then compared to less good performance. Sensori-motor strategies based on the dynamic relationship between the multiple EMG profiles and the related kinematics or kinetics will be accurately identified and quantified with the help of DRNN technology . Drafting the work or revising it critically for important intellectual content . Final approval of the version to be published . Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (GC and CC).We would like to thank T. D'Angelo, C. de Scoville, M. Dufief, E. Toussaint, E. Hortmanns, and M. Petieau, for expert technical assistance. This work was funded by the Belgian Federal Science Policy Office, the European Space Agency , the Belgian National Fund for Scientific Research (FNRS), the research funds of the Université Libre de Bruxelles and of the Université de Mons (Belgium), the FEDER support (BIOFACT), the MINDWALKER project (“FP7” 2007-2013) supported by the European Commission, the Fonds G. Leibu and the NeuroAtt BIOWIN and Easy Move projects supported by Walloon Country of Belgium.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


S-matrix over the entire operating frequency ranges of the sensors. For instance, assessing the health of metallic structures using a microwave sensor depends on the reflection or/and transmission coefficient measurements as a function of the sweeping frequencies of the operating band. The aim of this work is reducing sweeping frequencies using machine learning feature selection techniques. By treating sweeping frequencies as features, the number of top important features can be identified, then only the most influential features (frequencies) are considered when building the microwave NDT equipment. The proposed method of reducing sweeping frequencies was validated experimentally using a waveguide sensor and a metallic plate with different cracks. Among the investigated feature selection techniques are information gain, gain ratio, relief, chi-squared. The effectiveness of the selected features were validated through performance evaluations of various classification models; namely, Nearest Neighbor, Neural Networks, Random Forest, and Support Vector Machine. Results showed good crack classification accuracy rates after employing feature selection algorithms.Nondestructive Testing (NDT) assessment of materials’ health condition is useful for classifying healthy from unhealthy structures or detecting flaws in metallic or dielectric structures. Performing structural health testing for coated/uncoated metallic or dielectric materials with the same testing equipment requires a testing method that can work on metallics and dielectrics such as microwave testing. Reducing complexity and expenses associated with current diagnostic practices of microwave NDT of structural health requires an effective and intelligent approach based on feature selection and classification techniques of machine learning. Current microwave NDT methods in general based on measuring variation in the  Microwave Non-Destructive Testing (NDT) research is gaining increasing interest as its enables defects inspection of metallic surfaces and dielectric structures . DiffereThis work presents an implementation of machine learning feature selection methods to reduce the number of sweeping frequencies during microwave NDT. This, in turn, leads to a reduction in the detection circuit complexity and size of acquired data for reducing the costs of the testing equipment, especially for hand-held devices. A procedure for reducing sweeping frequencies in microwave NDT using machine learning feature selection is proposed in this paper. Employing feature selection methods to discover the most influential features among the full feature data set leads to minimizing the needed number of testing frequency points to perform NTD diagnostics. After selecting a subset of the important features, future structural health tests can be conducted using the selected features incorporated with supervised learning techniques for defect and damage detection using classification models. In fact, the idea of utilizing feature selection for minimizing sweeping frequencies is applicable for different NDT techniques.As a validation study for this concept, a microwave waveguide-sensor loaded with split-ring resonators was used for detecting millimeter cracks in metallic surfaces as in ,6. The mFrom a machine learning perspective, feature selection is the process of identifying and removing as much irrelevant and redundant information as possible in order to reduce the dimensionality of the data and allow learning algorithms of the classification models to operate faster and more effectively. In other words, feature selection reduces the number of features and provides a better learning accuracy by selecting the important features from the original data set without mapping original data sets to a lower space ,8. UnlikMachine learning involves computational methods that improve the performance of mechanizing the acquisition of knowledge from experience . It provThe process of applying machine learning techniques to predict the class of unseen data is depicted in etc. There exist many feature selectors that generate different sets of features. Furthermore, there are various classifiers that can be trained to produce classification models . Dividing by m guarantees that all weights are in the interval   . ReliefFal  .The chi-square distribution is one of the most widely used probability distributions methods for evaluating features individually . It filtThe goal of classification is to accurately predict a target class for each case in a data collection. In this study, four classification algorithms were implemented to determine the sub-set of features that yields the highest accuracy. The classification techniques used in this study were the K-nearest neighbor, Random Forest, Neural Networks, and Support Vector Machine algorithms.K-nearest neighbor algorithm (KNN) is part of supervised learning that has been used in many applications in the field of machine learning. The principle behind nearest neighbor methods is to find a predefined number of training samples closest in distance to the new point, and predict the label from them . The neaNeural networks (NN) are bio-inspired algorithms for data processing to enable computers to learn similar to a human brain . Neural The Random Forest (RF) is an approach that can also be thought of as a form of the nearest neighbor predictor. It starts with a standard machine learning decision trees ,17. SimiSupport Vector Machine (SVM) represents a recent advancement in machine learning theory and delivers high performance in different applications. The SVM approach possesses many advantages. It is less computationally intense than other machine learning classification algorithms such as artificial neural networks. It performs well in high-dimensional spaces. It handles a nonlinear classification efficiently using the kernel trick that implicitly transforms the input space into another high dimensional feature space. SVMs belong to the general category of kernel methods ,20, whicThe measured data set was comprised of real measurements of metallic plate scans using a waveguide sensor loaded with meta-materiel particles . The metSignals reflected back from the sensor contained information about the health of the scanned metallic plate. For example, the pattern of the reflected signal from a non-cracked  surface is different from the one reflected from a cracked  surface. As a and b are the min and max values of the new scale.Input normalization data is very important when dealing with parameters of different units and scales. Therefore, all parameters should have the same scale for a fair comparison between them. In the absence of normalization, features with large values have a greater influence on the cost function when designing the classier. The data set understudy was normalized using min-max normalization which restricts the values of all features within predetermined ranges. The general formula is given as:This section presents the outputs of the implemented feature selection techniques as well as their effect on the performance of the built classifiers.In this study, information gain, gain ratio, relief,and chi-squared algorithms were implemented using the R-project  to selecDeciding which classification algorithm to select in order to evaluate and classify the data set is one of the challenges in machine learning research. Predictive accuracy has often been used as one of the evaluation criteria for the predictive performance of classification or data mining algorithms. To overcome this issue, we have conducted experiments using different classification algorithms and used the classifier’s predictive accuracy on the experimental data set as the evaluation criteria.Defect (crack) detection using reduced data sets has been evaluated using KNN, RF, NN, and SVM classifier models. The classifiers were tuned using grid search and cross-validation. Three levels of search grid where used for tuning parameters of implemented models. The SVM model was tuned in terms of the polynomial kernel degree and the regularization constant. NN models were tuned in term of number of hidden units and weight decay. Three odd levels (to avoid ties) of nearest neighbors were used for tuning KNN classifiers. The average classification accuracy was used as a criterion for model selection. In the view that the feature selection models returned the the top five features, five-dimensional data sets were used to build classifiers. Furthermore, an additional two-dimensional data sets were used for defect detection based on the first two important features. Results have revealed high classification accuracy rates. The average training accuracy rates were higher than 0.995 for all models. Furthermore, classification results indicate that the SVM outperformed the rest of the implemented models for all data sets as it scored 100% accuracy rate for all data sets. The strong performance of the SVM can be explained in view of the fact that the SVM measures the complexity of the hypotheses based on the margin with which it separates the data set, not the number of used features, which, in turn, leads to better generalization compared to other algorithms .Considering the relationship between data sets and employed classification models, the data sets obtained by relief feature selection led to better accuracy as the KNN reached an accuracy rate of 100% only when it was working on data sets generated by the relief algorithm. Accuracy variation shown in The performance of implemented classifiers based on the data set obtained using relief feature selection technique was studied further in terms sensitivity and specificity, and results were reported as Kappa density  plots asDue to the strong performance in terms of the accuracy and kappa measures of the SVM classifier with all data sets, it has been selected as the final model among all implemented models. The two-dimensional SVM models have been tested using unseen data, and the learned decision boundary is plotted in This work demonstrated the employment of machine learning feature selection to reduce sweeping frequencies in NDT. Experimental measurements of metallic surface testing were reduced to five and two features only. Resultant data sets were evaluated using classification models including KNN, RF, NN and SVM. The accuracy rates for all implemented classifiers were higher than 0.995. Furthermore, based on the implemented classifiers’ performance, the relief selection algorithm was more effective than IG, GR and chi-Squared.Considering the training and testing classification accuracy rates achieved by the SVM classifier , the waveguide sensor can operate only at two frequencies achieving a classification accuracy rate of 100%.Finally, we note that a major cost in developing frequency scanning detection systems is the frequency bandwidth. We emphasize that reducing the features to only two instead of many frequencies leads to significant reduction in the electronic circuitry for a real-world portable detection system and to a significant enhancement in time efficiency.


Generalized models of joint surface shapes are the foundation for mechanism studies on the mechanical effects of rock joint surface shapes. Based on extensive field investigations of rock joint surface shapes, generalized models for three level shapes named macroscopic outline, surface undulating shape, and microcosmic roughness were established through statistical analyses of 20,078 rock joint surface profiles. The relative amplitude of profile curves was used as a borderline for the division of different level shapes. The study results show that the macroscopic outline has three basic features such as planar, arc-shaped, and stepped; the surface undulating shape has three basic features such as planar, undulating, and stepped; and the microcosmic roughness has two basic features such as smooth and rough. The morphology of rock joint surface is being more and more frequently discussed by authors specializing in various aspects of geology and rock mechanics , 2. GeneAccording to the recommendation of ISRM , the surface shape of joint could be described by a waviness and by an unevenness , 10. TheSun  used an According to the aforesaid analyses, it can be seen that the waviness and unevenness recommended by ISRM are equivalent to the undulation and roughness suggested by Sun , respectIn order to ease the description and study of complex joint surface shapes, the joint surface shape should be classified firstly. Then, classification description of the joint surface shape can be carried out. Essential factors of joint surface shape are the basis of classification description. Study results of Du  show thaThe macroscopic outline is the maximum level of geometric profile of joint surface and reflects the entire geometric shape of joint surface. The macroscopic outline is represented by the envelope curve of the apices or vales of surface undulating shape. The macroscopic outline is relevant to rock formation, characteristics of stress propagation in rock masses, and expansion and perforation mode of joints. For example, tensile joint surfaces formed by the perforation of several panache structures made by mode I crack expansion are usually arc-shaped; and shear joint surfaces formed by mode II crack expansion are commonly planar.The surface undulating shape constitutes undulating profile of apices and vales on the joint surface and reflects the undulating degree of joint surfaces. The surface undulating degree is often represented by the undulation amplitude, the relative amplitude, and the undulation angle. It is the dominant factor affecting the mechanical properties of joints.The surface undulating shape is the exhibition of joint wall rock formation and size, shape, and distribution of coarse grains  on the joint surface. It is also the records of the stress distribution and propagation mode in rock masses and crack expansion and perforation mode on the joint surface during the process of joint formation. For homogeneous rock, tensile joint surface formed by the perforation of panache structures  made by mode I crack expansion is usually more undulant; shear joint surface formed by mode II crack expansion consists of slickensided and stepped features and is commonly less undulant; and undulating degree of joint surfaces formed by mode III crack expansion is intervenient between those of the abovementioned two kinds of joint surfaces. With respect to rock containing nodule, gravel, or coarse mineral aggregation, the joint surface formed by through-grain crack is less undulant, and the joint surface formed by along-grain crack is more undulant.The microcosmic roughness is the minimum level of undulating shape of joint surface and reflects the sublevel tiny geometric character of slope surface on the apices and vales. It is the exhibition of distribution and arrangement character of mineral grains or tiny mineral aggregations on the joint surface.The stress distribution in rock masses and the crack expansion mode of joints have no significant effect on the microcosmic roughness. However, ingredient of mineral or crystal, rock formation, size and shape of mineral crystal, arrangement of mineral, and its outcrop status on the joint surface determine the basic properties of microcosmic roughness.Great deals of field investigations of rock joint surface shapes have been done by the authors since 1992. Twenty thousand and seventy eight profile curves have been recorded by use of the profilograph instrument . These cBased on the qualitative descriptions and statistical analyses of surface shape parameters for the abovementioned typical profile curves, generalized models of rock joint surface shapes can be obtained.Planar: the macroscopic outline of shear joint caused by shear stress or incomplete joint formed by interdissected is commonly planar. The macroscopic outline of marine sedimentary rock bedding and foliation, phyllite, and schistosity formed by metamorphism is also planar mainly.Arc-shaped: the macroscopic outline of tensile joint caused by tension stress or continental sedimentary rock bedding is commonly arc-shaped.Stepped: two or more planar joints communicated by minor implicit joints form stepped macroscopic outline.The macroscopic outline represents the entire geometric shape of joint surface and can be classified by drawing the envelope curve of the apices or vales of the surface undulating shape. The field investigations show that the macroscopic outline can be classified as follows see .Planar: RA is always less than 1/200 or its JRC is less than 2 if sampling length is 10 cm. For shear joint caused by shear stress, when its wall is uniformly distributed, cryptomere or vitreous magmatic rock , fine-grained sedimentary rock (such as clay rock), or fine-grained metamorphic rock (such as slate) planar surface undulating shape may form. The statistical results show that the possibility of rock joint with planar surface undulating shape is rare if the sampling length is more than 15 cm.Planar: if the surface undulating shape of familiar scale rock joint is planar, its relative amplitude RA is more than 1/200. The stepped joint is mostly caused by shear stress and its wall is homogeneous fine-grained rock. Due to friction and avulsion during the course of interslip of the two joint walls, stepped and/or antistepped features can be formed so its surface undulating shape is stepped. To tensile joint caused by tension stress, panache formation will be always formed on the joint surface and stepped surface undulating shape can be formed in the transition zone between two panache formations.Stepped: to rock joint with stepped surface undulating shape, its relative amplitude RA is more than 1/200. Whether shear joint or tensile joint, whether homogeneous wall rock or heterogeneous wall rock, and whether fine-grained wall rock or coarse-grained wall rock, all can form undulating surface shape. The experimental results show that fresh rock joint caused by tension rupture can form zigzag surface undulating shape [Undulating: the undulating is the most familiar surface undulating shape of rock joint and its relative amplitude ng shape , 8. The The field investigations and statistical analyses show that the surface undulating shape has three basic features  and several compound features  see .Planar: In conclusion, the generalized model for surface undulating shape of rock joint is mainly undulating or planar-undulating and stepped-undulating. The undulating shape is the generalized model for the great majority of hard rock joints. Generally, if rock joint size is small, its surface undulating shape is mainly a single feature ; the surface undulating shape will exhibit compound features with the increase of joint size (more than 20 cm).RA is less than 1/600. Joint surfaces with wall rock made of uniformly distributed fine grains, like slate and clay rock, are often smooth.Smooth: for rock joint with smooth microcosmic roughness, its relative amplitude RA is more than 1/600 and less than 1/200. To joint with wall rock made of nonuniformly distributed fine grains or coarse grains or joint with discontinuous and nonuniform stress propagation during the course of formation, its microcosmic roughness is always rough.Rough: to rock joint with rough microcosmic roughness, its relative amplitude The field investigations and statistical analyses show that the microcosmic roughness can be classified into two basic features of smooth and rough see .Smooth: The analysis procedure of generalized models of surface shapes for the profile curve of SSE set joint of calcareous clay rock in Xiaolangdi, China, is shown in The rock joint surface shape should be classified three different level shapes to describe objectively. Accordingly, the generalized models of the three different level surface shapes should be discussed, respectively.The macroscopic outline has three basic features named planar, arc-shaped, and stepped. Shear joint caused by shear stress and incomplete joint formed by interdissected is commonly planar. Marine sedimentary rock bedding and foliation, phyllite, and schistosity formed by metamorphism are also planar mainly. Continental sedimentary rock bedding is commonly arc-shaped. However, the stepped macroscopic outline is the combined feature of the planar macroscopic outline.The surface undulating shape has three basic features named planar, undulating, and stepped. The generalized model for surface undulating shape of rock joint is mainly undulating or planar-undulating and stepped-undulating. Generally, if the rock joint length is small, its surface undulating shape is mainly a single feature; the surface undulating shape will exhibit compound features with the increase of joint length.The microcosmic roughness has two basic features named smooth and rough. Joint with wall rock made by uniformly distributed fine grains is often smooth. To joint with wall rock made by nonuniformly distributed fine grains or coarse grains or joint with discontinuous and nonuniform stress propagation during the course of formation, its microcosmic roughness is always rough.Based on amounts of field investigations of rock joint surface shapes, the generalized models for the three level shapes such as macroscopic outline, surface undulating shape, and microcosmic roughness were established through the statistical analyses of surface profile curves of rock joints. The relative amplitude of profile curves was used as a borderline for the division of different level shapes. Several conclusions can be obtained as follows.


To investigate the clinicopathological features of six cases of soft tissue recurrent ameloblastoma and explore the role of increased aggressive biological behavior in the recurrences and treatment of this type of ameloblastomas. In this study, we retrospectively reviewed recurrent ameloblastomas during a 15-year period; six cases were diagnosed as soft tissue recurrent ameloblastoma. The clinical, radiographic, cytological and immunohistochemical records of these six cases were investigated and analyzed.All the six soft tissue recurrent ameloblastomas occurred after radical bone resection, and were located in the adjacent soft tissues around the osteotomy regions. In Case 4, the patient developed pulmonary metastasis, extensive skull-base infiltration and cytological malignancy after multiple recurrences and malignant transformation was diagnosed. In the other five cases, although there were no cytological signs are sufficient to justify an ameloblastoma as malignant, some malignant features were observed. In Case 1, the tumor showed moderate atypical hyperplasia and the Ki-67 staining percentage was 40% positive, which are strongly suggestive of potential malignance. In Case 5, the patient developed a second soft tissue recurrence in the parapharyngeal region and later died of tumor-related complications. All the remaining three patients showed cytology atypia of varying degrees and high expression of PCNA or Ki-67, which confirmed active cell proliferation.Increased aggressiveness is an important factor of soft tissue recurrence. An intraoperative rapid pathological examination and more radical treatment are suggested for these cases.Key words:Ameloblastoma, soft tissue recurrence, aggressive biological behaviour. The soft tissue recurrent ameloblastomas which occurred after radical bone resection and located in the adjacent soft tissues and without involvement of the residual jaw, showed clincopathologcial features which were not quite consistent with intraossous recurrent ameloblastomas. The role of increased aggressive biological behavior in the recurrences and treatment are discussed in this paper.We retrospectively reviewed the clinical data of ameloblastoma patients admitted to our hospital who underwent resection and had histopathologically confirmed recurrent ameloblastoma during 1998-2013. Of the 25 recurrent ameloblastomas, six cases were diagnosed as soft tissue recurrent ameloblastomas based on their clinical, radiographic and histological presentations. Of these six cases, three cases had multiple recurrences: Case 4 showed six recurrences during 1998-2013; cases 5, two recurrences during the period of study, and Case 6, had recurrences in 1992 and 1996 respectively. The following clinical data of the six recurrent cases were recorded for the six soft tissue recurrence cases: sex, age at presentation of recurrence, site of recurrence, time interval between primary operation and recurrence, number of recurrences, types of surgery and follow-up reviews.Histopathological sections of the primary and recurrent lesions were collected and evaluated for the histopathologic type and presence of cytology atypia. The histopathologic classifications included follicular, plexiform, acanthomatous, granular, basal cell type, and keratoameloblastoma ,12. The Immunohistochemical examination for the quantitative expression of Ki-67 or semi-quantitative expression  of antigen proliferating cell nuclear antigen (PCNA) was conducted in all the six recurrent cases ,15.All patients gave their written informed consent.This study was approved by the Ethics Committee of the Affiliated Stomatology Hospital of Medical School, Nanjing University.The clinical and pathological data of the six intraosseous ameloblastomas with soft tissue recurrence are shown in - Basal clinical data for recurrencesFour men and two women with soft tissue recurrent ameloblastoma were investigated in this study. The mean age at presentation of recurrence was 52.5 years . The average time interval between the primary operation and recurrence was 22.3 years . With the exception of Case 4, the time interval between the primary operation and the recurrences was ≥10 years in the remaining five cases.- Type of primary surgery In Case 4, enucleation and curettage were performed for the primary maxillary ameloblastoma; further, radical bone resection  was performed for the first recurrence 2 years later. In the other five cases, radical bone resection was performed for all the primary lesions: hemimandibulectomy in three cases, segmental resection in one case and resection of the lesion with the dentoalveolar segment and preservation of the lower border in one case. In two cases, osseous reconstruction was performed for the defects.- Location of the recurrent tumorsIn three cases, the recurrent tumors were located in the submandibular region on the same side of the primary lesion; in one case, it was located in the soft tissue of the osteotomy region; and in two cases, the tumors recurred in the gingival tissue of the molar regions.- Follow-up reviewIn all six cases, extensive tumor excision was performed for the recurrent tumors to prevent further recurrences. The follow-up time was 2-10 years, and in four cases, there were no additional recurrences after that. However, in Case 4, the patient developed pulmonary metastasis and extensive skull-base infiltration after multiple recurrences and died in 2013; in Case 5, the patient developed a second soft tissue recurrence in the parapharyngeal region, but he refused further treatment and died not long after that due to complications caused by the tumor.- Radiographic featuresIn all the six cases, all the primary lesions showed extensive bone destruction involving the cortical plate. With regard to the soft tissue recurrences, all the bone margins were totally intact and without signs of bone recurrence.- Histopathological featuresOf the six cases, four were of the follicular type; one was plexiform type and one, basal cell type. All the six patients presented with cytology atypia of varying degrees for both the primary lesions and recurrent lesions . In Case- Case Reports - Case 1The patient was 22 years old at the time of the initial diagnosis of ameloblastoma in 1994. Resection of the lesion with dentoalveolar segment and preservation of the lower border was performed. Eighteen years later, the patient developed an intraoral swelling in the right mandibular body. CT revealed a soft tissue mass in the osteotomy region with an intact bone defect Fig. . Thereaf- Case 2The female patient was 30 years old at the time of the initial diagnosis of ameloblastoma, and hemimandibulectomy was performed in 1979. Thirty years later, the patient developed a swelling in the submandibular region. CT revealed a soft tissue mass with a totally intact bone defect. Extensive resection of the tumor was performed, and the histological diagnosis was recurrent ameloblastoma. The Ki-67 staining percentage was 32% positive for the recurrent ameloblastoma. Retrospective evaluation of the histopathological sections of both the primary and recurrent lesion showed plexiform ameloblastoma with cytology atypia including hyper cellularity, hyper chromatic nuclei and mitotic figures.- Case 3The patient was 30 years old at the time of the initial diagnosis of ameloblastoma in 1973. In 1992 and 2006, the patient had soft tissue recurrences located in the buccal mucosa and mandibular retromolar pad respectively. Extensive resections were performed for the recurrent tumors and the patient has been followed up with no evidence of recurrence. The histopathological classification was follicular ameloblastoma and cytology atypia was found for the primary lesions and two times of recurrent lesions.- Case 4 The patient was referred to our hospital and underwent total enucleation and curettage for maxillary ameloblastoma in 1999 Fig. . Histolo- Case 5The patient was 33 years old at the time of the initial diagnosis in 1982 and hemimandibulectomy was performed for the primary lesion Fig. . Twenty-- Case 6The patient was 36 years old at the time of the initial diagnosis of ameloblastoma in 1989; hemimandibulectomy and osseous reconstruction were performed. Twelve years later, the patient developed a soft tissue recurrence in the mandibular third molar region. The final histological classification was recurrent follicular ameloblastoma. Similar with the other cases, retrospective cytological evaluation of the histopathological sections for the primary and recurrent lesion showed cytology atypia including hyper cellularity and hyper chromatic nuclei.According to the present classification of ameloblastoma, the benign ameloblastomas are divided into 1) solid/multi cystic, 2) extra-osseous/peripheral, 3) desmoplastic, and 4) unicystic ameloblastoma. The solid/multicystic ameloblastomas are more aggressive than other types because they carry a high risk of local recurrences after inadequate treatment . HoweverAmeloblastoma recurrence has been suggested to be correlated to both the histological features and the type of surgical treatment . It is kConsidering the highly aggressive nature of these atypical ameloblastomas, firstly, a preoperative radiographic evaluation of whether the tumor involves the cortical plate is required, as destruction of the cortical plate suggests possible infiltration into the adjacent soft tissues. Secondly, a frozen rapid pathological examination during the surgery is suggested for these ameloblastomas cases; if cytological atypia indicative of aggressiveness is observed, more radical treatment including clearance of at least one more layer of tissue around such lesions should be performed . MoreoveIt has also been reported that 50–80% of ameloblastoma recurrences are diagnosed within the first 5 years -4. HowevIn this clinical retrospective study of recurrent ameloblastomas during a 15-year database (1998-2013), it was noted that soft tissue recurrence following radical bone resection also showed some malignant features. An intraoperative rapid pathological examination and more radical treatment are suggested for these cases of aggressive tumors.


In Oral Implantology most of the procedures are predictable and have high success rates. The use of osseointegrated implants as a therapeutic option for the rehabilitation of patients with severe mandibular atrophy has decreased the need for pre-prosthetic surgery Nevertheless, complications may occur during implant surgery and also once the prosthesis has been placed. This paper describes the case of a totally edentulous patient with an upper complete removable denture and an implant-retained overdenture with two implants in the intermentonian region. During clinical examination, the implant abutments were totally covered by soft tissue since the floor of the mouth was elevated. The panoramic radiography showed severe mandibular atrophy. Vestibuloplasty was performed together with the lowering of the floor of the mouth under general anesthesia and nasotracheal intubation to expose the implants. A new prosthesis was fabricated for the patient to prevent recurrence and improve the patient’s chewing ability as it formed a physical barrier against soft tissue migration on prosthetic attachments. Key words:Vestibuloplasty, lowering of the mouth floor, complications in oral implantology. The rehabilitation of resorbed edentulous mandibles can be a challenge for a variety of reasons. These may include a lack of bone, exostosis, tori, genial tubercle obstruction or an elevated floor mouth .The use of osseointegrated implants as a therapeutic option for the rehabilitation of patients with severe mandibular atrophy has decreased the need for pre-prosthetic surgery . NeverthIn this paper, we present the case of a woman with an upper complete removable denture and an implant-retained mandibular overdenture with 2 implants that required a vestibuloplasty together with the lowering of the floor to expose the prosthetics abutments.A 75-year old Caucasian female with insulin-dependent diabetes mellitus. The patient was totally edentulous with an upper complete removable denture and an implant-retained overdenture with 2 implants in the intermentonian region. When she first visited the Service of Oral Implantology of the Dental Clinic of the University of Barcelona, the prosthetic abutments [ball-shaped anchors] were completely covered by soft tissue. The clinical examination revealed an elevated floor of the mouth and a reduced vestibular depth. The panoramic radiography showed severe mandibular atrophy Fig. .The vestibuloplasty and the lowering of the floor of the mouth were performed under general anaesthesia and nasotracheal intubation. A crestal incision was used and 2 partial-thickness flaps were raised, one buccal and one lingual, leaving the periosteum intact and adherent to the mandibular bone. Soft tissue dissection was carefully carried out in order to avoid mental nerve injuries. Once implant abutments were exposed, the flaps were repositioned through the placement of a transfixion suture surrounding the mandible. The soft tissues around the implants were left to heal by secondary intention and two wound dressings impregnated with castor oil and Balsam of Peru were placed in both buccal and lingual sides  Fig. .Most of the dental implant rehabilitations are predictable and have high success rates. However surgical complications can arise following such treatments . The useThe functional reconstruction of the edentulous mandible with implant-supported overdentures has become an accepted treatment option for several authors ,3,4. SomBone resorption and the use of removable prostheses negatively affect quantity and quality of keratinized mucosa. Furthermore, these patients usually present high muscle insertions, which leads to abnormal tongue position or function with a subsequent lack of stability and unsatisfactory prosthetic function. In this context, the lowering of the mouth floor maybe is recommended prior to implant surgery .Most authors agree that vestibuloplasties should be performed 2 months before implant placement. However the simultaneous placement of implants has reported good results in terms of prosthetic function and patient satisfaction ,5-7.et al. (Cillo and Finn  evaluateet al.  reviewed


Antidromic action potentials following distal stimulation of motor axons occasionally fail to invade the soma of alpha motoneurons in spinal cord, due to their passing through regions of high non-uniformity. Morphologically detailed conductance-based models of cat spinal alpha motoneurons have been developed, with the aim to reproduce and clarify some aspects of the electrophysiological behavior of the antidromic axon-somatic spike propagation. Fourteen 3D morphologically detailed somata and dendrites of cat spinal alpha motoneurons have been imported from an open-access web-based database of neuronal morphologies, NeuroMorpho.org, and instantiated in neurocomputational models. An axon hillock, an axonal initial segment and a myelinated axon are added to each model. By sweeping the diameter of the axonal initial segment (AIS) and the axon hillock, as well as the maximal conductances of sodium channels at the AIS and at the soma, the developed models are able to show the relationships between different geometric and electrophysiological configurations and the voltage attenuation of the antidromically traveling wave. In particular, a greater than usually admitted sodium conductance at AIS is necessary and sufficient to overcome the dramatic voltage attenuation occurring during antidromic spike propagation both at the myelinated axon-AIS and at the AIS-soma transitions. Since the early Fifties of the last century, microelectrode intracellular recordings from spinal motoneurons allowed the detailed analysis of the electrophysiological events generated at the soma by an antidromic spike evoked at the distal part of a motor fiber  properties at the transition region  the myelinated axon to the unmyelinated axon initial segment (AIS), (ii) the AIS to the soma, and (iii) the profusely branching dendritic tree Eccles, . In part+ channel densities onto somatic and AIS membranes .The proposed models were developed and run in the NEURON v7.3 simulation environment  the soma and a highly detailed three-dimensional dendritic tree, (b) a frustum-shaped axon hillock with the proximal enlarged end attached to the soma, and the opposite end attached to the unmyelinated axonal initial segment (AIS), (c) a myelinated axon (23 mm long) attached to the distal end of the AIS.In the simulations, we used reconstructed 3D morphologies of dendritic tree and soma from 14 cat spinal motoneurons Figure .The morphologies belong to distinct sets of data from two different works  of an infinite cylinder with identical anatomical and biophysical properties. A more thorough approach, considering the transient characteristics of the neural signals, takes into account the AC length constant λf computed at a frequency f that is high enough for transmembrane current to be primarily capacitative, yet still in the range of frequencies relevant to neural function  based on average measures of cat spinal motoneurons Conradi, . As a reThe myelinated part of the axon has been modeled according to the study of McIntyre et al. , who devin silico .The NaSoma and proximal dendrites. We considered proximal dendrites those parts of the primary dendrites extending from the soma along a distance equal to the 10% of the average dendritic length for each neuron model. The soma and the proximal dendrites include conductances representing non-linear fast Na+, persistent Na+, delayed rectifier K+, hyperpolarization-activated mixed cation, high-threshold Ca2+, and Ca2+-activated K+ channels as well as a linear leakage conductance (Table 2+-activated K+ channel is responsible for the after-hyperpolarization (AHP). Along the proximal dendrites, each conductance linearly decreases to the respective value set in the distal part of the dendritic tree, except for the hyperpolarization-activated conductance, which has the same value in soma and dendrites.ce Table . The som+ channels. In real neurons the persistent sodium current is not provided by a separate channel, but it is a feature of the Nav1.6 channel electrophysiological behavior. However, accurate representation of both of these components requires a multi-state kinetics model  and that for the fast current toward more hyperpolarized values (−5 mV) .Moreover, we set the persistent sodium conductance at a value able to produce a proportion of persistent current of about 20% compared to the peak of the transient one , few milliseconds were necessary to settle down a stable equilibrium potential, which slightly varied through the different sections. Thus, each simulation starts from a previously saved steady-state (300 ms without perturbations).An integration time-step of 0.025 ms was adopted for all the simulations.The electrophysiological features of the simulated models are summarized in Table IN) and high values of rheobase . The increased motoneuronal size, especially in motoneurons from the second pool  between two points in terms of voltage attenuation:However, due to the wide difference between real neurites and an ideal cable conductor, and to the changing By adopting the previous definition of electrotonic distance and by using the NEURON's tool for the study of electrotonus  remains large, which in turn can provide additional charge for depolarizing the adjacent region of increased diameter. However, as the axial current progressively increases, even the extra charge from the elevated inward sodium flux can become insufficient to depolarize the soma or the AIS membrane to threshold level.As already described  (Ascoli et al., In this study, we modeled the antidromic propagation of the action potential along a single motor fiber from the myelinated axon through the unmyelinated AIS to the soma of a spinal alpha motoneuron. To this purpose, we used a pool of morphologically detailed models of alpha motoneuron, exploiting the open-access web-based database of three-dimensional somato-dendritic reconstructions (+ conductances similar to those adopted in previous in silico studies (Dodge and Cooley, In addition, we adopted a highly detailed model of myelinated axon (McIntyre et al., In real intracellular recordings, a failure of the antidromic somatic invasion represents an exception, and is often the result of experimental artifacts, like an induced somatic hyperpolarization or a repetitive antidromic stimulation Eccles, . In thesIt can be hypothesized that spontaneous not induced blockages of antidromic spike mainly happen in motoneurons of larger size, due to the greater capacitive load provided by their soma and dendrites. Thus, the prevalence of large motoneurons in our pool of neuron models could bias our results toward a failure of the somatic invasion. As established in previous studies (Zengel et al., Our models provide for the first time a neurocomputational validation of a classical hypothesis carried out by the early electrophysiological studies, i.e., the probable failure of the antidromic propagation at the transition zone between the myelinated axon and the AIS Eccles, , in addi+ channels at the AIS has to be hypothesized to make the antidromic soma invasion to happen. Given that a precise and direct measure of Na+ channels density at the AIS of spinal motoneurons is still lacking, our hypothesis represents a neurocomputational prediction, which can be confirmed or contradicted by future experimental data.Our study clearly shows that, when dealing with detailed morphological reconstructions of motoneurons, a much higher density of Na+ channels density at AIS should be set much higher than at the soma (Table + channels at AIS and at the somato-dendritic compartment in cortical layer 5 pyramidal neurons by means of whole-cell patch clamping recordings, immunocytochemical imaging and neurocomputational models. That study found a value for Na+ channels density at AIS ~50 times higher than at the soma.Our findings show that the Nama Table . These dma Table , which ev1.2 and Nav1.6 sodium channel subtypes in the proximal or the distal region, respectively, of the AIS has been considered as the basis of two distinct tasks of the AIS: spike initiation and action potential back-propagation (Hu et al., v1.6 channels, while the high-threshold Nav1.2 channels control spike back-propagation because of their high density at the proximal AIS.The AIS is a highly organized cellular domain specialized to function as the site of spike initiation in neurons (Clark et al., Although the present study did not adopt distinct subtypes of fast sodium channel, our findings are in agreement with this unique role of the AIS in spike back-propagation.In our models, we directly attached the distal end of the AIS to the proximal edge of the first myelin attachment segment, so that the transition between these two segments was similar to that between a node and the myelin attachment segments. This agrees with the discovery that the axonal region where the myelin sheath begins seems organized with para-AIS and juxtapara-AIS, similar to the nodal regions (Duflocq et al., + channels at AIS and soma are also suggested.In this study, the development of detailed models of spinal motoneurons has provided novel insights about the voltage attenuation in proximal segments of the axon. Some experimentally testable predictions about the values of the densities of the NaMorphologically detailed models, indeed, have already demonstrated to provide more suitable results, compared to the reduced ones, especially when the examined events involve the integration of multiple synaptic inputs, or dendritic active conductances, or somato-dendritic back-propagation (Hendrickson et al., The implementation and the use of high-detailed neuron models to characterize the back-propagation from the myelinated axon through the initial segment to the soma, has been studied only in few cases. López-Aguado et al.  modeled + channels at AIS than at the soma. Also in this work the computational part of the study was carried out by implementing highly detailed morphological reconstructions of the examined neuronal type (Kole et al., More recently, Kole et al.  solved t+ channel density at AIS.Herein an axon-somatic back-propagation modeling study was performed for the first time in detailed models of spinal motoneurons, and further evidence was provided about the role of higher than usually admitted values of NaFinally, our study also supports the view that the electrophysiological behavior of detailed models may help to guide the process of complexity reduction: the detailed model can prevent modelers from adopting minimizing strategies carrying to reduced models incompatible with the experimental neuronal features.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI) were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy. Eumycetoma is an unusual chronic cutaneous and subcutaneous infection caused by various genera of fungi. Approximately 40% of mycetomas worldwide are eumycotic rather than actinomycotic . The disease is characterized by marked progressive destruction of soft tissue and bones causing functional disability. The most common site of occurrence is the foot . A proviWe assume that radiologic-pathologic correlation is an essential supplement for the accurate diagnosis and management of osteoarticular infections. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. The purpose of this review is to demonstrate why performing this correlation is an essential part of the diagnostic process of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in eumycetoma osteomyelitis of the foot. Our patient was informed that data concerning the case would be submitted for publication. Staphylococcus aureus, the patient was diagnosed with nonspecific bacterial calcaneal osteomyelitis. The patient was treated with multiple courses of oral and intravenous antibiotics over the following six years, to which he did not respond. The patient walked with painful limp that deteriorated over the past years till he finally used crutches permanently and became a household ambulatory. The patient was nonimmunosuppressed and had no systemic manifestations or other skeletal complaints. Blood and serum chemistry were also unremarkable.A 14-and-a-half-year-old boy from Fayoum Governorate in rural Egypt complained of an initially painless right foot swelling for the past six years. Multiple sinus tracts developed with an initial purulent discharge and an eventual extensive black granular discharge. He was previously subjected to multiple bony debridement procedures in other institutions to which the he did not respond. Based on the clinical/radiologic suspicion and results of culture and sensitivity from discharging sinuses that revealed Gram positiveBy examination, there was diffuse right foot oedema and tenderness especially over the hind foot. Two discharging sinuses were observed in relation to the hind foot. There was painful passive motion of the subtalar and ankle joints.X-ray findings of the foot and ankle revealed massive bony destruction of the calcaneus consistent with chronic osteomyelitis. MRI of the right ankle and foot was performed to characterize and evaluate the extent of the disease. Technique of examination included sagittal T1-, STIR, and T2-weighted images, axial T1- and T2-weighted images, and coronal T2-weighted images. The salient abnormality was the markedly altered marrow signals seen almost totally replacing the marrow texture of the calcaneus and to a lesser extent involving the opposing posteromedial aspect of the talus eliciting abnormal low T1, high T2, and iso-to-high STIR signals with evident cortical breaching and associated large soft tissue component eliciting low T1 and high T2 and STIR signals Figures .In march 2015, we performed total calcanectomy through a heel splitting approach. Under general anesthesia, a high tourniquet was employed in the prone position. Anatomic pathology of the excised calcaneus is depicted in Figures The concept of radiologic-pathologic correlation was born in 1947 with the establishment of the Radiologic Pathology Department and Registry at the Armed Forces Institute of Pathology in Washington, DC. This method has become a key teaching tool to understand the radiological manifestations of disease, initially on plain films and later with cross-sectional techniques . ObviousMusculoskeletal infection is common in clinical practice. Osteomyelitis refers to infection of the bone and marrow usually by pus producing organisms. It is commonly caused by bacteria, but fungi are also considered. Usually, the diagnosis of fungal osteomyelitis is challenging. The clinical and radiological findings of osteoarticular infection may be conflicting and confusing. Even with the advancement of imaging technology, findings may remain inconclusive. There are a wide variety of presentations seen on imaging reflecting the balance between host and organism, disease duration, and institution of antimicrobial treatment. A good understanding of various stages of osteoarticular infection is essential to augment the interpretation of the vast amount of imaging information available to arrive at an accurate diagnosis and thereby institute timely and effective treatment to prevent destructive sequelae in the immature skeleton .In eumycetoma fungal osteomyelitis bones are almost always attacked from outside, in contrast to bacterial osteomyelitis, and periosteal reaction, cortical erosions, and bone texture abnormalities may then be seen. It is important to detect whether bone is infected as nonsurgical cure is uncertain in such cases. Conventional radiographs are used to determine whether bone is affected and to identify the limits of lesions in eumycetoma. Multiple radiographic changes can be detected . Abd El Several authors found that MRI is useful for visualizing soft tissue involvement and bone destruction; with MRI, multiple small spherical hyperintense lesions separated by tissue of low signal intensity appear. Some of these lesions show a central tiny hypointense focus. These hypointense foci were named “dot in circle” and were seen in 80% of patients, which made this appearance highly indicative of mycetoma , 4, 6, 7The MRI of our patient revealed thickening of the overlying skin with multiple defects, ulceration, and sinus tracts breaching the posterior and plantar posterior skin, subcutaneous fat, and plantar fascia. These findings clearly correlated with the intraoperative multiple small cavities and black grain discharge observed on the plantar surface of the calcaneus following calcanectomy. There was a significant correlation between the previous radiologic-pathologic findings and the black grain discharging sinuses observed on clinical examination.The MRI findings of our patient revealed markedly abnormal signal intensity involving the sinus tarsi and the subtalar articulation. The gross pathologic findings of the calcaneus revealed complete destruction of the articular cartilage of posterior subtalar joint, joint depression, and partial destruction of the middle facet. There was a significant correlation between the previous radiologic-pathologic findings and the preoperative painful passive range of motion of the subtalar joint.In 2012, El Shamy and colleagues reported a new grading system for MRI diagnosis of mycetoma. They found that actinomycetoma more often showed soft tissue microabscesses, bony periosteal reaction, and reactive sclerosis, while eumycetoma frequently exhibited soft tissue macroabscesses with bone cavitation; such differences were not statistically significant . The MRISince both actinomycetes and fungi are implicated as causative agents, it is important to distinguish them in order to ensure that correct treatments are given . MycetomCulture methods are still considered to be the gold standard in species identification of the causal agents of mycetoma. However, some agents are difficult to identify by morphology alone. Furthermore, most cultures methods are time consuming, contamination is common, and experience is needed to read results accurately . HistoloThe granules of actinomycetoma consist of fine, branching filaments, only about 1 micron thick, whereas the granules of eumycetoma are composed of septate hyphae 4-5 microns thick . This hiIn our patient, all of the above mentioned histopathological findings clearly correlated to the anatomic pathology aiding definitive species diagnosis.Agreement between radiology and pathology was recognizable. The radiologic-pathologic correlation may be used in explaining the role of plain radiographs and MRI in identifying eumycetoma osteomyelitis of the calcaneus in children. Establishment of a clear correlation between radiology and pathology may help differentiate eumycetoma from other infections and tumorous lesions. Radiologic-pathologic correlation augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.


Terminal transverse deficiency of forearm is a very rare limb malformation. Most of the cases have traumatic etiology and congenital presentation is less common. A series of six individuals with transverse deficiency through the hands is presented in this communication. The cases were congenital, morphologically similar and showed loss of four fingers, most often postaxial. The affected arm was reduced in size compared to the contralateral limb and there was distortion of palmer creases. All cases were sporadic and non-syndromic in nature. The characteristics of these cases were concordant with the symbrachydactyly type III or monodactylous type, when classified according to the scheme proposed by Blauth and Gekeler (1973). The malformation resulted in permanent quality-of-life impairment in these subjects and warrant prosthetic management. Detailed physical and phenotypic features of the patients have been presented. Terminal transverse amputations are characterized by the absence of distal portions of the extremities extending across the width of the limb/autopod.4Data on congenital transverse amputation (CTA) in Pakistani patients are scarce and there is no systematic documentation of such cases. In this communication, we present six individuals with variable degrees of CTA through hand/palm.Six individuals  with CTA were ascertained during 2011-2015 from different regions across Pakistan . ClinicaThe CTA of hand was essentially unilateral in all the cases and there was no family history of limb or any other congenital malformation. There were amputations of variable degrees which resulted in loss of four fingers, mostly postaxial . The indThe individual was fourth in the sibship of four. Reportedly, the first pregnancy of his mother was delayed for three years and the first two sibs  died in postpartum. The individual was observed to have CTA through his left palm. Fingers 2-5 were represented by bead-like remnants and there was distortion of palmer dermatoglyphics . RoentgeThis male patient was observed to have CTA of right hand through the palm. A short thumb was evident in the affected hand . RoentgeThere was CTA of right hand which culminated in four nubbin-like digits and a relatively normal thumb . CharactThe individual had CTA through the medial axis of left palm and digits 2-5 were completely omitted. The thumb appeared unaffected .th finger was present. The affected arm was markedly reduced in size.The left hand exhibited CTA through the proximal plan of palm . FingersThe individual had CTA through the left hand . Fingersth finger was present.The CTA is generally reported as symbrachydactyly. In a retrospective study on patients with terminal amputations, Kallemeier et al.Nubbin-like digits appear to be an occasional feature of symbrachydactyly. Two of our patients also exhibited soft nubbin-like finger remnants at the distal border of affected hand. Kallemeier et al.The unilateral and isolated nature in most of the cases of symbrachydactyly supports the nongenetic etiology. However, involvement of this anomaly with other syndromes likes Adams-Oliver syndrome (OMIM-100300) and ADAM complex (OMIM-217100) may suggest genetic factors in certain types. Other hypothesis than the vascular disruption explaining symbrachydactyly and associated syndromes have been proposed.Hand amputations have devastating effect on the lives of the individuals. CTA have not gained much attention in Pakistan.


Medical imaging is today becoming one of the most important visualization and interpretation methods in biology and medicine. The past decade has witnessed a tremendous development of new, powerful instruments for detecting, storing, transmitting, analyzing, and displaying images. These instruments are greatly amplifying the ability of biochemists, biologists, medical scientists, and physicians to see their objects of study and to obtain quantitative measurements to support scientific hypotheses and medical diagnoses. Noise, artifacts, and weak contrast are the cause of a decrease in image quality and make the interpretation of medical images very difficult. These sources of interference, which are of a different nature for mammograms than for ultrasound images, are responsible for the fact that conventional or traditional analysis and detection algorithms are not always successful. The biomedical imaging scene is one of the most challenging since we have to deal not only with non-Gaussian, nonstationary, and nonlinear processes  but also with mixtures of components interacting in a quite complicated form. Therefore, much of the research done today is geared towards improvement of the reduced quality of the available biomedical imaging material.The aim of this special issue is to present the current state-of-the-art in the theory of advanced computer vision approaches and applications to biomedical image analysis and modeling. In this special issue, we have invited articles that explore novel problems in biomedical imaging that require advanced computer vision approaches. Three papers address the important aspect of segmentation in medical images, two papers deal with automated detection, and three others propose theoretical and computational or hardware solutions for encountered artifacts.One of the papers evaluates the feasibility of computer aided malignant tumor detection using the traditional texture analysis applied on two-compartment-based parameter pseudoimages of dynamic contrast enhanced magnetic resonance (DCE-MR) breast image data. The innovation lies in the through-plane assessment capability. The paper shows that neural network classification using the textural parameters for automated screening of two-compartment-based parameter pseudoimages of DCE-MRI as input data represents a useful tool for the radiologists in the preassessment stage by revealing possible cancerous regions and in the postassessment stage by reviewing the segmentation especially in analyzing complex DCE-MRI cases.A paper identifies and analyzes the artifacts produced by the simultaneous use of two probes of different or equal operating frequencies. These artifacts arising in 3D ultrasound images are of obscure nature and represent a challenging task in the daily clinical environment.Another paper addresses the important problem for automated segmentation of medical images in the presence of intensity inhomogeneity and proposes a novel kernel-based fuzzy level set method to alleviate this problem and achieves in practical examples a high accuracy and is invariant to the inhomogeneity degree.A paper proposes a novel method based on histogram equalization as a preprocessing step to improve the convergence rate in an affine registration algorithm. Its applicability is demonstrated on SPECT and PET brain images resulting from several neurodegenerative diseases.One of the papers presents a new image segmentation method based on multiple active contours guided by differential evolution, called MACDE. The segmentation method uses differential evolution over a polar coordinate system to increase the exploration and exploitation capabilities regarding the classical active contour model. The authors successfully demonstrated that MACDE outperforms the classical active contour model and the interactive Tseng method in terms of efficiency and robustness for obtaining the optimal control points and attains high accuracy segmentation.Another paper introduces a novel segmentation technique using 3D statistical features extracted from the volume image and is based on unsupervised vector quantization and fuzzy clustering techniques without using any a priori information. The resulting fuzzy segmentation method addresses the problem of partial volume effect (PVE) and has been assessed using real brain images from the Internet Brain Image Repository (IBSR).A paper describes an algorithm for the automatic detection of white blood cells embedded into complicated and cluttered smear images. The technique, which is based on the differential evolution (DE) algorithm, transforms the detection task into an optimization problem whose individuals represent candidate ellipses. An objective function evaluates if such candidate ellipses are actually present in the edge map of the smear image. In experimental studies, white blood cell images with a varying range of complexity are included to validate the efficiency of the proposed technique in terms of its accuracy and robustness.One of the papers is more visionary and presents several low-cost hardware implementation approaches for the new generation of tablets and/or smartphones for estimating motion compensation and segmentation in medical images. These systems have been optimized for breast cancer diagnosis using magnetic resonance imaging technology with several advantages over traditional X-ray mammography and also address the challenge of offering a medical tool that runs on widespread portable devices to aid in patient diagnostics.Anke Meyer-BaeseAnke Meyer-BaeseClaudia PlantClaudia PlantJuan Manuel Gorriz SaezJuan Manuel Gorriz Saez


This paper presents a multimodal system for seamless surveillance of elderly people in their living environment. The system uses simultaneously a wearable sensor network for each individual and premise-embedded sensors specific for each environment. The paper demonstrates the benefits of using complementary information from two types of mobility sensors: visual flow-based image analysis and an accelerometer-based wearable network. The paper provides results for indoor recognition of several elementary poses and outdoor recognition of complex movements. Instead of complete system description, particular attention was drawn to a polar histogram-based method of visual pose recognition, complementary use and synchronization of the data from wearable and premise-embedded networks and an automatic danger detection algorithm driven by two premise- and subject-related databases. The novelty of our approach also consists in feeding the databases with real-life recordings from the subject, and in using the dynamic time-warping algorithm for measurements of distance between actions represented as elementary poses in behavioral records. The main results of testing our method include: 95.5% accuracy of elementary pose recognition by the video system, 96.7% accuracy of elementary pose recognition by the accelerometer-based system, 98.9% accuracy of elementary pose recognition by the combined accelerometer and video-based system, and 80% accuracy of complex outdoor activity recognition by the accelerometer-based wearable system. Combining mature techniques of medical diagnostics with traditional surveillance system solutions leads to a generalized approach to health- and activity-based supervision of elderly, providing the comfort of independence together with security of seamless monitoring and alerting.etc. These sensors are usually developed for a specific disease-related purpose, and following the demand of most frequent age-related disorders. Early applications were developed mainly for diabetic  and x2[j] at different time points i and j. A particular alignment corresponds to a path φ through the distance matrix of the form:φ1 and φ2 represent row and column indices into the distance matrix, and K is the alignment length. The DTW method yields the optimal alignment that minimizes the overall cost:Each value in this matrix indexed by . The DTW quantifies changes in morphology resulting from state-space amplitude and timing differences between two patterns. Using this information, behavioral patterns carrying information of possible danger are clustered in separate groups, with appropriate unique symbols.The final energy difference between the two behavioral patterns In the setup mode, the human operator (supervisor) defines the premise-specific permission list, redundant sensors and sensor overlapping areas and configures the alerting rules.In the learning mode the system records the subject's behavior and calculates statistics of behavioral patterns. In case the permission list or subject-related limits are exceeded, or in case the subject presses the button, detailed data from selected sensors are recorded for future review.In the supervision mode the system records the subject's behavior, calculates statistics of behavioral patterns and performs alerting as programmed. For all events classified as ‘suspicious’ the detailed data from selected sensors are recorded for further review.Before being applied for the danger detection mechanism, the contents of both databases have to be initialized. Although basic information on expected subject behavior in particular zones is entered manually, behavioral patterns are entered as examples recorded by the same system that is used for surveillance for preserving the specificity of subjects' actions. Unfortunately, intentional recording of patterns for a variety of possible dangerous or critical behaviors by the subject is not feasible. Therefore we initially perform recordings of patterns of all behavior available in everyday life and then, in a series of interview with a human operator, selected patterns are indicated as examples of dangerous behavior. During the later operation of the surveillance system, all recordings that not match the patterns of safe behavior are recorded as suspicious (together with respective raw data streams) and subject to a visual inspection by the human operator. The danger detection mechanism runs either in setup, learning and discrimination modes :In the 5.5.1.The main components of the system were tested under laboratory conditions with the help of volunteers playing out different test poses and scenarios. Tests with elderly volunteers in a dedicated apartment-like laboratory are currently being prepared and tests in domiciles of elderly volunteers are scheduled for a three-year project.The concept of complementary use of sensors from embedded and wearable networks for improvement of data reliability was verified in a series of elementary activities detected and classified based on single sensors and multiple sensor signals. Results of tests for separate visual and accelerometer-based detection and for combined modes detection are summarized in the following tables.Based on the presented summary of the final results it can be concluded that the combination of two sensors enables to improve reliability of the activities recognition. Some type of the activities  were less reliably recognized than others. Probably worse gait results  can be attributed for too high diversity of walking rhythm for different volunteers. Reaching activities were also difficult to recognize, since there are characterized by low level of whole human body dynamics.5.2.Separate testing was performed for monitoring of outdoor activities captured by a unique use of wearable sensor network controlled and synchronized by the wearable server.ad-hoc mode. Our other studies [The experiment setup for outdoor activities consisted of wearable server, Bosch BMA180 accelerometer and GPS receiver (MTK chipset). However, system monitoring capability can be extended by adding up to two more sensors in an  studies ,74 proveThe aim of the experiment was to investigate the system performance during complex outdoor activities and the ability of recognition of selected subject states while performing different activities. The experiment was carried out in an open area (garden). All sensors were attached to subject's body or hidden in the clothes. A connection between wearable server and system server was established via a wireless 3G network. The implemented software controlled data transmissions during the experiment.Outdoor testing was carried out by four young volunteers performing simple actions such as standing, walking, running and next performing complex activities in the garden. Each session lasted for ca. 2 min and aimed to simulate an excerpt of everyday life. Our measurements show that it is possible to establish an open architecture wearable wireless sensor network and apply it to monitor complex outdoor activities of humans. Furthermore, the implemented algorithms allowed for calculation of a two-dimensional feature vector which consists of the average of the normalized sum of accelerometer data and subject speed from the GPS sensor. Based on this feature vector we achieved an overall accuracy of 80% in recognition of different activities. This study demonstrated the possibility of applying wearable subject-specific sensors for human behavior tracing under the specified outdoor conditions.6.A system for seamless tracing of human behavior using complementary wearable and house-embedded sensors was designed according to a three-layer architecture allowing for separate adaptation of sensors  network organization (in response to subjects or premise changes) and behavioral record interpretation . The system automatically collects the data from the best available sensors and performs energy-aware selection of data gateways in order to increase the operation time of wireless body area sensor networks. The system automatically compensates the processing and transmission delay based on two acceleration-representative data series, and evaluates the reliability of wearable accelerometers-based outdoor measurements of mobility with the use of cross matching of acceleration patterns recorded during indoor tracing.Putting aside possible delay and inaccuracy of values of some status components, the subject's behavior may be captured and analyzed in real time  in order to detect abnormalities and to warn about possible health dangers. Such preventive analysis is very welcome for general surveillance of elderly people living on their own, as well as in specific circumstances such as car driving or similar activities.The experiments performed by means of different sensors enabled us to establish a range of interchangeability and to choose the most appropriate sensor or sensor set for the specific application. Results of the research clearly confirmed that the analysis of human motion recorded with different methods leads to convergent conclusions, which can be used in home care monitoring or assisted living. It is possible to identify the selected movements in human daily life with a significant probability using single video or acceleration sensor and we demonstrated how the recognition accuracy raises with simultaneously using of both sensors.Although our prototype does not address all the issues mentioned in the ‘Introduction’, we successfully implemented the prototype system for seamless tracing of human behavior using complementary wearable and house-embedded sensors. Our system uses an open architecture and allows for monitoring of multiple subjects in multiple smart environments . Thanks to the double communication gateway of personal server, the subject stays connected to the system without limitation on his or her mobility. Particular sensors may be remotely switched on and off accordingly to the individual needs of the subject. The system learns from the subject's actions manually classified as regular, detects any exemption on behavior in real time, alerts and records corresponding data for further review.For an indoor subjects, the activity recognition is based on synergy of accelerometer data gathered by a wearable sensor network, and results of optical flow-based visual data analysis. In case of outdoor subjects, the system has to rely on accelerometers only, and thus the recognition accuracy is lower. Our experiments show that the visual method is more reliable than the accelerometer-based method. Short activity sequences recorded simultaneously by both systems is used to establish a consensus on subject's behavior, but also to measure differences between methods, which help to assess the reliability of accelerometer-based method when the subject goes outdoor.–temporary usage of image processing-dedicated computer instead of intelligent camera–ca. 5 h)short operating time of wearable server  and accepting some degree of inaccuracy. At the next stage, the decision making software will be revised and we plan to have 200 copies of the personal subsystem manufactured and implement it in private homes, a nursing home and a psychiatric hospital. These implementations are expected to return statistically relevant results on the social and medical advantages of the system and on its usability.


Skin is the most commonly affected organ by adverse drug reactions in almost 30% of all cases. According to the international consensus on drug allergy, drug hypersensitivity reactions (DHRs) constitute 15% of all adverse drug reactions affecting more than 7% of the general population.Herein we present case series of various non-immediate DHRs  amongst which drug-related intertriginous and flexural exanthema (Baboon syndrome), DRESS syndrome, fixed drug eruption and contact dermatitis. In all cases we performed patch testing with standardized and allergens prepared at our laboratory with the suspected drugs. The timing of patch test procedure was in median 6 weeks after the resolution of skin changes.Based on the patch test results, we comment on the sensitivity and specificity of patch test in non-immediate DHRs. Different variables influence patch testing in DHRs such as allergen preparation, vehicle, concentration, intake of certain medications and testing healthy controls with the suspected allergens. We emphasize on these and on the demand for control and interpretation of the results. The role of web drug allergen databases in preparation of proper drug concentration and vehicle for patch testing is reviewed.This presentation reports the personal experience with in vivo skin patch testing in patients with non-immediate DHRs.


Maytenus illicifolia, a medicinal species from Brazil.Pentacyclic triterpenes are secondary metabolites which are promising molecules in the pharmaceutical field and food and material industries. These compounds are formed by the cyclization of oxidosqualene catalyzed by oxidosqualene cyclases (OSC) . The aimM. ilicifolia and used in the synthesis of cDNA. The PCR amplification of core fragments of OSC genes was performed with partially degenerated primers designed to anneal to highly conserved regions among OSC genes. The cloned fragments were sequenced and specific primers were designed for the rapid amplification of cDNA end (RACE) of 3' regions and for a first round amplification of 5' extension. After sequencing, another set of specific primers were generated for the RACE of 5' regions. Finally, it was possible to clone the full-length cDNA of the OSCs and confirm the predicted identity of the genes by sequencing [For this purpose, we adopted the strategy of RT-PCR using degenerated primers obtained from sequences of known plant OSC genes. Total RNA was extracted from leaves of quencing .In silico assembly and sequencing of the full-length cDNA covered the ORF of two main different groups of OSCs with ~2500 bp. Multiple alignment of these genes showed identity of about 50% between those two groups. Comparison of M. ilicifoliaOSC genes with those described in the Genebank revealed that one group showed high identity (~90%) with cycloartenol synthase enzymes, while the other one showed high identity (>75%) with triterpene synthases as beta-amyrin and lupeol synthases.M. ilicifolia demonstrated two main groups of OSC enzymes present: the cycloartenol synthase, which is part of the plant primary metabolism and one triterpene synthase, which may be part of the secondary metabolism [Saccharomyces cerevisiae will further characterize the oxidosqualene cyclases from M. ilicifolia leaves.Cloning of OSC genes from the leaves of tabolism . Future


Previously, we have shown that kasugamycin treatment in E. coli stimulates the formation of protein-depleted ribosomes that are selective for leaderless mRNAs. Here, we provide evidence that prolonged kasugamycin treatment leads to selective synthesis of specific proteins. Our studies indicate that leaderless and short-leadered mRNAs are generated by different molecular mechanisms including alternative transcription and RNA processing. Moreover, we provide evidence for ribosome heterogeneity in response to kasugamycin treatment by alteration of the modification status of the stalk proteins bL7/L12.The bacteriostatic aminoglycoside antibiotic kasugamycin inhibits protein synthesis at an initial step without affecting translation elongation. It binds to the mRNA track of the ribosome and prevents formation of the translation initiation complex on canonical mRNAs. In contrast, translation of leaderless mRNAs continues in the presence of the drug