Bowstring Effect for Cervical Angina

Bowstring Effect for Cervical Angina Bowstring effect of longus colli secondary to Luschkas  joint  hyperplasiaa potential factor contributing tocervical angina Running title: Bowstring effect for cervical angina Highlights: Thirty-eight patients affected by cervical vertebra disease were involved. All the patients in Group cervical angina relieved syndromes after operation. Bowstring effect of longus colli might be a factor contributing to cervical angina. Abstract Purpose: The aim of this study was to evaluate Luschkas joint hyperplasia and homolateral musculuslonguscolli atrophy and explore their role in cervical angina (CA) pathogenesis. Materials and Methods: After informed consent, 38 patients affected by cervical vertebra disease were included. Of these, 19 cervical angina patients were included as Group CA. As amatchedcontrol group (Group C), another 19 patients were included. All Patients were maintained under general anesthesia and underwent anterior cervical fusion surgeries. The degree of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy were evaluated using Japanese Orthopaedic Association Scores (JOA) score, Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score, and radiological parameters were also evaluated. Results: There was no significant difference in Cobb’s Angel, Sum ROM and Segment ROM between two groups. The osteophyte area of Luschka joint in Group CA was higher than that in Group C. The musculuslonguscolli area of the pathological cord segment in Group CA was lower than that in Group C. All the patients in Group CA relieved syndromes after operation, and there was no recurrence in follow-up. JOA score increased, while NDI score and VAS score decreased after operation in both two groups (P Conclusion: Anterior cervical surgery could effectively improve the symptoms of CA. Luschkasjointhyperplasia could result in bowstring effect of longus colli, which might be a pathogenic factor of CA. Evaluating the degree of Luschkasjointhyperplasia might assist in the diagnosis of CA. Keywords: cervical angina; bowstring effect; Luschkasjointhyperplasia; pathogenesis Introduction Chest pain is a frequent complaint in the Emergency Department (ED) in the world 1. Each year, more than 7 million patients present to EDs with chest pain 2. Only 20% to 25% of patients with acute chest pain will actually have acute coronary syndrome 3-5. Cervical angina (CA) is one potential cause of noncardiac chest pain being overlooked 6. It is defined as chest pain resembling true cardiac angina but originating from disorders of the cervical spine 7.Oille 8 firstly described the symptom in patients with chest pain of cervical nerve root origin. According to the Jacobs’s study 9, common manifestations associated with CA included arm and neck pain, upper arm radicular symptoms and fatigue, parasternal tenderness and occipital headache 10. Patients should be well aware of this presentation in their clinical examinations, unfortunately and in fact, a number of patients still appear to be diagnosed as coronary artery disease, and thus undergo unnecessary medications 10. Generally, CA originates from a cervical discopathy with nerve root compression 11,12. The pathogenesis of cervical angina can be explained by the fact that cervical neural roots from C4 to C8 contribute to the sensory and motor innervations associated with ante rior chest pain, and patients with true cervical angina are more likely to have disease at the C6 and/or C7 level 12. Some reports have indicated that anterior cervical surgery to correct nerve root or spinal cord compression might be a useful measure for CA 7. However, the diagnosis of cervical angina remains unresolved. The present study evaluated the degree of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy of 38 cases of cervical vertebra disease using Picture Archiving and Communication Systems (PACS), and aimed to explore their role in CA pathogenesis. Materials and methods Subjects Between June 2008 and June 2013, a total of 553 patients who underwent anterior cervical fusion surgeries enrolled the match-paired retrospective cohort study. Reviewing the clinical charts in retrospect, 489 patients had presented with complete follow-up (more than 12 months) data. Of these, 19 cervical angina patients were included as group cervical angina (Group CA). As amatchedcontrol group (Group C), another 19 patients were included according to age, gender, weight, most pathological cord segment, the number of pathological segment, the MRI high T2 signal and complications of Group CA. The inclusion criteria were as follows: (1) have cervical angina as their primary complaint; (2) consent to the standardized evaluation program at the cervical angina clinic 13. The exclusion criteria were as follows:(1) malignant disease; (2) cervical infection (specific/non-specific) or inflammatory joint disease; (3) cervical spine traum; (4) severe osteoporosis; (5)combined with heart disease. Surgical Technique All Patients were induced and maintained under general anesthesia. All surgeries were performed by one surgeon using as described previously 14-16. A right-side oblique incision was pursued for the anterior cervical spine, followed by Robinson’s anterior decompression and inter body fusion or subtotal spondylectomy with autologous iliac bone grafting. In ossified posterior longitudinal ligament, the essential technique was resection of the ossified plaque anteriorly with complete decompression of the spinal cord 16. The surgery was approved by local Ethical Committee and was performed in accordance with the ethical standards. All patients gave their informed consent prior to their inclusion in the study. Postoperative treatment Postoperative patients were treated with intravenous antibiotics for 3 days, and then replaced with oral antibiotics as anti-inflammatory therapy. The drainage tube and drainage fluid properties were carefully monitored, and cerebrospinal fluid leakage and neck hematoma were timely treated. The drainage tube was pulled up 24 hours after operation. Dehydrating agent was used to relieve reactive oedema caused by spinal cord decompression. Small dose of hormone therapy was employed for three days. Cervical X ray films were needed after operation, and a neck collar was fixed for six weeks. Follow-up exam was scheduled for more than 12 months. Detection index and postoperative evaluation CT (SIENMENS SOMATOM sensation cardiac 64, 120 kV, 300 mA, slicethickness: 1 mm, reconstruction slice: 1 mm, C1-T1) and MRI were performed in all patients. For MRI, T1- and T2-weighted images in at least two planes (in most cases a sagittal and an axial slice, Figure 1) were obtained from each patient. The Cobb’s Angel, Sum ROM, Segment ROM, Area of LJO and Area of LC were measured through X-ray filter, CT scan and MRI by two independent orthopedic surgeon 17. Disease-specific clinical data one week preoperatively and postoperatively collected measures included modified Japanese Orthopaedic Association Scores (JOA) score, Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score 18. Statistical analysis Data were analyzed usingSPSS 18.0 (SPSS Inc., Chicago, IL, USA). Continuous data are reported as means  ± standard deviation (SD). Paired t tests were used for comparing paired variables in the same vertebrae. Value of P Results Subjects’ characteristics Table 1 showed the characteristics of the included 38 patients. There was no difference in age, gender, weight and the number of pathological cord segment between Group CA (n=19) and Group C (n=19). There were 11 cases whose pathological cord segment located in C5/6, 8 cases in C6/7, 4 cases in single segment and 12 cases in 2 segments in both two groups. The median follow-up were 38.42  ± 15.06 months and 33.32  ± 12.69 months in Group CA and Group C, respectively. Clinical presentation before and after surgical treatment As shown in Table 2, there was no significant difference in Cobb’s Angel, Sum ROM and Segment ROM between the two groups. The osteophyte area of Luschka joint were 11.14  ± 4.11 mm2 and 9.56  ± 3.49 mm2 in left and right respectively of Group CA, which were 6.1  ± 2.19 mm2 (P 2 (P = 0.002) higher than those in Group C. The musculuslonguscolli area of the pathological cord segment were 51.56  ± 14.79mm2 and 58.58  ± 13.98 mm2 in left and right respectively of Group CA, which were 4.83  ± 13.43 mm2 (P 2 (P = 0.001à ¯Ã‚ ¼Ã¢â‚¬ °lower than those in Group C. The osteophyte area of Luschka joint in left of Group CA was higher than that in right, and the homolateral musculuslonguscolli area of the pathological cord segment was lower than contralateral area, while the differences were not statisticallysignificant. All the patients in Group CA relieved syndromes after operation, and there was no recurrence in follow-up. JOA score increased from 9.42  ± 1.86 to 12.89  ± 1.91 (P ) after operation in Group CA and increased from 9.42  ± 1.86 to 12.68  ± 1.89 (P (P P P > 0.05). VAS score decreased from 5.89  ± 5.89 to 2.63  ± 1.07 (P P P Discussion The current match-paired retrospective cohort study evaluated the degree of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy in 38 patients with cervical spine disease using JOA Scores, NDI, VAS scores and radiological parameters. The results showed that there was no significant difference in Cobb’s Angel, Sum ROM and Segment ROM between two groups (P Group C. The musculuslonguscolli area of the pathological cord segment in both left and right of Group CA were lower than those in Group C. All the patients in Group CA relieved syndromes after operation, and there was no recurrence in follow-up. JOA score increased, NDI score and VAS score decreased after operation in both Group CA and Group C (P P musculuslonguscolli atrophy might assist in the diagnosis of CA. Luschkasjointhyperplasia could result in homolateral musculuslonguscolli atrophy and bowstring effect, which might be a pathogenic factor of CA. Anterior cervical surgery could effectivelyimprove the symptoms of CA, while the subjective standards such as JOA could not well display the severity of the CA. CA, a noncardiac chest pain, is the most common pathological condition underlying pseudoangina 10. The mechanisms of pain production in cervical angina have been a matter of considerable speculation 19. Cervical spine disorders may often be present with pain in the upper anterior chest and scapular areas, resembling true angina pectoris 20. Some studies have suggested that pain in CA is a radicular pain, secondary to root compression by a herniated disk, osteoarthritic spurs, or compression in a narrow intervertebral foramen 21. While other studies have speculated that the referred pain may be caused by painful foci in the neck caused by factors such as disk degeneration, facet syndrome, or anterior or posterior longitudinal ligaments 22. Besides, some cervical angina is myelopathic pain 23. However, more and more investigators believe that CA is mediated through the sympathetic nervous system. The present study found 19 cases of CA, accounting for 3.8% of the surgical patients at the same period, which is similar to the scale of Nakajima 10. Among the 19 patients, 11 cases pained in the praecordia and accompanied by sweating, 5 cases pained in interscapular region and 3 cases pained in epigastrium. There were paroxysmal and continuous. It was worth mentioning that the preoperative JOA score was significantly higher in Group CA than that in Group CA, while there was no significant difference in JOA score and improvement rate between the two groups. JOA could only reflect the onset of the sensorimotor function and bladder function but not reflect the severity of the chest pain. The results found that the preoperative neurological function of Group CA was better than Group C, while the improvement rate of JOA period was lower than Group C. CA appears to be relatively unknown clinical syndrome compared with other angina. Prompt and accurate diagnosis requires a strong sense of suspicion in patients with inadequately explained chest pain. Routine MRI examination, or even if myelopathy is suspected, is insufficiently informative for the functional assessment of CA, a number of patients even appear to be diagnosed as coronary artery disease. Nine cases of patients were diagnosed in Department of Cardiology in the present study, and the other 10 cases presented chest pain without abnormal T wave, while the cervical spine MRI found definite compression of the spinal cord. All the 19 patients in Group CA relieved pain syndromes after cervical vertebra surgery, which proved the diagnosis of CA. It is necessary to indicate some limitations of this study. Firstly, as a match-paired retrospective cohort study, it was different to do completely same on the CA diagnostic criteria. Besides, although the population was highly selected according to the standards of match-paired retrospective cohort study, the patient sample was small, which would have caused selection bias.Furthermore, the osteophyte area of hyperplasia and the area of musculus longus colli were detected on MRI and CT respectively, and it was difficult to insure the same plane. Therefore, larger randomized studies and longer long-term studies are needed to evaluate the role of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy in the medical and surgical management of CA. In summary, the present data suggested that evaluating the degree of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy might assist in diagnosis of CA. Luschkasjointhyperplasia could result in homolateral musculuslonguscolli atrophy and bowstring effect, which might be a pathogenic factor of CA. Anterior cervical surgery could effectively improve the symptoms of CA, while the subjective standards such as JOA could not display the severity of the CA. Table 1 Clinical Characteristics of the Study Population CA, cervical angina Table 2 Image Examination of the Study Population Table 3 Function Scores of the Study Population JOA, Japanese Orthopaedic Association Scores score; NDI, Neck Disability Index score; VAS, Visual Analog Scale score Figure legends Figure 1 Area measuring of Luschkasjointhyperplasia and homolateral musculuslonguscolli atrophy A. targeting for biggest hyperplasia slice on CT axial; B area measuring of musculuslonguscolli according A. Figure 2 Comparation between two groups in subjective scores, * statistically significant. 1

Fluids And Solids Handling Technology Engineering Essay

Slurry is by and large defined as a thick suspension of solids in liquid. In a commercial slurry grapevine system we deal with assorted composings of slurries at changing distances. The grapevine building techniques for a coal slurry grapevine are about the same for a conventional grapevine. In a slurry grapevine system H2O is used as the chief conveyance medium. The ore is normally assorted with H2O by 50 % such that the slurry can be worked by the pumps and can be transported between the assorted phases. Slurries are divided into two groups harmonizing to their different features ; non-settling and settling slurries. In non-settling slurries, the all right atoms form a stable homogeneous mixtures exhibiting increased evident viscousness. This all right particles causes the slurry to act in a instead unusual manner than a normal liquid and are termed as non-Newtonian. On the other manus, settling slurries are formed by thick atoms signifiers an unstable mixture. The atoms have higher erosion belongingss and organize the bulk of slurry applications. They are termed as heterogenous slurries.[ 1 ]DrumheadSection ( a ) The maps of slurry conveyance can be composed into three major parts which are ; Slurry readying Conveying Dewatering of slurry Ore suppression and grinding Figure 1: Ore Oppressing Process In order for the mineral to be used more rationally, it must be processed and crushed into different sizes such that they can be worked upon by the staying parts of the grapevine system. The oppressing procedure can cut down the size of the ore by 8 inches or less holding decrease ratios of 4 to 10. The size of the ores depends upon the system demands runing from 150mm to less than 1mm in size. These crushed atoms can be farther grinded into smaller atoms ( up to micro metres in size ) such that they can be mixed with the working fluid, holding decrease ratios of 50 to 100. Sometimes by merchandises are added into the system so that the wet content can be retained in the system.coal crusher work rule Picture Mention: hypertext transfer protocol: //en.rockscrusher.com/wp-content/uploads/2012/05/coal-crusher-work-principle-286Ãâ€"300.jpg Cyclone centrifuges Figure 2: Cyclone centrifuge They are typically used to divide the crushed atoms to a needed size. They use the action of centrifugal force created by a digressive recess. The digressive recess produces a whirl in the system and the heavier atoms are collected on the underside and the igniter particles flight on the top called the whirl. The size of the atoms to be spectated depends on the diameter of the cyclone. Larger the diameter, larger the atom size. Thus cyclones are used in the grapevine system so that the needed partial size of the ore to be worked upon can be obtained. It is of import that the system is harder than the merchandise conveyed otherwise even the presence of little per centums of extremely scratchy stuffs will do terrible wear in the system.Cyclone Centrifuge Picture Mention: hypertext transfer protocol: //2.imimg.com/data2/PK/JO/MY-/cyclone-separator-250Ãâ€"250.jpg Pumps Figure 3: A Centrifugal slurry pump Usually for long grapevines the Piston stop positive supplanting pump are used. These pumps are robust, dependable and have great public presentation while working with slurryaa‚ ¬a„?s in a grapevine. It is a positive supplanting pump that uses the combination of a gum elastic or thermoplastic stop and a non-return cheque valves to pump the fluid. One of the chief advantage is that the pumping Chamberss and the slurry being pumped are non in contact with any close adjustment rotary sliding seals. There is no demand to utilize variable velocity drivers or motors because the capacities are varied within the pumps range. They can develop force per unit areas up to 125 pounds per square inchs when high suction lifts are required. Normally a power supply of 15MW is required to present power to these pumps. The discharge of the pump can be shut off at any clip for long periods of clip with no harm. Fluid force per unit area alleviation valv es or force per unit area control devices are non normally needed as pump discharge force per unit area can be no higher than the air force per unit area. They are self-priming with suction lifts up to 20 pess and more and can pump highly high barbarous fluids. These pumps can be submerged in fluids, even caustic fluids. They can work with immense scope of fluids, even those which are organic and caustic. hypertext transfer protocol: //img.directindustry.com/images_di/photo-g/hard-metal-centrifugal-slurry-pump-20610-2262577.jpg Picture Mention: hypertext transfer protocol: //img.directindustry.com/images_di/photo-g/hard-metal-centrifugal-slurry-pump-20610-2262577.jpg Grapevine The stuff of the pipe should be well much harder than the conveyed stuff such that there is no wear and tear. Their hardness should be greater than the stuff slurry. The pipes are made up of stuffs from high strength low metal steels to bimetallic and metallurgical bonded stuffs. These stuffs are normally enhanced even more to run into the system demands of the grapevine. Debasing the steel can better the strength and wear opposition, for illustration adding high degrees of C and manganese additions the tensile strength of mild steel by 70 % and the wear opposition by 20 % . Other debasing stuffs include chrome, nickel, V etc. The pipe diameter used should be such that the minimal slurry speed needed to forestall solid subsiding is achieved. Figure 4: Slurry Handling System including slurry keeping armored combat vehicle, slurry pump and slurry grapevine A figure of valves and adjustments are used in the system which overcomes obstructions and interruptions in the system. Dump pools might besides be used to pin down the slurry when interruptions and obstructions are needed to be tackled. The pipe stuff microstructure can be modified by cold working ( produces stronger and rougher stuff ) and by heat treating ( better profile than cold working and is done by fire or by initiation hardening ) . However the addition in material hardness decreases its malleable belongings and increases its crispness, therefore by slaking the interior of the surface of the pipe by intensive slaking engineering the needed hardness can be obtained. The outer surface will be still malleable which an advantage because it allows the easiness of transit. Picture Mention: hypertext transfer protocol: //ars.els-cdn.com/content/image/1-s2.0-S0892687510001160-gr1.jpg The interior bed of the pipe can be improved by run alonging it with a bed of wear tiles which are made up of stuffs that are harder than the pipe stuff. They can be cast as rings and layered inside the pipe. Depending on the atom size and form, every bit good as the belongings to absorb impact energy, gum elastic and high ductile polymers can be used to line the inside bed of the pipe. Sometimes double walled pipes are besides used in a grapevine system. It consists of a pipe holding two distinguishable stuffs, a high tensile strength outer pipe covering a hard-boiled inner pipe. This produces system in which the outer aa‚ ¬E?shellaa‚ ¬a„? absorbs the impacts of the interior pipe. However the hardened bed is non bonded to the outside pipe, and can do a plugging obstructor. This is tackled by utilizing bimetallistic pipes which rely on a metallurgical bond between two distinguishable chemical sciences. The interior pipe stuff can be selected depending on the slu rry being conveyed. The outer pipe can be selected by sing force per unit area capacity, lastingness and weld ability. Dewatering of Slurry At the discharge of a slurry grapevine it is indispensable to take the H2O so that the transported stuff can be worked with. It can be done automatically by utilizing filter imperativenesss, screens and extractors. Screening is normally used as the efficiency of dewatering depends on the atom size distribution. In the instance of coal, two phase cyclones are used for dewatering. The underflow from the cyclones is collected in a extractor to cut down the residuary moister content by 17 to 20 % . Hydro cyclones are besides used in some instances. Thermal drying is normally the last measure of the dewatering procedure. Section ( B ) Section ( degree Celsius )

The Pain of Ap Language and Composition Essay Student Samples Question 2

The Pain of Ap Language and Composition Essay Student Samples Question 2 Choosing Good Ap Language and Composition Essay Student Samples Question 2 Essays are a kind of commonly used academic writing in the area of education. Writing the background often provides you with a notion of how you wish to do the intro, and therefore you don't need to fret over it. The AP English Language and Composition Exam is utilized by colleges to evaluate your ability to do college-level work. Each one directs you to finish a particular sort of response. Just place your order for virtually any sort of essay, and it is going to be done at the maximal level. By writing a few of the essays from the next list, you're see what level of writing is required to pass your proficiency exam. Build a connection by means of your writing. When you have finished with your composition, it is quite important you take an instant and read over what you have written. Both have a broad array of expensive, elegant restaurants together with a similar quantity of global and national chains. Essayis a sort of composition. Let us first consider the significance of composition. Ap Language and Composition Essay Student Samples Question 2 and Ap Language and Composition Essay Student Samples Question 2 - The Perfect Combination Make certain your essay follows a particular format, consisting of the correct partsA of essay. You're able to employ the Best Essay Writing Service and receive an original customized essay written by a seasoned writer. An essay has to be composed of an introduction, a body, and a conclusion. When you're writing an English essay, you have zero opportunity to verify your paper by another individual. If you cannot determine what the question is, return and reread the prompt. The body should support your principal contention with supporting evidence and potential objections. The response is quite easy. Identify your own opinion on the matter. Doing this will enhance your AP writing. The AP English argument FRQ is easily the most straightforward of the AP English FRQs as it's the most like essays you're already utilised to writing. Regardless of what essay topic you were given, our essay generator will have the ability to finish your essay easily. Mind that downloading two or three literary analysis essay examples is a wonderful idea. After grasping the meaning of what's a literary analysis essay, it's necessary for you to read the bit of literature in question repeatedly. The trick to writing a great effectiveA essay is to get the passion to write it. The Unexposed Secret of Ap Language and Composition Essay Student Samples Question 2 There are different things in life, like dirty floors, and relationships which don't always do the job, and meals which must be made. Today, huge numbers of people wish to learn or enhance their English. however, it is hard to obtain the very best method. You don't need to make significant adjustments to your life. Firstly, you're going to be in a position to follow the language all the time you're in the nation. Putting a plan in place may also help save you time later as you'll have the ability to rearrange things even before you commence writing. Let's say that you're writing an essay on The important causes of Road Accidents in your City, it's obvious you're going to develop two or three points. The very first room, through the door, is the principal portion of the restaurant. It's therefore imperative you make sure you thoroughly plan it well and earn a draft (rough work) of the things which you're going to be discussing before you transfer the draft into the home work.

John Steinbeck s Of Mice And Men - 1397 Words

In the 1930s, a variety of different events has transpired, including a detrimental downfall in the American economy known as The Great Depression. During this time, many people suffered the wrath of poverty and unemployment, which ravaged through this epoch. Furthermore, American citizens were forced to be parsimonious, pitching every penny that came their way. While the value of the stock market plummeted, the American perspective on life swelled, creating what many saw as â€Å"The American Dream.† The dream that Americans, no matter the position, heritage, or gender, has an equal opportunity for a better life. In John Steinbeck s â€Å"Of Mice and Men,† two migrant workers have a dream of, one day, achieving prosperity through obtaining a ranch of their own. Throughout their endeavor, however, it is shown that their ambitions are torn down, never to be accomplished. As discerned throughout this novella, it is probable that through George, Lennie, and even Curleyâ €™s wife that Steinbeck is trying to send the reader a message about the actuality of the American Dream.† Steinbeck exemplifies through this message that the American Dream is conceptual, yet unattainable because of the grim face of reality. From the beginning chapters of â€Å"Of Mice and Men,† the reader can identify the ideals of George’s ambition of possessing a ranch of his own. Upon the analysis of his dream, it is revealed that George’s desires mirror those of the American Dream. This is due to the fact thatShow MoreRelatedJohn Steinbeck s Of Mice And Men1248 Words   |  5 PagesIn Steinbeck s novel Of Mice and Men, He uses imagery many times to create a realistic setting and plot. Steinbeck’s depiction of migrant workers and their daily complications during the depression are objectively precise due to his use of imagery with idioms, dreams, nature, loneliness and animal imagery. 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John Steinbeck uses Crooks’ situationRead MoreJohn Steinbeck s Of Mice And Men968 Words   |  4 PagesSolidifying the theme of John Steinbeck’s Of Mice and Men, the protagonist George expresses his significant loneliness despite a strong kinship with his friend Lennie, â€Å"’I ain’t got no people†¦ I seen the guys that go around the ranches alone. That ain’t no good’† (41). Published in 1937, amidst the horrific turmoil of the Great Depression, Steinbeck’s novella struck a sensitive chord with readers. Set in the heart of California’s Central Valley, this story follows two men, George and Lennie, as they