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The article focuses on research on surgical procedures for the ophthalmic-maxillary nerve trunks in laboratory rats. It comments on a method of exposing the retroorbital and pterygopalatine fossae of rats for exposure of the major ophthalmic-maxillary nerve trunks using surgery. It mentions that associated peripheral and autonomic nerve branches are also exposed. It comments on anesthetic procedures, which includes utilizing a lidocaine solution mixed with epinephrine injected behind the eyeball to provide extra anesthesia, partially herniating the eyeball from its orbit, and helping in hemostasis. It talks about the surgical procedure to expose the nerve and mentions that the procedure results in few postoperative infections and can even be used on newborn rats.

Domain microstructures in single crystal lamellae of 88%Pb(Zn1/3Nb2/3)O3-12%PbTiO3 (cut from bulk using focused ion beam milling) have been mapped using both piezoresponse force microscopy and transmission electron microscopy. Dramatic changes from mottled microstructures typical of relaxors to larger scale domains typical of ferroelectrics have been noted. Stresses associated with substrate clamping are suspected as the cause for the transition from short- to long-range polar order, akin to effects induced by cation ordering achieved by thermal quenching. [ABSTRACT FROM AUTHOR]

The extent to which notches inhibit axial switching of polarization in ferroelectric nanowires was investigated by monitoring the switching behavior of single crystal BaTiO3 wires before and after patterning triangular notches along their lengths. Static zero-field domain patterns suggested a strong domain-notch interaction, implying that notches should act as pinning sites for domain wall propagation. Surprisingly though, notches appeared to assist, rather than inhibit, polar switching. The origin of this effect was rationalized using finite element modeling of the electric field distribution along the notched wire; it was found that the air gap associated with the notch acted to enhance the local field, both in the air, and in the adjacent region of the ferroelectric. It seems that this local field enhancement outweighs any pinning interactions. [ABSTRACT FROM AUTHOR]

Thin lamellae were cut from bulk single crystal BaTiO3 using a focused ion beam microscope. They were then removed and transferred onto single crystal MgO substrates, so that their functional properties could be measured independent of the original host bulk ferroelectric. The temperature dependence of the capacitance of these isolated single crystal films was found to be strongly bulklike, demonstrating a sharp Curie anomaly, as well as Curie–Weiss behavior. In addition, the sudden change in the remanent polarization as a function of temperature at TC was characteristic of a first order phase change. The work represents a dramatic improvement on that previously published by Saad et al. [J. Phys.: Condens. Matter 16, L451 (2004)], as critical shortcomings in the original specimen geometry, involving potential signal contributions from bulk BaTiO3, have now been obviated. That the functional properties of single crystal thin film lamellae are comparable to bulk, and not like those of conventionally deposited heterogeneous thin film systems, has therefore been confirmed. [ABSTRACT FROM AUTHOR]

The International Roadmap for Ferroelectric Memories requires three-dimensional integration of high-dielectric materials onto metal interconnects or bottom electrodes by 2010. Here, we demonstrate the possibility of conformally coating carbon nanotubes with high-dielectric oxide as a first step toward ultrahigh integration density of three-dimensional ferroelectric random access memories. [ABSTRACT FROM AUTHOR]

We have studied the atomic force microscopy (AFM), X-ray Bragg reflections, X-ray absorption spectra (XAS) of the Pd L-edge, Scanning electron microscopey (SEM) and Raman spectra, and direct magnetoelectric tensor of Pd-substituted lead titanate and lead zirconate-titanate. A primary aim is to determine the percentage of Pd+4 and Pd+2 substitutional at the Ti-sites (we find that it is almost fully substitutional). The atomic force microscopy data uniquely reveal a surprise: both threefold vertical (polarized out-of-plane) and fourfold in-plane domain vertices. This is discussed in terms of the general rules for Voronoi patterns (Dirichlet tessellations) in two and three dimensions. At high pressures Raman soft modes are observed, as in pure lead titanate, and X-ray diffraction (XRD) indicates a nearly second-order displacive phase transition. However, two or three transitions are involved: First, there are anomalies in c/a ratio and Raman spectra at low pressures (P = 1 − 2 GPa); and second, the c/a ratio reaches unity at ca. P = 10 GPa, where a monoclinic (Mc) but metrically cubic transition occurs from the ambient tetragonal P4 mm structure in pure PbTiO3; whereas the Raman lines (forbidden in the cubic phase) remain until ca. 17 GPa, where a monoclinic-cubic transition is known in lead titanate. [ABSTRACT FROM AUTHOR]

In 1949, Forsbergh, Jr. reported spontaneous spatial ordering in the birefringence patterns seen in flux-grown BaTiO3 crystals under the transmission polarized light microscope [Phys. Rev. 76, 1187 (1949)]. Stunningly regular square-net arrays were often only found within a finite temperature window and could be induced on both heating and cooling, suggesting genuine thermodynamic stability. At the time, Forsbergh rationalized the patterns to have resulted from the impingement of ferroelastic domains, creating a complex tessellation of variously shaped domain packets. However, no direct evidence for the intricate microstructural arrangement proposed by Forsbergh has subsequently been found. Moreover, there are no robust thermodynamic arguments to explain the finite region of thermal stability, its occurrence just below the Curie temperature, and the apparent increase in entropy associated with the loss of the Forsbergh pattern on cooling. Despite decades of research on ferroelectrics, this ordering phenomenon and its thermodynamic origin have hence remained a mystery. In this paper, we reexamine the microstructure of flux-grown BaTiO3 crystals, which show Forsbergh birefringence patterns. Given an absence of any obvious arrays of domain polyhedra or even regular shapes of domain packets, we suggest an alternative origin for the Forsbergh pattern in which sheets of orthogonally oriented ferroelastic stripe domains simply overlay one another. We show explicitly that the Forsbergh birefringence pattern occurs if the periodicity of the stripe domains is above a critical value. Moreover, by considering well-established semiempirical models, we show that the significant domain coarsening needed to generate the Forsbergh birefringence is fully expected in a finite window below the Curie temperature. We hence present a much more straightforward rationalization of the Forsbergh pattern than that originally proposed in which exotic thermodynamic arguments are unnecessary. [ABSTRACT FROM AUTHOR]

Domain walls in Cu-Cl boracite develop as a consequence of an improper ferroelastic, improper ferroelectric transition, and have attracted close interest because some are conductive and all can be mechanically written and repositioned by application of an electric field. The phase transition and its associated dynamical properties have been analysed here from the perspective of strain and elasticity. Determination of spontaneous strains from published lattice parameter data has allowed the equilibrium long-range order parameter for F [Formula: see text]3c → Pca2 1 to be modelled simply as being close to the order-disorder limit. High acoustic loss in the cubic phase, revealed by resonant ultrasound spectroscopy, is consistent with the presence of dynamical microdomains of the orthorhombic structure with relaxation times in the vicinity of ∼10 -5 -10 -6  s. Low acoustic loss in the stability field of the orthorhombic structure signifies, on the other hand, that ferroelastic twin walls which develop as a consequence of the order-disorder process are immobile on this time scale. A Debye loss peak accompanied by ∼1% elastic stiffening at ∼40 K is indicative of some freezing of defects which couple with strain or of some more intrinsic freezing process. The activation energy of ⩾∼0.01-0.02 eV implies a mechanism which could involve strain relaxation clouds around local ferroelectric dipoles or freezing of polarons that determine the conductivity of twin walls.

Application of conducting ferroelectric domain walls (DWs) as functional elements may facilitate development of conceptually new resistive switching devices. In a conventional approach, several orders of magnitude change in resistance can be achieved by controlling the DW density using supercoercive voltage. However, a deleterious characteristic of this approach is high-energy cost of polarization reversal due to high leakage current. Here, we demonstrate a new approach based on tuning the conductivity of DWs themselves rather than on domain rearrangement. Using LiNbO 3 capacitors with graphene, we show that resistance of a device set to a polydomain state can be continuously tuned by application of subcoercive voltage. The tuning mechanism is based on the reversible transition between the conducting and insulating states of DWs. The developed approach allows an energy-efficient control of resistance without the need for domain structure modification. The developed memristive devices are promising for multilevel memories and neuromorphic computing applications.

Enhanced conductivity at specific domain walls in ferroelectrics is now an established phenomenon. Surprisingly, however, little is known about the most fundamental aspects of conduction. Carrier types, densities and mobilities have not been determined and transport mechanisms are still a matter of guesswork. Here we demonstrate that intermittent-contact atomic force microscopy (AFM) can detect the Hall effect in conducting domain walls. Studying YbMnO 3 single crystals, we have confirmed that p-type conduction occurs in tail-to-tail charged domain walls. By calibration of the AFM signal, an upper estimate of ∼1 × 10 16 cm -3 is calculated for the mobile carrier density in the wall, around four orders of magnitude below that required for complete screening of the polar discontinuity. A carrier mobility of∼50 cm 2 V -1 s -1 is calculated, about an order of magnitude below equivalent carrier mobilities in p-type silicon, but sufficiently high to preclude carrier-lattice coupling associated with small polarons.

For over a decade, controlling domain-wall injection, motion and annihilation along nanowires has been the preserve of the nanomagnetics research community. Revolutionary technologies have resulted, like racetrack memory and domain-wall logic. Until recently, equivalent research in analogous ferroic materials did not seem important. However, with the discovery of sheet conduction, the control of domain walls in ferroelectrics has become vital for the future of what has been termed 'domain-wall electronics'. Here we report the creation of a ferroelectric domain-wall diode, which allows a single direction of motion for all domain walls, irrespective of their polarity, under a series of alternating electric field pulses. The diode's sawtooth morphology is central to its function. Domain walls can move readily in the direction in which thickness increases gradually, but are prevented from moving in the other direction by the sudden thickness increase at the sawtooth edge.

Recently, lead iron tantalate/lead zirconium titanate (PZTFT) was demonstrated to possess large, but unreliable, magnetoelectric coupling at room temperature. Such large coupling would be desirable for device applications but reproducibility would also be critical. To better understand the coupling, the properties of all 3 ferroic order parameters, elastic, electric, and magnetic, believed to be present in the material across a range of temperatures, are investigated. In high temperature elastic data, an anomaly is observed at the orthorhombic mm2 to tetragonal 4mm transition, T ot = 475 K, and a softening trend is observed as the temperature is increased toward 1300 K, where the material is known to become cubic. Thermal degradation makes it impossible to measure elastic behavior up to this temperature, however. In the low temperature region, there are elastic anomalies near ≈40 K and in the range 160-245 K. The former is interpreted as being due to a magnetic ordering transition and the latter is interpreted as a hysteretic regime of mixed rhombohedral and orthorhombic structures. Electrical and magnetic data collected below room temperature show anomalies at remarkably similar temperature ranges to the elastic data. These observations are used to suggest that the three order parameters in PZTFT are strongly coupled.

Freestanding BaTiO3 nanodots exhibit domain structures characterized by distinct quadrants of ferroelastic 90° domains in transmission electron microscopy (TEM) observations. These differ significantly from flux-closure domain patterns in the same systems imaged by piezoresponse force microscopy. Based upon a series of phase field simulations of BaTiO3 nanodots, we suggest that the TEM patterns result from a radial electric field arising from electron beam charging of the nanodot. For sufficiently large charging, this converts flux-closure domain patterns to quadrant patterns with radial net polarizations. Not only does this explain the puzzling patterns that have been observed in TEM studies of ferroelectric nanodots, but also suggests how to manipulate ferroelectric domain patterns via electron beams.

In specific solid-state materials, under the right conditions, collections of magnetic dipoles are known to spontaneously form into a variety of rather complex geometrical patterns, exemplified by vortex and skyrmion structures. While theoretically, similar patterns should be expected to form from electrical dipoles, they have not been clearly observed to date: the need for continued experimental exploration is therefore clear. In this Letter we report the discovery of a rather complex domain arrangement that has spontaneously formed along the edges of a thin single crystal ferroelectric sheet, due to surface-related depolarizing fields. Polarization patterns are such that nanoscale "flux-closure" loops are nested within a larger mesoscale flux closure object. Despite the orders of magnitude differences in size, the geometric forms of the dual-scale flux closure entities are rather similar.

Single-phase magnetoelectric multiferroics are ferroelectric materials that display some form of magnetism. In addition, magnetic and ferroelectric order parameters are not independent of one another. Thus, the application of either an electric or magnetic field simultaneously alters both the electrical dipole configuration and the magnetic state of the material. The technological possibilities that could arise from magnetoelectric multiferroics are considerable and a range of functional devices has already been envisioned. Realising these devices, however, requires coupling effects to be significant and to occur at room temperature. Although such characteristics can be created in piezoelectric-magnetostrictive composites, to date they have only been weakly evident in single-phase multiferroics. Here in a newly discovered room temperature multiferroic, we demonstrate significant room temperature coupling by monitoring changes in ferroelectric domain patterns induced by magnetic fields. An order of magnitude estimate of the effective coupling coefficient suggests a value of ~1 × 10(-7) sm(-1).

Domain states in PbZr((0.42))Ti((0.58))O(3) single-crystal ferroelectric nanodots, formed on cooling through the Curie temperature, were imaged by transmission electron microscopy. In the majority of cases, 90° stripe domains were found to form into four distinct "bundles" or quadrants. Detailed analysis of the dipole orientations in the system was undertaken, using both dark-field imaging and an assumption that charged domain walls were energetically unfavorable in comparison to uncharged walls. On this basis, we conclude that the dipoles in these nanodots are arranged such that the resultant polarizations, associated with the four quadrant domain bundles, form into a closed loop. This "polarization closure" pattern is reminiscent of the flux-closure already commonly observed in soft ferromagnetic microdots but to date unseen in analogous ferroelectric dots.

Over 60 years ago, Charles Kittel predicted that quadrant domains should spontaneously form in small ferromagnetic platelets. He expected that the direction of magnetization within each quadrant should lie parallel to the platelet surface, minimizing demagnetizing fields,and that magnetic moments should be configured into an overall closed loop, or flux-closure arrangement. Although now a ubiquitous observation in ferromagnets, obvious flux-closure patterns have been somewhat elusive in ferroelectric materials. This is despite the analogous behaviour between these two ferroic subgroups and the recent prediction of dipole closure states by atomistic simulations research. Here we show Piezoresponse Force Microscopy images of mesoscopic dipole closure patterns in free-standing, single-crystal lamellae of BaTiO(3). Formation of these patterns is a dynamical process resulting from system relaxation after the BaTiO(3) has been poled with a uniform electric field. The flux-closure states are composed of shape conserving 90° stripe domains which minimize disclination stresses., (© 2011 Macmillan Publishers Limited. All rights reserved.)

Naturally occurring boundaries between bundles of 90° stripe domains, which form in BaTiO(3) lamellae on cooling through the Curie Temperature, have been characterized using both piezoresponse force microscopy (PFM) and scanning transmission electron microscopy (STEM). Detailed interpretation of the dipole configurations present at these boundaries (using data taken from PFM) shows that in the vast majority of cases they are composed of simple zigzag 180° domain walls. Topological information from STEM shows that occasionally domain bundle boundaries can support chains of dipole flux closure and quadrupole nanostructures, but these kinds of boundaries are comparatively rare; when such chains do exist, it is notable that singularities at the cores of the dipole structures are avoided. The symmetry of the boundary shows that diads and centers of inversion exist at positions where core singularities should have been expected.

Changes in domain wall mobility, caused by the presence of antinotches in single crystal BaTiO(3) nanowires, have been investigated. While antinotches appeared to cause a slight broadening in the distribution of switching events, observed as a function of applied electric field (inferred from capacitance-voltage measurements), the effect was often subtle. Greater clarity of information was obtained from Rayleigh analysis of the capacitance variation with ac field amplitude. Here the magnitude of the domain wall mobility parameter (alpha) associated with irreversible wall movements was found to be reduced by the presence of antinotches--an effect which became more noticeable on heating toward the Curie temperature. The reduction in this domain wall mobility was contrasted with the noticeable enhancement found previously in ferroelectric wires with notches. Finite element modeling of the electric field, developed in the nanowires during switching, revealed regions of increased and decreased local field at the center of the notch and antinotch structures, respectively; the absolute magnitude of field enhancement in the notch centers was considerably greater than the field reduction in the center of the antinotches and this was commensurate with the manner in, and degree to, which domain wall mobility appeared to be affected. We therefore conclude that the main mechanism by which morphology alters the irreversible component of the domain wall mobility in ferroelectric wire structures is via the manner in which morphological variations alter the spatial distribution of the electric field.

Almost free-standing single crystal mesoscale and nanoscale dots of ferroelectric BaTiO(3) have been made by direct focused ion beam patterning of bulk single crystal material. The domain structures which appear in these single crystal dots, after cooling through the Curie temperature, were observed to form into quadrants, with each quadrant consisting of fine 90 degrees stripe domains. The reason that these rather complex domain configurations form is uncertain, but we consider and discuss three possibilities for their genesis: first, that the quadrant features initially form to facilitate field-closure, but then develop 90 degrees shape compensating stripe domains in order to accommodate disclination stresses; second, that they are the result of the impingement of domain packets which nucleate at the sidewalls of the dots forming "Forsbergh" patterns (essentially the result of phase transition kinetics); and third, that 90 degrees domains form to conserve the shape of the nanodot as it is cooled through the Curie temperature but arrange into quadrant packets in order to minimize the energy associated with uncompensated surface charges (thus representing an equilibrium state). While the third model is the preferred one, we note that the second and third models are not mutually exclusive.

We present a novel method for creating damage-free ferroelectric nanostructures with a focused ion beam milling machine. Using a standard e-beam photoresist followed by a dilute acid wash, nanostructures ranging in size from 1 µm down to 250 nm were created in a 90 nm thick lead zirconate titanate (PZT) wafer. Transmission electron microscopy and piezoresponse force microscopy (PFM) confirmed that the surfaces of the nanostructures remained damage free during fabrication, and showed no gallium implantation, and that there was no degradation of ferroelectric properties. In fact DC strain loops, obtained using PFM, demonstrated that the nanostructures have a higher piezoresponse than unmilled films. As the samples did not have any top hard mask, the method presented is unique as it allows for imaging of the top surface to understand edge effects in well-defined nanostructures. In addition, as no post-mill annealing was necessary, it facilitates investigation of nanoscale domain mechanisms without process-induced artefacts.

Periodic arrays of nanorings of morphotropic phase boundary lead zirconium titanate (PZT) have been successfully fabricated using a novel self-assembly technique: close-packed monolayers of latex nanospheres were deposited onto Pt-coated silicon substrates, and then plasma cleaned to form ordered arrays of isolated nanospheres, not in contact with each other. Subsequent pulsed laser deposition of PZT, high angle argon ion etching and thermal annealing created the arrays of isolated nanorings, with diameters of ∼100 nm and wall thicknesses of ∼10 nm. Energy dispersive x-ray analysis confirms that the rings are compositionally morphotropic phase boundary PZT, and high resolution transmission electron microscopy imaging of lattice fringes demonstrates some periodicities consistent with perovskite rather than pyrochlore material. The dimensions of these nanorings, and the expected 'soft' behaviour of the ferroelectric material from which they are made, means that they offer the most likely opportunity to date for observing whether or not vortex arrangements of electrical dipoles, analogous to those seen in ferromagnetic nanostructures, actually exist.

We review the current state of the art in EELS fingerprinting by computer simulation, focusing on the bandstructure approach to the problem. Currently calculations are made using a one electron theory, but we describe in principle the way to go beyond this to include final state effects. We include these effects within the one electron framework using the Slater transition state formula and assess the errors involved. Two examples are then given which illustrate the use of the one electron approximation within density functional theory. Our approach is to combine predicted atomic structure with predicted electronic structure to assist in fingerprinting of complex crystal structures.

Objective: To develop an arthroscopic approach to, and describe the arthroscopic anatomy of, the equine temporomandibular joint (TMJ)., Study Design: Cadaveric study, after which the technique was tested in horses., Animals or Sample Population: Ten cadaveric equine heads and 5 normal horses (age, 5-13 years; weight, 425-545 kg)., Methods: Specimens or horses were positioned in right lateral recumbency. After fluid distention of the TMJ, arthroscopic portals were made in the dorsal compartment over the most prominent portion of the joint outpouching (caudodorsal approach) and in rostral and intermediate locations. The joint was explored and photographed. Positional changes in the mandible were made to determine if observation of the joint could be improved. Instrument portals were created to assess the feasibility of surgical arthroscopy. Cadaveric heads were dissected to assess iatrogenic damage, whereas experimental horses were observed for postoperative complications for 30 days., Results: A caudodorsal arthroscopic approach provided the best evaluation of the dorsal compartment of the TMJ. The approach allowed observation of the rostral and caudal synovial pouches and the lateral aspect of the joint including the articular disc. Examination of the medial aspect of the joint was limited to the most rostral and caudal aspects. Access to the lateral aspect of the ventral compartment of the TMJ was precluded by the position of the transverse facial artery and vein. In specimens, iatrogenic damage was minimal and limited to the articular fibrocartilage, articular disc, and penetration of the parotid salivary gland. If the latter also occurred in horses, no adverse effects were noted. In horses, mild fluid extravasation occurred and resolved within 1 day. All horses ate normally after surgery but had periarticular swelling and mild pain upon palpation of the TMJ for 2 days., Conclusions: A caudodorsal arthroscopic approach to the TMJ allowed adequate observation of the lateral aspect of the dorsal compartment of the joint. Access to the ventral compartment was precluded by the location of the transverse facial artery and vein., Clinical Relevance: Conditions affecting the lateral and caudal aspects of the dorsal compartment of the TMJ should be visible by arthroscopy., (Copyright 2001 by The American College of Veterinary Surgeons)

Objective: To measure the effects of 4 weeks of nasal positive airway pressure therapy (PAP) on exercise performance in obstructive sleep apnea patients (OSA).Background: Little published research is available which describes the effects of OSA on exercise tolerance or upon the potential of exercise testing to evaluate the outcomes of PAP therapy.Methods: Exercise testing was performed on an electronic cycle ergometer with continuous ramping to allow collection of numerous data points for each subject, up to a vigorous terminal intensity. Linear regression established each subject's pre-treatment scores for the dependent variables at 60% of estimated peak power (W(60%)). Responses at the pre-treatment W(60%) test were used to quantify and compare to responses at the same power output after treatment.Results: OSA by nocturnal polysomnography was moderately severe in this group; the respiratory distress index was 48+/-22 (mean+/-SD; n=9). Exercise heart rates after PAP therapy averaged 10.2 bt/min less at W(60%) (P<0.05). Other variables were lower but non-significantly so, further suggesting a lower cardiorespiratory exercise demand after treatment, i.e. oxygen consumption ( downward arrow7.6%), and Rating of Perceived Exertion ( downward arrow8.8%).Conclusion: Brief treatment with PAP therapy improves objective markers of aerobic exercise performance.

Injuries to trigeminal nerves during endosseous implant placement in the posterior mandible appear to occur acutely in approximately 5-15 of cases, with permanent neurosensory disorder resulting in approximately 8%. Nerve lateralization holds even higher risks from epineurial damage or ischaemic stretching. Neuropathy from implant compression and drill punctures can result in neuroma formation of all types, and in some cases precipitate centralized pain syndrome. Two patterns of clinical neuropathy are seen to result; hypoaesthesias with impaired sensory function, often seen with phantom pain, and hyperaesthesias with minimal sensory impairment but presence of much-evoked pain phenomena. The clinician must differentiate, through careful patient questioning and stimulus-response testing, those patients who are undergoing satisfactory spontaneous nerve recovery from those who are developing dysfunctional or dysaesthetic syndromes. Acute nerve injuries are treated with fixture and nerve decompression and combined with supportive anti-inflammatory, narcotic and anti-convulsant therapy. Surgical exploration, neuroma resection and microsurgical repair, with or without nerve grafting, are indicated when unsatisfactory spontaneous sensory return has been demonstrated, and in the presence of function impairment and intractable pain.

Obstructive sleep apnoea (OSA) affects up to 24% of middle aged males, resulting in excessive daytime sleepiness, cognitive dysfunction, hypertension, increased risks for acute coronary events, stroke and auto accidents. At special risk are individuals with BMI greater than 29, neck circumference greater than 43 cm (17 inches), macroglossia and retrognathia. Although non-surgical nasal positive air pressure (nCPAP) and mandibular advancement oral appliances are often effective and are the most widely used therapy, they are not definitive for more severe OSA and patients show poor long-term compliance. Surgical reduction of palatal, lingual and nasal soft tissue volumes improve airway functions in approximately 40% of patients with mild to moderate OSA. Maxillary and mandibular advancement osteotomies have proven over the past decade to reverse even severe OSA at greater than the 90% efficacy levels. Surgical treatment targeted to skeletal and airway soft tissue anomalies using a multidisciplinary treatment approach can have a major impact on this widespread and high-risk disorder.

Purpose: The accuracy of the clinical neurosensory test to diagnose trigeminal nerve injuries has never been statistically evaluated. The purpose of this study was to determine the statistical efficacy of the clinical neurosensory test using surgical findings as the "gold" standard, and to determine whether a correlation existed between the sensory impairment score obtained by preoperative testing and the degree of nerve injury found at surgery., Materials and Methods: A multisite, randomized, prospective, blinded, clinical trial was conducted on 130 patients with inferior alveolar nerve (IAN) and lingual nerve (LN) injuries. Preoperatively, patients were provided a sensory impairment score using a three-level drop-out clinical neurosensory test (NST), and blind comparisons were made with the surgical findings postoperatively., Results: The positive predictive and negative predictive values for LN-injured patients were 95% and 100%, respectively. The positive predictive and negative predictive values for IAN patients were 77% and 60%, respectively. There were statistically significant differences in the distribution of age, duration of injury, cause of injury, presence of neuropathic pain, presence of trigger pain, and degree of injury between the IAN and LN patient populations. There was a statistically significant positive relationship found between the sensory impairment score and the degree of nerve injury., Conclusions: The NST is a clinically useful method to diagnose IAN and LN injuries. However, the NST results are less efficient for IAN injuries than LN injuries, and have a high incidence of false-positive (23%) and false-negative (40%) results when testing patients with IAN injuries. The different rates of statistical efficiency between the two groups of patients may be attributable to differences in prevalence and biologic covariates.

Microsurgical exploration of injured trigeminal nerves in patients with neuralgia revealed four variations of traumatic neuroma, associated foreign objects, and a sprouting of nerve collaterals from adjacent uninjured nerve. A comprehensive theory of traumatic trigeminal pain is proposed based on three sites of pathosis: peripheral neuroma, somatic and autonomic collateralization, and central deafferentation pathoses. Anesthesia dolorosa is related in this model to amputation neuromas and central pathosis. Sympathetic mediated pain is attributed to autonomic C-fiber units in peripheral injured zones. Hyperalgesia is attributed to mechanosensitive A-fiber units in the nerves being linked to corresponding irritable central nervous system neurons. Hyperpathia is explained on the basis of ephaptic transmission between adjacent fibers in neuromas.

Patients with chronic pain following trigeminal nerve injuries were studied before and after microsurgical repairs using the McGill Pain Language Inventory, sensory reflex testing, and assessment of pain relief from nerve blocks. This protocol differentiated four syndrome types that appeared singly or in combination: anesthesia dolorosa (AD), sympathetic mediated pain (SMP), hyperalgesia, and hyperpathia. Trigeminal nerve blocks proved to be good predictors of pain relief from microsurgical treatments. Surgical pain reduction was poor for AD and SMP (14.6% and 20.7%) as compared with hyperalgesia and hyperpathia (60.5% and 56.3%).

This study evaluated the effects of several psychological factors on postsurgical recovery while controlling for and also evaluating the effects of the physical trauma induced by the surgery. Subjects were 38 patients (18 males and 20 females) who were scheduled to have four third molars surgically removed. The psychological factors measured included anxiety and expectations about recovery, trait anxiety, coping behaviors, and health locus of control. Surgical trauma was rated after surgery, and the following aspects of recovery were monitored: postoperative pain, interference with normal function, swelling, and healing. Poorer postoperative recovery was significantly predicted by each of the psychological variables and by higher levels of surgical trauma. In addition, the effects of the psychological variables on recovery were shown to be largely independent of the trauma effects. The data suggest that (a) future studies which give patients more positive expectations and reduce their anxiety about recovery may improve their recovery and (b) the types of patients most in need of preoperative psychological support would be those who have higher trait anxiety, vigilant coping behaviors, or an internal locus of control.

The respiratory depressant effects of fentanyl, diazepam, and methohexital were studied in 18 patients who were breathing room air. Two patients had 70% oxygen supplementation administered by a nasal inhaler. Varying degrees of hypoxia occurred when the narcotic was given but hypoxia was not seen in patients who received diazepam alone. The hypoxic changes may be attributed to various physiological responses and can probably be prevented with administration of adequate oxygen.

Neurologic alteration in 36 patients who had received either a sagittal split osteotomy, an intraoral vertical ramus osteotomy, or a mandibular vestibuloplasty was evaluated by questionnaire, detailed neurosensory examination, and personality testing. Subjective sensory alteration was reported by 69.4% of the entire group; neurosensory examination showed demonstrable neuropathy in 54% of the 72 nerve divisions that were examined, with the greatest incidence, 84.6%, in the group that had received sagittal split osteotomies. Personality testing indicated that dysesthetic patients experienced greater degrees of neuroticism and depression than did patients without pain.

Fifty-five clinical trials were conducted to determine the cardiovascular combined effects of stressful oral surgery and systemic cannabinols. In a first study, delta9-tetrahydrocannabinol (THC) was given IV as a premedicant and compared with diazepam and with a placebo. A classic dose-related tachycardia followed THC injection. The peak heart rate response of patients premedicated with 0.044 mg/kg THC was 24.1% higher (p less than 0.05) than the peak effect for a nonsurgerized control group, suggesting a synergistic effect between THC and surgical stress. A predisposition to syncopal hypotension followed THC premedication, and antiarrhythmic effects were observed after large doses. The injection of local anesthetic preparations containing epinephrine did not alter THC cardiovascular response. An apparent drug interaction was observed, however, in a second study, in patients given general anesthesia within 72 hours after smoking marijuana. These patients demonstrated sustained abnormal postoperative tachycardia when compared with control nonsmokers, an effect which may have resulted from an interaction between stored cannabinol metabolites and atropine administered as part of the anesthetic technic. It was concluded that THC had no particular advantage over diazepam or placebo as a premedicant. Further, THC altered the patients' adaptivity to stress and interacted undesirably with other anesthetic medications.

Twelve obese women were studied to determine the effects of the combination of an aerobic exercise program with either a high carbohydrate (HC) very-low-caloric diet (VLCD) or a low carbohydrate (LC) VLCD diet on resting metabolic rate (RMR), serum thyroxine (T4), 3,5,3'-triiodothyronine (T3), and 3,5,3'-triiodothyronine (rT3). The response of these parameters was also examined when subjects switched from the VLCD to a mixed hypocaloric diet. Following a maintenance period, subjects consumed one of the two VLCDs for 28 days. In addition, all subjects participated in thrice weekly submaximal exercise sessions at 60% of maximal aerobic capacity. Following VLCD treatments, participants consumed a 1,000 kcal mixed diet while continuing the exercise program for one week. Measurements of RMR, T4, T3, and rT3 were made weekly. Weight decreased significantly more for LC than HC. Serum T4 was not significantly affected during the VLCD. Although serum T3 decreased during the VLCD for both groups, the decrease occurred faster and to a greater magnitude in LC (34.6% mean decrease) than HC (17.9% mean decrease). Serum rT3 increased similarly for each treatment by the first week of the VLCD. Serum T3 and rT3 of both groups returned to baseline concentrations following one week of the 1,000 kcal diet. Both groups exhibited similar progressive decreases in RMR during treatment (12.4% for LC and 20.8% for HC), but values were not significantly lower than baseline until week 3 of the VLCD. Thus, although dietary carbohydrate content had an influence on the magnitude of fall in serum T3, RMR declined similarly for both dietary treatments.

The administration of delta9THC intravenously as a premedicant to oral surgery resulted in acute pronounced elevations in anxiety states, a predominance of dysphoria over euphoria, and varying degrees of psychotic-like paranoiac thought. Neural effects that appeared to promote these effects included distortions of perception with sensory delusions, and heightened sensory receptiveness including antalgesic impressions of surgery; autonomic and visceral arousal greater than control or placebo levels; lack of overt behavioral signals of distress due to depersonalization; and time disintegration leading to fear-inducing misinformation about real surgical events. Introverted subjects who generally were inclined to rely on drug solutions to their problems tended to respond poorly to surgical pain and anxiety with delta9THC. These results, obtained from subjects considered to have levels of presurgical apprehension that were average or below average, suggest that the environment in which high doses of cannabinols are experienced is a potent factor in determining the quality of the emotional response. A surgical environment containing even the mild stress of outpatient oral surgery appears to have the potential to precipitate undesirable emotional responses among cannabinol-intoxicated patients. There is continued high-level social use of cannabinols inour society, with an estimate of 40% to 55% among the college-age group seen frequently by oral surgeons. Results of this study suggest that clinicians should be prepared to detect the subtle signs of marijuana intoxication to protect their patients from further psychophysiologic complications during surgery.

The development of interpositional and onlay bone grafting techniques for atrophic mandibles is reviewed. A further modification of the visor osteotomy is presented along with follow-up evaluation of the conditions of 16 patients. Results of radiographic measurements show the procedure to be stable, vertical resorption of the augmented mandible in the body regions being 11.2% over a mean follow-up of 8.8 months. Neurosensory evaluation showed altered sensation and dysesthesia as a significant problem in these patients. The results are presented and discussed.

Forty patients with chronic pain below the waist level were evaluated in a multidisciplinary pain clinic using a refined differential spinal block (DSB) technique. The refinements consisted of verbal instructions to prevent biasing the patients, coupled with a thorough evaluation of verbal and physiologic responses to the block. When demographic and psychologic data were assessed according to pain mechanisms, a pattern of patient groups emerged along a chronic pain continuum. Stress, anxiety, depression, and hysteria, as well as the neurophysiologic and demographic factors, modified the responses to the block. Long-term follow-up of these patients, including repeat DSB procedures and confirmatory anatomic blocks of sympathetic and somatic nerves, validated these impressions. The findings indicate a link between pain mechanisms and psychosocial factors that may directly influence responses to DSB.

p-Phenylenediamine/pyrocatechol mixture (PPD-PC) was evaluated as a reagent for the ultracytochemical demonstration of retrograde axonal transport of horseradish peroxidase (HRP). HRP crystals were applied to the proximal stumps of the severed infraorbital nerves in rats. After 48 h the rats were sacrificed by perfusion, and the trigeminal ganglia ipsilateral to the severed nerves were processed for HRP cytochemistry and then prepared for electron microscopy. PPD-PC was rapidly oxidized in HRP-labeled neurons to form a dark brown-black osmiophilic reaction product which was more readily visible than the DAB product in the sections. This facilitated selection by light microscopy of areas in the epoxy wafers for ultrathin sectioning. In thin sections viewed under the electron microscope, the osmicated electron opaque PPD-PC reaction product was present in membrane-bound structures including smooth endoplasmic reticulum and granules of various sizes. The PPD-PC reaction product formed after 10-min incubation appeared to be more electron opaque than the DAB reaction product formed after 20 min. PPD-PC was found to be much less readily oxidized than DAB by endogenous hemoproteins. This methodology facilitated the ultracytochemical localization of HRP in neurons following retrograde axonal transport.

Infraorbital nerves were subjected to experimental transection or crushing injury. Repair was evaluated using horseradish peroxidase as a tracer. Labeled neurons in the trigeminal ganglion were compared in both types of injury. Results showed that regeneration of the infraorbital nerve after crushing injury was better than when there was nerve transection with passive reapproximation.

Nerve blocks are an effective treatment in patients with many types of acute pain. However, they are much less effective in patients with chronic pain. Candidates for therapeutic nerve blocks should be carefully screened by: assessment of organic disease; evaluation of psychologic and behavioral disorders, and differential nerve blocks. The best candidates for therapeutic nerve blocks have known or inferred organic disease, minimal psychologic or behavioral disorders, and evidence of sympathetic or somatic pain mechanisms.

The University of North Carolina Comprehensive Pain Center, which has been in existence since 1972, is a pain evaluation, treatment and research program based upon individual diagnosis, comprehensive evaluation, and individualized therapy. This is done within the framework of a concurrent program involving anesthesiologists, oral surgeons, neurosurgeons, psychiatrists, physicians from family medicine, clinical psychologists, social workers and specialized nurses. The Center is organized in both the inpatient and outpatient modes. This presentation will briefly describe the operation of the Pain Center and discuss plans for future expansion.