Anatomical Integrity Research Articles

Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India.

This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.

Analysis of cognitive framework and biomedical translation of tissue engineering in otolaryngology

Tissue engineering is a relatively recent research area aimed at developing artificial tissues that can restore, maintain, or even improve the anatomical and/or functional integrity of injured tissues. Otolaryngology, as a leading surgical specialty in head and neck surgery, is a candidate for the use of these advanced therapies and medicinal products developed. Nevertheless, a knowledge-based analysis of both areas together is still needed. The dataset was retrieved from the Web of Science database from 1900 to 2020. SciMAT software was used to perform the science mapping analysis and the data for the biomedical translation identification was obtained from the iCite platform. Regarding the analysis of the cognitive structure, we find consolidated research lines, such as the generation of cartilage for use as a graft in reconstructive surgery, reconstruction of microtia, or the closure of perforations of the tympanic membrane. This last research area occupies the most relevant clinical translation with the rest of the areas presenting a lower translational level. In conclusion, Tissue engineering is still in an early translational stage in otolaryngology, otology being the field where most advances have been achieved. Therefore, although otolaryngologists should play an active role in translational research in tissue engineering, greater multidisciplinary efforts are required to promote and encourage the translation of potential clinical applications of tissue engineering for routine clinical use.

E72 Distribution of cells and extracellular matrix in the marginal synovium during the postnatal period

Abstract Introduction The marginal transitional zone of the joint is of fundamental importance in joint pathology. The normal marginal synovium takes part in articular cartilage repair (Adachi et al. 2012). The inflamed marginal synovium, in turn, promotes irreversible damage to the adjacent cartilage and bone (Hitchon & El-Gabalawy, 2011). Early erosive damage in rheumatoid arthritis and osteophyte formation in osteoarthritis occurs primarily here (Allard et al. 1990). Objectives The morphology of the marginal synovium from birth till the 90th day was studied using the hip joints of Wistar rats. Methods The collection of joints was carried out on the first, seventh, 14th, 30th, 45th, 60th and 90th day (six rats in each group, 42 in total). Joints were fixed, decalcified and dehydrated. Histologic paraffine sections were stained with Mallory's trichrome and Hart's elastin staining, analyzed at the acetabular labrum by light microscopy (χ100), morphometrical and statistical (P < 0.05) methods with extrapolation to humans (Sengupta, 2013). The obtained data were presented as percentages. Results In the marginal synovium, cells and components of the extracellular matrix, which are typical for fibrous connective tissue, could be seen. The synovial lining cells are embedded in the modified basement membrane which includes collagen and elastic fibers. They form a three-dimensional reticulum in it and adjacent synovial subintima. Vessels of the microcirculatory bed are also widely represented in the marginal synovium. The overall quantity of collagen fibers increased gradually, exceeding on the 90th day (approximately corresponds to 18–19 human years) that of newborns by one and a half times (48.92 ± 3.39 vs 72.17 ± 7.77; P = 0.023). The number of arranged collagen fibers increased gradually, exceeding on the 90th day that of newborns almost twofold (37.25 ± 3.21 vs 60.08 ± 5.99; P = 0.008). The area of distribution of disarranged collagen fibers in newborns was almost four and a half times less than the overall quantity of collagen fibers (11.67 ± 1.03 vs 48.92 ± 3.39; P < 0.001) and did not change substantially throughout the experiment. The number of elastic fibers increased till the 30th day (0.63 ± 0.11 vs 18.3 ± 1.25; P < 0.001) and did not undergo significant changes later. In newborns, the area of distribution of ground substance was not considerably higher than the ratio of disarranged collagen fibers (10.42 ± 1.8 vs 11.67 ± 1.03; P = 0.562) and did not undergo substantial changes later. The distribution density of vessels increased till the 30th-45th day (4.5 ± 0.67 vs 7.5 ± 0.82 and 7.7 ± 0.54; P < 0.001; approximately corresponds to the 9th and 14th human years respectively), followed by a gradual decrease from the 60th day (7.05 ± 0.72; roughly corresponds to the 16th human years). The maximum number of cells was in newborns. Subsequently, it gradually decreased and was almost three times less on the 90th day than that of newborns (38.01 ± 3.06 vs 12.58 ± 1.53; P < 0.001). Conclusion The morphogenesis of the marginal synovium during the postnatal period is accompanied by a gradual decrease in the number of cells, an increase in the area occupied by elastic and arranged collagen fibers with a relatively constant distribution density of disarranged collagen fibers and ground substance together with an undulatory pattern in the distribution of vessels. These peculiarities emphasize the morphological uniqueness of the marginal transitional zone, which forms the innate nonspecific barrier between the joint capsule and the articular cartilage, and thereby provides the necessary anatomical and physiological integrity of the joint as a whole organ. Knowledge about the patterns of morphogenesis of the marginal synovium will help in the future to analyze the modeled pathological or boundary states in it. Ethics The study was approved by the ethics committee of the Zaporizhzhia State Medical University.

E71 Distribution of cells and extracellular matrix in the normal marginal synovium of the hip joint capsule during the postnatal period

Abstract Introduction The marginal transitional zone is of fundamental importance in joint pathology. It includes the marginal cartilage and marginal synovium. The normal marginal synovium takes part in articular cartilage repair (Adachi et al. 2012). The inflamed marginal synovium, in turn, promotes irreversible damage to the adjacent cartilage and bone (Hitchon & El-Gabalawy, 2011). Objectives The morphology of the normal marginal synovium from birth till the 90th day was studied using the hip joints of Wistar rats. Methods The collection of joints was carried out on the first, seventh, 14th, 30th, 45th, 60th and 90th day (six rats in each group, 42 in total). Joints were fixed, decalcified and dehydrated. Histologic paraffine sections were stained with Mallory's trichrome and Hart's elastin staining, analyzed at the acetabular labrum by light microscopy (χ100), morphometrical and statistical (P < 0.05) methods with extrapolation to humans (Sengupta, 2013). The obtained data were presented as percentages. Results In the marginal synovium, cells and components of the extracellular matrix, which are typical for fibrous connective tissue, could be distinguished. The synovial lining cells are embedded in the modified basement membrane which is a meshwork of collagen and elastic fibers. They form a three-dimensional reticulum in it and adjacent synovial subintima. Vessels of the microcirculatory bed are also widely represented in the marginal synovium. The overall quantity of collagen fibers increased gradually, exceeding on the 90th day (∼18–19 human years) that of newborns by one and a half times (48.92 ± 3.39 vs 72.17 ± 7.77; P = 0.023). The number of arranged collagen fibers increased gradually, exceeding on the 90th day that of newborns almost twofold (37.25 ± 3.21 vs 60.08 ± 5.99; P = 0.008). The area of distribution of disarranged collagen fibers in newborns was almost four and a half times less than the overall quantity of collagen fibers (11.67 ± 1.03 vs 48.92 ± 3.39; P < 0.001) and did not change substantially throughout the experiment. The number of elastic fibers increased till the 30th day (0.63 ± 0.11 vs 18.3 ± 1.25; P < 0.001) and did not undergo significant changes later. In newborns, the area of distribution of ground substance was not considerably higher than the ratio of disarranged collagen fibers (10.42 ± 1.8 vs 11.67 ± 1.03; P = 0.562) and did not undergo substantial changes later. The distribution density of vessels increased till the 30th-45th day (4.5 ± 0.67 vs 7.5 ± 0.82 and 7.7 ± 0.54; P < 0.001; ∼9-14th human years), followed by a gradual decrease from the 60th day (7.05 ± 0.72; ∼16 human years). The maximum number of cells was in newborns. Subsequently, it gradually decreased and was almost three times less on the 90th day than that of newborns (38.01 ± 3.06 vs 12.58 ± 1.53; P < 0.001). Conclusion The morphogenesis of the marginal synovium during the postnatal period is accompanied by a gradual decrease in the number of cells, an increase in the area occupied by elastic and arranged collagen fibers with a relatively constant distribution density of disarranged collagen fibers and ground substance together with an undulatory pattern in the distribution of vessels. These peculiarities emphasize the morphological uniqueness of the marginal transitional zone, which forms the innate nonspecific barrier between the joint capsule and the articular cartilage, and thereby provides the necessary anatomical and physiological integrity of the joint as a whole organ. Knowledge about the patterns of morphogenesis of the normal marginal synovium will help to understand joint pathology. Ethics The study was approved by the ethics committee of the Zaporizhzhia State Medical University.

Therapeutic Penetrating Keratoplasty for Severe Fungal Keratitis in a Thai Tertiary Care Center

Objective: To evaluate the outcomes of therapeutic penetrating keratoplasty (TPK) performed for severe fungal keratitis. Materials and Methods: Medical records of all patients who underwent TPK in Siriraj Medical Center between April 2010 and July 2020 were culled, and those in which fungal pathogens were definitively identified were studied. Patient records with follow up less than three months were excluded. Patient demographic data, outcome measures and complications following TPK were recorded. The primary outcome was eradication of the fungal infection. Secondary outcomes were preservation of anatomical integrity, graft survival and achievement of visual acuity (VA) greater than or equal to 3/60. Results: Sixty patients met the study criteria and were included in the analysis. The mean patient age was 56 (range: 23-79) years, and most patients were men (46, 77%). The mean follows up time was 30.87 months (range1.61-122.71). Fifteen eyes (25%) sustained corneal perforation before undergoing TPK. Graft survival was 30% at 1 year, 18% at 5 years, and 11% at 10 years. The most common organism was fusarium (23 patients, 38%). The median duration from presentation to surgery was 14 (8-21) days. Disease eradication was achieved in 44 patients (73%) and VA better than 3/60 was achieved in 14 (23%). Anatomical integrity was maintained in 46 (76%) eyes. Repeat PKP was performed in 15 patients (25%), most commonly for recurrent infection. Conclusion: TPK offers a good chance of disease eradication and maintenance of anatomical globe integrity and is a reasonable therapeutic option in patients with severe fungal infection.

A Comparative Clinical Study of Marham-e-raal and Povidone-Iodine 5% Ointment in Nonhealing Ulcers

Introduction: Nonhealing ulcers are those that have not proceeded through timely and orderly reparation to produce anatomic and functional integrity. Povidone iodine is widely used ointment among physician and surgeons globally for wound dressings. In texts of Unani medicine literature, Marham-e-raal has been described as a potent ointment for gaining timely healing of wounds. The aim of this study is to compare the effects of povidone iodine and Marham-e-raal in nonhealing ulcers/chronic wounds. Methods: A randomized controlled study was carried out in the Department of Jarahat (Surgery) in National Institute of Unani Medicine, Bengaluru. A total of 45 subjects were included and randomized into Marham-e-raal and betadine dressing groups based on inclusion criteria. Dressing was done on daily basis and subjects were assessed on every 15 day from baseline to day 45 for primary outcomes (appearance of healthy granulation, epithelialization, and reduction in wound surface area) and secondary outcomes (decreases in tenderness score and depth of wound). Results: Nineteen out of 27 subjects in Marham-e-raal dressing group achieved complete healing as compared to one in povidone-iodine dressing group. There was significant reduction in wound surface area, median tenderness score and depth of wounds among subjects in Marham-e-raal dressing group at 0.05 level of significance. Conclusion: Marham-e-raal is an effective wound dressing and healing agent as compared to povidone-iodine ointment.

Utility of the continuous intraoperative neuromonitoring in the prevention of the recurrent laryngeal nerve paralysis during thyroid surgery. A prospective observational study

BackgroundThe continuous intraoperative neuromonitoring (C-IONM) of the recurrent laryngeal nerve (RLN) could help reducing the incidence of nerve paralysis after thyroid surgery, in comparison with the mere anatomical visualization of the RLN. The objective is to assess the efficacy and utility of C-IONM as a predictive test for recurrent laryngeal nerve paralysis after thyroidectomy. MethodsA prospective observational study was performed in 248 patients who underwent thyroid surgery where C-IONM was applied, between September 2018 and December 2019, in a high-volume center. A previous and later laryngoscopy was performed, which allowed to evaluate the reliability of the C-IONM as a predictive test for recurrent paralysis. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) were studied. ResultsA total number of 171 thyroidectomies, 62 hemithyroidectomies, 15 totalization thyroidectomies and 27 thyroidectomy with cervical dissections were performed. Postoperative laryngoscopy was altered in 40 patients (16.12%). The SE, SP, PPV and NPV values ​​were 65%, 94.7%, 70.2% and 93.4% respectively. ConclusionsC-IONM is a safe technique that provides real-time information about anatomical and functional integrity of the RLN and can improve the results of thyroid surgery.

The role of intraoperative neuromonitoring of facial nerve in microsurgical excision of vestibular schwannomas

Abstract Background Preserving the function of facial nerve (FN) is an important objective of cerebellopontine angle tumor excision. FN paresis and paralysis possibly happen postoperatively, in particular for vestibular schwannoma (VS) excision, despite efforts to prevent injury and preserve anatomic integrity of the FN during dissection. Aim Evaluation of the role of neuromonitoring of FN in microsurgical resection of VSs and its impact on FN function preservation and quality of life. Patients and methods This trial was conducted on 22 patients with VS in the period from February 2018 to February 2020. All patients had undergone VS microsurgical excision in the Neurosurgery Department, Tanta University Hospitals. Results According to House-Brackmann grading scale, the functions of FN postoperatively were grade I in 16 patients (72.6%), grade III in three patients (13.6%), grade IV in two patients (9%), and grade V in one patient (4.7%). So, House-Brackmann grading scale II to VI means preservation less than 100%, which was achieved in six patients (27.3%). Conclusion Intraoperative neurophysiologic monitoring plays an essential step in modern skull base surgery generally and in VS surgery specifically. FN electromyography does not only help localize and identify the anatomy of FN but as well keep FN integrity of function and can be helpful in the prediction of its postoperative functional outcome.

Ultrasound diagnostics in the assessment of traumatic peripheral nerve damage in combat trauma

BACKGROUND: Traumatic peripheral nerve damage is a significant clinical and social problem, which is characterized by a high level of disability in young patients.
 AIM: To assess the diagnostic efficiency of ultrasound in the diagnosis of peripheral nerve damage in combat trauma.
 METHODS: A total of 163 patients (362 peripheral nerves) were examined. The duration of traumatic nerve damage was 2273 days. All patients were men aged 2048 years. Ultrasound was performed with 717 MHz linear transducers on an ACUSSON S2000 device using standard technique in B-mode, in longitudinal and transverse scanning planes, with the use of Doppler techniques. Statistical analysis was conducted to assess diagnostic efficiency. Calculation of operational (sensitivity and specificity) and integral (accuracy) characteristics was performed by the qualitative assessment of the reference method (surgical intervention) and the method under study (ultrasound).
 RESULTS: Peripheral nerve damage resulted from combat trauma. In 120 (73.6%) cases, injuries of the limbs were accompanied by injuries of the osteoarticular apparatus and vessels. A total of 274 (75.7%) nerves had signs of traumatic damage. Multiple nerve injuries were observed in 95 (58.3%) people. Nerves of the upper extremities were damaged more frequently (185 [67.5%]) compared to nerves of the lower extremities (89 [32.5%]). Contusional structural changes were observed in 181 (66%) nerves. Impairment of anatomical integrity was diagnosed in 46 (16.8%) nerves, while complete impairment was found in 29 (10.6%) cases with the presence of diastasis between the nerve ends. Early after injury, a wound canal and hematomas were visualized near the nerve. In 4 cases, a foreign body of metallic density was visualized in the nerve sheath. After 3 weeks from the moment of injury, terminal neuromas were observed. The neuroma sizes for the proximal and distal ends were 0.50.3 to 1.60.6 cm and 0.40.2 to 1.30.6 cm (avascular), respectively. Adjacent sections of the nerve over 35 cm were thickened and characterized by echo structure, however, with thickening of all fasciculi and blood flow observed along the periphery of the nerve. Marginal nerve damage was observed in 17 (6.2%) people. In case of marginal neuroma, a significant nerve thickening of 1.43.2 times over a short distance (from 0.4 cm to 1.5 cm) with loss of bundle differentiation of the part of the nerve, pronounced decrease in echogenicity, and absence of Doppler signal was detected. Nerve compression in 47 cases (17.1%) was accompanied by 1.22.3 times thickening of nerve trunks, indistinct contours, decreased echogenicity, and significant changes in the nerve structure. Compression was due to cicatricial changes, hematomas, foreign bodies, bone fragments, and in 2 cases spokes from external fixation devices. A total of 106 patients underwent surgery.
 CONCLUSIONS: The ultrasound sensitivity and specificity were 96% and 67%, respectively. The peculiarities of the examination included extensive soft tissue defects and external fixation devices, which significantly complicated the examination. The diagnostic accuracy was 91%. A pronounced cicatricial process (70%) was the main cause of false-positive (6.6%) and false-negative (2.8%) results.

Ultrasound as the main method for diagnosing peripheral nerve injuries in mine blast trauma

BACKGROUND: The amount of published data related to peripheral nerve blast injuries is limited.
 AIM: The study was aimed at determining the accuracy and sensitivity and assessing the specificity of ultrasound in the diagnosis of peripheral nerve injuries in mine blast trauma.
 METHODS: A total of 159 patients (274 peripheral nerves) were examined. Ultrasound was performed according to the standard technique using a HI VISION Avius HITACHI scanner with an EUP-L74M linear transducer (a frequency range of 513 MHz) and a preset musculoskeletal system ultrasound program. The duration of nerve injuries ranged from 2 to 273 days. All patients were men aged 20 to 48 years. Peripheral nerves were damaged as a result of mine blast trauma. Statistical analysis was used to assess sensitivity, specificity, and diagnostic accuracy. These characteristics were calculated according to the qualitative assessment of surgical intervention, the results of conservative treatment, and the method under study (ultrasound).
 RESULTS: A total of 274 damaged peripheral nerves were examined. The Group 1 included 93 (34%) nerves that required surgical intervention. In Group 2, consisting of 181 (66%) nerves, conservative treatment was used. Most of the nerves (47 [51%]) in Group 1 were damaged due to the compression effects of scarring in the surrounding tissues. Seventeen (18%) partial violations of the anatomical integrity of nerves with the formation of intramural and marginal neuromas were detected. Multiple and single nerve injuries were observed in 95 (59.7%) and 64 people (40.3%), respectively. Peripheral nerves of the upper extremities were damaged more frequently (185 [67.5%]), whereas nerves of the lower extremities were damaged in 89 (32.5%) cases. Ultrasound showed an increase in the cross-sectional area of nerves, blurred contours, decreased echogenicity, and changes in the bundle structure up to the complete absence of differentiation of individual fascioculi. The formation of neuromas was observed in complete and partial nerve ruptures. All 93 nerves in Group 1 underwent surgical intervention, particularly, external neurolysis (32 [34%]), internal neurolysis (15 [16%]), nerve suture (15 [16%]), excision of neuroma followed by microsurgical epineural suture (18 [19%]), and autoneural plasty (11 [12%]). In 2 (3%) cases, a decision was made to abstain from plasty and perform a tendon transposition due to a pronounced diastasis. All patients of Group 2 were shown to have a wait-and-see approach, and conservative therapy was prescribed. In 179 (99%) cases, complete recovery of sensory and motor activity was observed within 21 days. In 2 (1%) patients, a repeated ultrasound was performed due to no effect of treatment. Compression by scar tissues was revealed, and surgical intervention was made.
 CONCLUSIONS: In mine-explosive impact, ultrasound is the leading method for diagnosing peripheral nerve injuries. Ultrasound with sensitivity of 97.8% and specificity of 98.8% reveals lesions for which surgical treatment is indicated. The diagnostic accuracy is 98.5%.

Этапная реконструктивно-пластическая хирургия при дефекте нижнего века после удаления базалиомы

Purpose. Evaluation of the effectiveness of multi-staged plastic and reconstructive rehabilitation of the patient with a large lower eyelid defect after the excision of basal cell carcinoma. Material and methods. The patient L., 75 years old, was treated with postoperative coloboma of the lower eyelid, lagophthalmos of the right eye after removal of the eyelid basal cell carcinoma, applied to the S.N. Fyodorov Eye Microsurgery Federal State Institution in Moscow. She underwent a multi-stage reconstructive plastic treatment in order to restore the anatomy and function of the lower eyelid, eliminate the cosmetic defect. Results and discussion. As a result of the first surgical stage, we were able to restore the skin defect using a free skin flap from the upper eyelid of the left eye. The second stage of treatment allowed us to restore the function of the lower eyelid by eliminating the artificial ankyloblepharone created earlier. The consequence of performing the following stages of surgery was the filling of the lack of the mucous membrane of the lower eyelid, the creation of the correct ratio and position of the cutaneous and conjunctival layers of the eyelid, the elimination of lagophthalmos and the restoration of anatomical and functional characteristics of the eyelid. Conclusion. As a result of multi-stage surgical treatment, the anatomical and functional integrity of the lower eyelid was achieved, prevented the loss of visual functions, achieved a satisfactory cosmetic effect, and also improved the patient's quality of life. Keywords: basal cell carcinoma, lower eyelid, staged plastic and reconstructive surgery

Intraductal papillary mucinous neoplasm of the accessory pancreatic duct in the pancreas uncinate process: A case report.

Intraductal papillary mucinous neoplasms (IPMN) of the accessory pancreatic duct (APD) are very rare and their clinical significance is not known. Here, we describe a case of IPMN originating in a branch of the duct of APD within the uncinate process of the pancreas, which initially presented with acute pancreatitis. A 70-year-old man visited our medical center presenting with acute pancreatitis around the head and uncinate process of the pancreas. Computer tomography scans revealed the presence of a 35-mm cystic mass-like lesion within the pancreas uncinate process communicating with a branch of the APD. The patient was diagnosed with APD-IPMN in the pancreas uncinate process accompanied by acute pancreatitis. Conservative management of the acute pancreatitis relieved his symptoms, while duodenum-preserving partial pancreatic head resection (DPPHR-P) was performed to treat the APD-IPMN. Intraoperative exploration showed the presence of severe adhesions within the uncinate process of the pancreas and that the tumor's "peduncle" - a branch of the duct of APD - was saddling just at the front of the main pancreatic ducts. Thus, surgical removal of the tumor required special handling of the region between the main duct (MD) and APD to protect the integrity of the main pancreatic ducts. Finally, a 35*30*15 mm IPMN was successfully removed and the MD was preserved combined with ligation from the root of the APD of the pancreas. The drainage volume of the ventral tube increased by around 20-fold in 24 hours on the fourth day after surgery. The presence of high amylase levels in the drainage discharge (40713.5 U/L) led to the diagnosis of postoperative pancreatic fistula (POPF). The drainage volume remained high for 3 days. The patient was discharged and POPF was successfully managed through endoscopic pancreatic duct stenting. APD-IPMN in the pancreas uncinate process has its own characteristics of localized pancreatitis, and MD-preserving DPPHR-P not only protects the exocrine and endocrine functions of the pancreas, but it also protects the physiological and anatomical integrity. The appearance of POPF after DPPHR-P may be managed by endoscopic pancreatic duct stenting.

Anatomical and biophysical basis for graft incompatibility within the Solanaceae.

Interspecies grafting is an economically relevant technique that allows beneficial shoot and root combinations from separate species to be combined. One hypothesis for the basis of graft compatibility revolves around taxonomic relatedness. To test how phylogenetic distance affects interspecific graft compatibility within the economically important Solanaceae subfamily, Solanoideae, we characterized the anatomical and biophysical integrity of graft junctions between four species: tomato (Solanum lycopersicum), eggplant (Solanum melongena), pepper (Capsicum annuum), and groundcherry (Physalis pubescens). We analyzed the survival, growth, integrity, and cellular composition of the graft junctions. Utilizing various techniques, we were able to quantitatively assess compatibility among the interspecific grafts. Even though most of our graft combinations could survive, we show that only intrageneric combinations between tomato and eggplant are compatible. Unlike incompatible grafts, the formation of substantial vascular reconnections between tomato and eggplant in the intrageneric heterografts likely contributed to biophysically stable grafts. Furthermore, we identified 10 graft combinations that show delayed incompatibility, providing a useful system to pursue deeper work into graft compatibility. This work provides new evidence that graft compatibility may be limited to intrageneric combinations within the Solanoideae subfamily. Further research amongst additional Solanaceous species can be used to test the extent to which our hypothesis applies to this family.

Evaluating the contact anatomy and contact bone volume of spinal screws using a novel drilled surface image.

Intraoperative navigation systems have been widely applied in spinal fusion surgery to improve the implantation accuracy of spinal screws using orthogonal tomographic and surface-rendering imaging. However, these images contain limited anatomical information and no information on bone volume contact by the implanted screw, which has been proven to affect the stability of implanted screws. This study proposed a novel drilled surface imaging technique that displays anatomical integration properties to calculate the contact bone volume (CBV) of the screws implanted along an implantation trajectory. A cylinder was used to represent the area traversed by the screws, which was manually rotated and translated to a predetermined implantation trajectory according to a vertebra model obtained using computed tomography (CT) image volumes. The drilled surface image was reconstructed by interpolating the CT numbers at the predefined sampling points on the cylinder surface. The anatomical integration property and CBV of the screw implanted along the transpedicular trajectory (TT) and cortical bone trajectory (CBT) were evaluated and compared. The drilled surface image fully revealed the contact anatomical structure of the screw under the trajectories, improving the understanding of the anatomical integration of the screw and surrounding tissues. On average, the CBV of the CBT was 30% greater than that of the TT. The proposed drilled surface image may be applied in preoperative planning and integrated into intraoperative navigation systems to evaluate the anatomical integration and degree of bone contact of the screw implanted along a trajectory.

Surgical methods of retinal pigment epithelium transplantation in rabbits in experiment

The article is devoted to the study of surgical methods of retinal pigment epithelium transplantation in experiment on rabbits. The history of retinal pigment epithelium transplantation is briefly characterized in the study. Characteristics of the methods used are presented, their limitations, possibilities, and requirements for implementation in practice are highlighted. The results of transplantation of suspension of retinal pigment epithelium cells differentiated from human induced pluripotent stem cells (IPSC-RPE) without and with the use of platelet-rich blood plasma (PRP) are also considered. According to the results of the analysis we have developed modified methods of IPSC-RPE cells transplantation in the experiment on rabbits, which allow to reduce the number of postoperative complications, which provides the best therapeutic effect. Prospects for further studies are associated with a comparative analysis of the proposed techniques in terms of cell survival at different terms, anatomical integration and functional efficiency in the dynamics.

Middle Neolithic Burials in Baikal-Yenisey Siberia: Problems of Cultural Identity and Genesis

The study focuses on the analysis of Middle Neolithic burial complexes of the Baikal-Yenisey Siberia. Based on a series of reliable radiocarbon dates, their age lies within the range of 6190–5900 cal BP. It partly corresponds to the end of the hiatus in the mortuary traditions of Cis-Baikal. Features of the burial rite and funerary offerings are analyzed and compared with those of neighboring territories. One of the most frequent images in the art of the Middle Neolithic Baikal-Yenisey Siberia is that of the waterfowl, rendered as fi gurines. The common grave goods are leaf-shaped stone arrowheads, shell beads, and pendants made of animal bones and teeth. The funerary rite included the use of fi re and reddish mineral pigment, as well as disrupting the anatomical integrity of the skeletons, possibly due to partial burial (the data are tentative). Most burials of the late stage of the hiatus are evidently those of hunter-gatherers manufacturing the Ust-Belaya ceramics, which were found in certain burials. A bone arrowhead with a biconical point and fi gurines representing waterfowl suggest cultural ties with the Urals and Western Siberia; but their nature has yet to be clarifi ed, which requires large-scale AMS-dating and paleogenetic analysis.

Anatomically Integrated In-Place Visualization of Patient Data for Cooperative Tasks with a Case Study on a Neurosurgical Ward.

The workflow in modern hospitals entails that the medical treatment of a patient is distributed between several physicians and nurses. This leads to intensive cooperation, which takes place under particular time pressure and requires efficient conveyance of relevant patient-related medical data to colleagues. This requirement is difficult to achieve with traditional data representation approaches. In this paper, we introduce a novel concept of anatomically integrated in-place visualization designed to engage with cooperative tasks on a neurosurgical ward by using a virtual patient's body as spatial representation of visually encoded abstract medical data. Based on the findings of our field studies, we provide a set of formal requirements and procedures for this kind of visual encoding. Moreover, we implemented a prototype on a mobile device that supports the diagnosis of spinal disc herniation and has been evaluated by 10 neurosurgeons. The physicians have assessed the proposed concept as beneficial, especially emphasizing the advantages of the anatomical integration such as intuitiveness and a better data availability due to providing all information at a glance. Particularly, four of nine respondents have stressed solely benefits of the concept, other four have mentioned benefits with some limitations and only one person has seen no benefits.

Corneal Ulcer Impending Perforation et causa Corpus Alienum

Introduction: The cornea is a transparent, avascular tissue that serves as a structural barrier and protects the eye from infection. A corneal ulcer is an inflammatory or, more dangerously, infective disorder involving abnormalities of the cornea’s epithelial layer or stroma. Corneal ulcers can develop due to contact lenses, trauma, adnexal illnesses, or ocular surface abnormalities. Despite aggressive nonsurgical therapies, corneal perforation frequently occurs in the event of resistant corneal ulcers. The anatomic integrity of the eyeball must be preserved through urgent surgical intervention to avoid potentially fatal consequences such as endophthalmitis, subsequent glaucoma, perforation, or corneal scarring. Case Presentation: A-11-year-old male child was taken to Community Eye Hospital, East Java due to a corneal ulcer. He complained of pain and redness right after he played with bamboo two weeks ago. The patient had been previously treated in other hospitals; however, there was a worsening of symptoms rather than improvement. Clinical examination of oculus sinister revealed a conjunctival injection, episcleral injection, corpus alienum (bamboo) sized 50 mm, an ulcer in the central cornea sized 3 x 2 mm irregular, shallow anterior chamber, impending perforation in the central cornea with a diameter of 2 mm. Thus, there had shown impending perforation, and the patient had to undergo surgery, of amniotic graft and antibiotic injection immediately to avoid perforation. Conclusions: A perforation, an ophthalmological emergency requiring surgery, can result from corneal ulceration, a medical emergency. The primary objectives of the procedure are to restore the eye’s anatomical integrity and to reduce problems as much as feasible.

Хірургічне лікування повного тубулярного подвоєння товстої кишки, асоційованого з природженою аноректальною вадою розвитку - ректовестибулярною норицею та аномаліями сечостатевої системи

Doubling of the colon is a rare, complex congenital anomaly, both in terms of diagnosis and in the choice of treatment tactics. Patients with this pathology need a thorough comprehensive examination to determine the type of doubling (cystic, diverticular or tubular) and to diagnose possible associated malformations, in particular, the genitourinary system. Anorectal duplications in most cases are tubular doublings that end in distal fistula / fistula on the perineum, or in the genitourinary system. Surgical treatment of this malformation requires a differentiated approach for each patient. Until now, various methods of surgical correction of this defect are used: dissection of the common wall, resection of only the duplicate section, resection of both parts of the double colon, mucosectomy of the duplicate intestine. Their main task is to maximize the anatomical integrity of the colon, with adequate blood supply. In the postoperative period, patients definitely need constant monitoring and rehabilitation treatment. Purpose - to analyze the methods of correction of this defect and evaluate their effectiveness; to present a case of our own staged surgical treatment of complete tubal doubling of the TC associated with congenital anorectal malformation - rectovestibular fistula and anomalies of the genitourinary system. Our proposed phased surgical treatment of complete tubular doubling of the colon, with rectovestibular fistula, allowed to normalize of the motor-evacuatory function of the formed main intestine and the retaining function of the anal sphincter apparatus with good functional results. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent from the child’s parents was obtained for the research. No conflict of interests was declared by the authors.

Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

BackgroundHemispherectomy is an effective treatment option for patients with drug-resistant epilepsy caused by hemispheric lesions. However, patients often have deterioration of their motor functions postoperatively. Diffusion spectrum imaging (DSI) was reliable in presenting the natural shape of the white matter fibers. At the same time, the natural sprawl pyramid tract (PT) might be more intuitive for predicting postoperative motor functions. Therefore, we assessed the motor functions by the natural shape revealed by DSI tractography.MethodsTen children with drug-resistant epilepsy who were candidates for hemispherectomy performed DSI PTs tractography and transcranial magnetic stimulation (TMS) for motor mapping. The motor function was evaluated with muscle strength and hand grasping capability. Pyramidal tract (PT) structural integrity and TMS mapping results were compared between patients who remained stable and those with deteriorated motor functions. Receiver operating characteristic (ROC) curves with PTs asymmetric ratio were analyzed to evaluate DSI tractography diagnostic value.ResultsAll patients underwent DSI acquisition, while four patients successfully performed TMS. One patient had no response to TMS until the maximal machine output was reached. Four patients failed to perform TMS due to lacking cooperation. One patient was contraindicated to TMS. DSI successfully reconstructed the sharp angle fan-shaped PTs within the hemisphere. The accurate fiber distribution with fiber termination and thickness within the lesioned hemisphere was replicated with DSI tractography. No significance was found in patients’ age, sex, seizure frequency, or medication between patients with stable or deteriorated postoperative motor functions. DSI effectively predicted postoperative motor function as stable with damaged PTs, mild deterioration with atrophied PTs, and intact PTs with contralateral innervation confirmed by intracranial stimulation. The area under the curve (AUC) of DSI tractography was 0.84. According to ROC, the cut-off value of PTs asymmetric ratio was 11.5% with 100% sensitivity and 75% specificity. The sensitivity and specificity of TMS were 2/3 and 1/2, respectively.ConclusionsThe anatomic integrity of PTs with DSI tractography could effectively predict postoperative motor function after hemispherectomy. This enables neurosurgeons to inform patients and relatives about postoperative motor functions with direct morphological evidence of PTs to help them with their surgical decisions.