Anatomical Origin Research Articles

Quantitative Assessment of the Restoration of Original Anatomy after 3D Virtual Reduction of Long Bone Fractures.

Background: The purpose of this study was to demonstrate the usefulness of 3D image-based virtual reduction by validating the evaluation criteria according to guidelines suggested by the AO Surgery Reference. Methods: For this experiment, 19 intact radial ORTHObones (ORTHObones radius, 3B Scientific, Germany, Hamburg) without any fractures were prepared. All ORTHObones with six cortical marking holes (three points on the distal part and three points on the proximal part) were scanned using a CT scanner twice (before/after intentional fracture of the ORTHObone). After the virtual reduction of all 19 ORTHObones, accuracy evaluations using the four criteria (length variation, apposition variation, alignment variation, Rotation Variation) suggested in the AO Surgery Reference were performed. Results: The mean (M) length variation was 0.42 mm, with 0.01 mm standard deviation (SD). The M apposition variation was 0.48 mm, with 0.40 mm SD. The M AP angulation variation (for alignment variation) was 3.24°, with 2.95° SD. The M lateral angulation variation (for alignment variation) was 0.09°, with 0.13° SD. The M angle of axial rotation was 1.27° with SD: 1.19°. Conclusions: The method of accuracy evaluation used in this study can be helpful in establishing a reliable plan.

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

The purpose of this study was to evaluate the restoration of original anatomy after fixation of sawbone fractures using case-specific 3D printing plates based on virtual reduction (VR). Three-dimensional models of 28 tibia sawbones with cortical marking holes were obtained. The sawbones were fractured at various locations of the shaft and 3D models were obtained. The fractured models were reduced virtually and customized non-locking metal plates that fit the reduced model were produced via 3D printing. The fractured sawbones were actually fixed to the customized plate with nonlocking screws and 3D models were generated. With the proximal fragments of the 3D models overlapped, the changes in length, 3D angulation, and rotation of the distal fragment were evaluated. Compared to the intact model (IN), the virtual reduction model (VR) and the actual fixation model (AF) showed no significant differences in length. Compared to the IN, the VR and the AF had mean 3D angulations of 0.39° and 0.64°, respectively. Compared to the IN model, the VR and the AF showed mean rotations of 0.89° and 1.51°, respectively. A customized plate based on VR facilitates the restoration of near-original anatomy in fractures of tibial sawbone shaft.

Измерение деформации поврежденных сегментов в грудном и поясничном отделах позвоночника по данным спиральной компьютерной томографии для расчета необходимой коррекции

Introduction The more accurate is the measurement of the parameters for correcting the deformity of damaged spinal segments the more accurate will be the restoration of the sagittal profile and original anatomy of the spine. Purpose Substantiation of calculated indicators for deformity correction in one or two damaged spinal motion segments in the thoracic and lumbar spine according to spiral computed tomography. Material and methods The material for the study was the results of spiral computed tomography (SCT) of an anatomically unchanged thoracic and lumbar spine in 25 patients (12 women and 13 men aged 18 to 60 years). The study model consisted of three vertebral bodies and four adjacent discs from T4 to L4. Anterior and posterior dimensions of the vertebral bodies, intervertebral discs, and segmental deformity angle α (formed by the lower endplate of the overlying vertebra and the upper endplate of the underlying vertebra) were measured using RadiAnt computer software in the midsagittal projection. Damage to the body of the middle vertebra with adjacent discs was modeled, the dimensions of which were calculated from the adjacent vertebral bodies and adjacent discs. Statistical processing of the material was carried out using the computer software SPSS Statistics. Results The measurement error of the anterior interbody spaces was 1.4 ± 0.4 mm, the posterior interbody spaces were 1.3 ± 0.5 mm, the error in calculating the segmental deformation angle α was 2.5 ± 0.6 degrees, what indicates the high accuracy of the proposed method. Discussion The use of absolute deformity values as a standard for surgical intervention in the treatment of vertebral fractures is complicated by varieties of normal anatomy. Conclusion The proposed calculations for the restoration of the anterior and posterior interbody distances, as well as the angle of segmental deformity α after a spinal cord injury of the thoracic and lumbar spine provide an approach to the target individualized anatomical dimensions.

Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT

Background: In patients with chronic ankle instability, it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomic ATFL repair. Purpose: To compare the clinical outcomes after arthroscopic ATFL repair according to whether the anchor is fixed at an anatomic position. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for chronic ankle instability and were available for a minimum 2-year follow-up. The patients were divided into 3 groups according to the anchor position at the distal fibula on 3-dimensional computed tomography: anatomic arthroscopic ATFL repair (anatomic group), subanatomic arthroscopic ATFL repair (subanatomic group), and nonanatomic arthroscopic ATFL repair (nonanatomic group). The visual analog scale for pain, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes. Results: Of 96 patients, 16 were excluded per the exclusion criteria, and 80 were evaluated (anatomic group, n = 24; subanatomic group, n = 42; nonanatomic group, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that the anatomic group had better clinical scores on the FAOS than did the nonanatomic group in all 5 domains (all P < .017). Patients in the anatomic and subanatomic groups had better Karlsson scores and fall risk than those in the nonanatomic group (P = .004 and P = .013, respectively). In terms of objective outcomes, patients in the anatomic and subanatomic groups had better outcomes in fall risk than did those in the nonanatomic group (both P = .001). There were no differences in clinical scores and objective outcomes between the anatomic and subanatomic groups. Conclusion: Nonanatomic ATFL repair showed inferior outcomes when compared with anatomic ATFL repair. When arthroscopic ATFL repair is performed, the anchor should be fixed in the anatomic position to improve prognosis.

Clinical and Morphologic Characteristics of Perivenular Fernlike Leakage on Ultrawide-field Fluorescein Angiography

To analyze the spectrum of the perivenular fernlike leakage on ultrawide-field fluorescein angiography (UWFA) and discuss its potential implications in the current understanding of the retinal venous outflow. Retrospective, observational case series. Eyes presenting with fernlike patterns of dye leakage on UWFA were included in this study. Analysis of the clinical characteristics and multimodal imaging findings using UWFA and wide-angle swept-source OCT-angiography (SS-OCTA). The disease spectrum, anatomic origin, and clinical implications of this fernlike leakage. Multimodal retinal images from 40 eyes of 29 patients with fernlike leakage on UWFA were studied. The underlying etiologies included a wide range of inflammatory disorders, including pars planitis (18 eyes) and central retinal vein occlusion (2 eyes). On UWFA, the fernlike leakage originated from the retinal capillaries and venules directly adjacent to the veins and spared the periarterial zone. This perivenular fernlike leakage involved the far periphery in all cases and progressed more diffusely and centripetally in cases with more severe intraocular inflammation. On wide-angle SS-OCTA, the impairment of deep capillary plexus (DCP) flow signals precisely colocalized with the perivenular fernlike leakages identified on UWFA. The fernlike leakage on UWFA refers to the distinctive perivenular dye leakage that originates from the retinal capillaries and venules. Multimodal imaging correlation suggests that the predominant impairment is at the level of the DCP. The axial symmetry of the fernlike leakage with the veins and sparing of the periarterial zone may support the dominant venous role of the DCP.

MR Imaging Artifacts in the Head and Neck Region: Pitfalls and Solutions.

MR Imaging artifacts are features appearing in MR images that are not present in the original anatomy. MR imaging artifacts can be patient-related, hardware-related, or signal-processing-related and affect diagnostic quality or mimic pathology. It is necessary to take MR imaging artifacts into consideration when interpreting images. A basic knowledge of MR imaging physics and the potential origin of MR imaging artifacts can help to find solutions to eliminate or reduce the influence of artifacts on image quality by adjusting acquisition parameters appropriately for a better diagnosis.

Paradoxical Hyperexcitability in Disorders of Neurodevelopment.

Autism Spectrum Disorder (ASD), Rett syndrome (RTT) and Angelman Syndrome (AS) are neurodevelopmental disorders (NDDs) that share several clinical characteristics, including displays of repetitive movements, developmental delays, language deficits, intellectual disability, and increased susceptibility to epilepsy. While several reviews address the biological basis of non-seizure-related ASD phenotypes, here, I highlight some shared biological mechanisms that may contribute to increased seizure susceptibility. I focus on genetic studies identifying the anatomical origin of the seizure phenotype in loss-of-function, monogenic, mouse models of these NDDs, combined with insights gained from complementary studies quantifying levels of synaptic excitation and inhibition. Epilepsy is characterized by a sudden, abnormal increase in synchronous activity within neuronal networks, that is posited to arise from excess excitation, largely driven by reduced synaptic inhibition. Primarily for this reason, elevated network excitability is proposed to underlie the causal basis for the ASD, RTT, and AS phenotypes. Although, mouse models of these disorders replicate aspects of the human condition, i.e., hyperexcitability discharges or seizures on cortical electroencephalograms, measures at the synaptic level often reveal deficits in excitatory synaptic transmission, rather than too much excitation. Resolving this apparent paradox has direct implications regarding expected outcomes of manipulating GABAergic tone. In particular, in NDDs associated with seizures, cortical circuits can display reduced, rather than normal or increased levels of synaptic excitation, and therefore suggested treatments aimed at increasing inhibition could further promote hypoactivity instead of normality. In this review, I highlight shared mechanisms across animal models for ASD, RTT, and AS with reduced synaptic excitation that nevertheless promote hyperexcitability in cortical circuits.

A Novel Method for Digital Reconstruction of the Mucogingival Borderline in Optical Scans of Dental Plaster Casts.

Adequate soft-tissue dimensions have been shown to be crucial for the long-term success of dental implants. To date, there is evidence that placement of dental implants should only be conducted in an area covered with attached gingiva. Modern implant planning software does not visualize soft-tissue dimensions. This study aims to calculate the course of the mucogingival borderline (MG-BL) using statistical shape models (SSM). Visualization of the MG-BL allows the practitioner to consider the soft tissue supply during implant planning. To deploy an SSM of the MG-BL, healthy individuals were examined and the intra-oral anatomy was captured using an intra-oral scanner (IOS). The empirical anatomical data was superimposed and analyzed by principal component analysis. Using a Leave-One-Out Cross Validation (LOOCV), the prediction of the SSM was compared with the original anatomy extracted from IOS. The median error for MG-BL reconstruction was 1.06 mm (0.49–2.15 mm) and 0.81 mm (0.38–1.54 mm) for the maxilla and mandible, respectively. While this method forgoes any technical work or additional patient examination, it represents an effective and digital method for the depiction of soft-tissue dimensions. To achieve clinical applicability, a higher number of datasets has to be implemented in the SSM.

Non-glandular findings on breast ultrasound. Part I: a pictorial review of superficial lesions.

Ultrasound (US) represents the first-level imaging technique in the assessment of breast in young patients, whereas it is complementary to mammography in adult ones. It is not uncommon to encounter non-glandular mass during either screening or diagnostic breast US; sometimes the evaluation of palpable lump may be the reason of clinician's US request. The breast US field-of-view includes not only the glandular parenchyma, but also the tissues located anterior and posterior to it, from the skin to the ribs. In this setting, the radiologist must be familiar with the non-glandular breast diseases, which can occur in the superficial layers as well as in the chest wall. The differential diagnosis varies according to anatomic layer, so the anatomic origin is the first feature to assess and the correct localization is needed to avoid misdiagnosis and to choose, when requested, the second diagnostic step, imaging or histologic analysis. This paper is the first of two focused on non-glandular breast lesions; characterization, differential diagnosis, and pitfalls of superficial lesions are reviewed. They may be located in the dermis or hypodermis: the former are usually benign skin lesions, whereas the latter, although usually benign, may arise also from the anterior terminal lobular units, hence the papilloma, fibroadenomas, and breast cancers should be included in the differential diagnosis. US is more sensitive than CT and MRI in the assessment of superficial lesions due to higher spatial resolution.

Aortoiliac Occlusion Disease.

Leriche syndrome is characterized by abdominal aorta and/or bilateral iliac occlusive disease, with a triad of clinical symptoms and signs such as claudication, erectile dysfunction, and decreased distal pulses. Diagnostic imaging is one of the key factors for diagnosis of the anatomic origin of the Leriche symptoms. We report the case of a 56-year-old man with diagnosis of abdominal aorta and bilateral iliac occlusive disease with a wide collateral vascular network.

HETEROGENEITY IN BIOLOGICAL FEATURES OF OSTEOARTHRITIC AND NON-OSTEOARTHRITIC CARTILAGE ACCORDING TO THE JOINT LOCATION: A COMPARATIVE STUDY OF KNEE VERSUS HAND CARTILAGE FROM CADAVERS

Purpose: The search for endotypes in osteoarthritis (OA) is the basis of many studies with the aim of discovering disease-specific signatures. Nevertheless, the anatomical origin of the tissues used for these studies is always the knee. We wondered whether the origin of the tissue could have an influence on such signatures. For this purpose, we compared the expressions of different markers involved in the pathophysiology of OA in order to determine if their expression varied according to the localization (knee, proximal interphalangeal (PIP), metacarpophalangeal (MCP)) in the presence or not of an inflammatory environment.

Imaging of the mediastinum: Mimics of malignancy.

In the imaging of the mediastinum, benign lesions mimicking malignancy constitute potential pitfalls in interpretation. Localization and characteristic imaging features are key to narrow the differential diagnosis and avoid potential pitfalls in interpretation. Based on certain anatomic landmarks, the mediastinal compartment model enables accurate localization. Depending on the anatomic origin, mediastinal lesions can have various etiologies. The anatomic location and structures contained within each mediastinal compartment are helpful in generating the differential diagnoses. These structures include thyroid, thymus, parathyroid, lymph nodes, pericardium, embryogenic remnants, and parts of the enteric tracts, vessels, and nerves. Imaging characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT), including attenuation (fluid, fat, calcification), contrast enhancement, and metabolic activity, aid in narrowing the differential diagnoses. Understanding the roles and limitations of various imaging modalities is helpful in the evaluation of mediastinal masses. In this review, we present potential pitfalls in the imaging of mediastinal lesions with emphasis on the mimics of malignancy.

Acute anterolateral knee instability in adults: combined proximal ACL and ALL injury repair is not inferior to standard ACL reconstruction with LET in 2 years.

Objectives:The objective was to compare the clinical results of ACL and ALL repair with those of standard ACL reconstruction + LET. The hypothesis was that combined repair is non-inferior to standard reconstruction + LET in adults with acute anterolateral knee instability.Methods:Patients with severe acute anterolateral instability (ACL + ALL injuries) who underwent early ACL surgery (injury-to-surgery interval < 14 days), a total of 58 patients, were prospectively enrolled in the study. ACL injuries were classified according to the Sherman classification. Patients with a proximal injury (types 1 and 2) were assigned to receive ACL repair (ACLrep) (n = 37), patients with types 3 and 4 and moderate tissue quality (n = 21) were assigned to receive ACL reconstruction (ACLrec) + lateral extra-articular tenodesis (LET). Repair consisted of transosseous suture of the stump to the anatomic origin of the ACL and direct repair of the ALL. Reconstruction consisted of standard ACL reconstruction by semitendinosus-gracilis (STG) autograft + LET. PROMs included IKDC, Lysholm, KOOS, and assessment of anteroposterior (AP) knee laxity in 2 years.Results:A sample size calculation showed that 21 patients in each group were needed for a 95% power (with a 95% CI) to show non-inferiority of the repair group considering an arthrometric side-to-side difference of at least +1.5. Patients in the ACLrep group showed better results on all scales: mean IKDC was 95.51 ± 52.4 versus 86.92 ± 13.92 (p = 0.02); mean KOOS was 97.49 ± 2.71 versus 93.50 ± 7.05 (p = 0.009); and mean Lysholm was 96.98 ± 5.14 versus 91.69 ± 10.08 (p = 0.02). There was no difference in the KT1000 measurement (ACLrep: 1.70 ± 1.02; ACLrec: 2.21 ± 0.80; p = 0.11). The one-sided 95% CI was 1.7 (to 2.02) (< at the 3.01 limit for non-inferiority) for ACLrep and 2.21 (to 2.46) for ACLrec, p = 0.147. Therefore, non-inferiority was provenConclusion:In acute knee instability resulting from a combined ACL and ALL injury, direct repair is non-inferior in terms of PROM and knee laxity compared to standard ACL + LET reconstruction in 2 years.

Anatomical connections among the depressor supercilii, levator labii superioris alaeque nasi, and inferior fibers of orbicularis oculi: Implications for variation in human facial expressions.

The aim of this study was to determine how the depressor supercilii (DS) connects to the levator labii superioris alaeque nasi (LLSAN) and inferior fibers of the orbicularis oculi (OOc INF) in the human midface. While grimacing, contraction of the DS with fibers connecting to the LLSAN and OOc INF can assist in pulling the medial eyebrow downward more than when these connecting fibers are not present. Contraction of these distinct connecting fibers between the DS and the LLSAN can also slightly elevate the nasal ala and upper lip. The DS was examined in 44 specimens of embalmed adult Korean cadavers. We found that the DS connected to the LLSAN or the OOc INF by muscle fibers or thin aponeuroses in 33 (75.0%) of the 44 specimens. The DS was connected to both the LLSAN and OOc INF by muscle fibers or aponeuroses and had no connection to either in 5 (11.4%) and 11 (25.0%) specimens, respectively. The DS was connected to the LLSAN by the muscle fibers and thin aponeuroses in 6 (13.6%) and 4 (9.1%) specimens, respectively. The DS was connected to the OOc INF by the muscle fibers and thin aponeuroses in 5 (11.4%) and 23 (52.3%) specimens, respectively. Our findings regarding the anatomical connections of the glabellar region DS to the midface LLSAN and OOc INF provide insights on the dynamic balance between the brow depressors such as the DS and brow-elevating muscle and contribute to understanding the anatomical origins of individual variation in facial expressions. These results can also improve the safety, predictability, and aesthetics of treatments for the glabellar region with botulinum toxin type A and can be helpful when performing electromyography.

An Exploratory Study on Vectorcardiographic Identification of the Site of Origin of Focally Induced Premature Depolarizations in Horses, Part II: The Ventricles.

Simple SummaryVentricular arrhythmias occur commonly in horses. Knowledge on the origin of ventricular arrhythmias is essential for proper treatment. Former studies in horses showed contradictory results regarding the diagnostic value of 12-lead electrocardiography and vectorcardiography due to the anatomical differences in horses compared to humans and small animals. As a consequence, no standardized approach is available for electrocardiography electrode configurations in horses. The current study investigated whether the anatomical origin of experimentally induced ventricular premature depolarizations in horses could be differentiated based upon spherical statistics of the vectorcardiography characteristics. Vectorcardiography shows the magnitude and direction of the cardiac electrical forces in three dimensions. The vectorcardiogram was recorded in seven horses under general anesthesia while right and left ventricular pacing was performed from inside the heart. Using spherical statistics, it could be shown that pacing induces significantly different initial and maximum electrical axes between different locations and between pacing and normal sinus rhythm. The current approach could be used in clinical patients to identify the origin of ventricular arrhythmias without the need for invasive studies. The technique could also be used in other species for which a standardized electrocardiogram electrode configuration is not available.In human cardiology, the anatomical origin of ventricular premature depolarizations (VPDs) is determined by the characteristics of a 12-lead electrocardiogram (ECG). Former studies in horses had contradictory results regarding the diagnostic value of the 12-lead ECG and vectorcardiography (VCG), which results were attributed to the different cardiac conduction system in this species. The objective of this study was to determine if the anatomical origin of pacing-induced VPDs could be differentiated in horses based upon VCG characteristics. A 12-lead ECG was recorded in seven horses under general anesthesia while right and left ventricular endomyocardial pacing was performed (800–1000 ms cycle length) at the apex, mid and high septum and mid and high free wall, and at the right ventricular outflow tract. Catheter positioning was guided by 3D electro-anatomical mapping and echocardiography. A median complex, obtained from four consecutive complexes, was calculated for each pacing location and sinus rhythm. The VCG was calculated from the 12-lead ECG-derived median complexes using custom-made algorithms and was used to determine the initial and maximum electrical axes of the QRS complex. An ANOVA for spherical data was used to test if VCGs between each paced location and between pacing and sinus rhythm were significantly (p < 0.05) different. The model included the radius, azimuth and elevation of each electrical axis. Pacing induced significantly different initial and maximum electrical axes between different locations and between pacing and sinus rhythm. The current results suggest that VCG is a useful technique to identify the anatomical origin of ventricular ectopy in horses.

An Exploratory Study on Vectorcardiographic Identification of the Site of Origin of Focally Induced Premature Depolarizations in Horses, Part I: The Atria.

Simple SummaryArrhythmias are common in horses, but in order to offer adequate treatment, the anatomical location from where the arrhythmia originates must first be known. The objective of this study was to differentiate between the various anatomical origins of atrial premature depolarizations and to further differentiate these from normal sinus rhythm based upon the vectorcardiography characteristics of seven horses without cardiovascular disease. With vectorcardiography, the magnitude and direction of the cardiac electrical forces were derived from an electrocardiographic recording and were plotted in three dimensions. The three directions were represented by the right–left axis, head–tail axis, and dorsoventral axis. Under general anaesthesia, atrial premature depolarizations were induced by pacing inside the heart, guided by a 3D mapping system that allowed us to see the 3D position of the pacing catheter inside the heart in real-time. An adapted statistical test optimized for spherical data was used to demonstrate that the maximal directions of the first and second half of the P wave showed significant differences between the paced locations and between the paced complexes and sinus rhythm. The current study provides a practical approach to identifying the approximate site of origin of an atrial arrhythmia using a custom 12-lead ECG.In human cardiology, the anatomical origin of atrial premature depolarizations (APDs) is derived from P wave characteristics on a 12-lead electrocardiogram (ECG) and from vectorcardiography (VCG). The objective of this study is to differentiate between anatomical locations of APDs and to differentiate APDs from sinus rhythm (SR) based upon VCG characteristics in seven horses without cardiovascular disease. A 12-lead ECG was recorded under general anaesthesia while endomyocardial atrial pacing was performed (800–1000 ms cycle length) at the left atrial free wall and septum, right atrial free wall, intervenous tubercle, as well as at the junction with the cranial and caudal vena cava. Catheter positioning was guided by 3D electro-anatomical mapping and transthoracic ultrasound. The VCG was calculated from the 12-lead ECG using custom-made algorithms and was used to determine the mean electrical axis of the first and second half of the P wave. An ANOVA for spherical data was used to test if the maximal directions between each paced location and the maximal directions between every paced location and SR were significantly (p < 0.05) different. Atrial pacing data were not available from the LA septum in three horses, the intervenous tubercle in two horses, and from the LA free wall in one horse. The directions of the maximal electrical axes showed significant differences between all paced locations and between the paced locations and SR. The current results suggest that VCG is useful for identifying the anatomical origin of an atrial ectopy.

Non-invasive localization of premature ventricular focus: A prospective multicenter study

BackgroundAccurate localization of premature ventricular contractions (PVC) focus is a prerequisite to successful catheter ablation. ObjectiveThe objective was to evaluate the software View Into Ventricular Onset (VIVO) accuracy at locating the anatomical origins for premature ventricular contractions. The VIVO device noninvasively creates a model of the patient's heart and torso, with exact locations of 12‑lead ECG electrodes, and applies a mathematical algorithm from surface signals to determine the origin of the arrhythmia. We sought to compare the agreement between VIVO-predicted locations to invasive electroanatomical mapping results. Methods51 consecutive patients who presented for PVC ablations at the study centers were recruited. VIVO images were collected at baseline preprocedure and all patients underwent invasive electroanatomical activation mapping of the clinical arrhythmia. Pacing was performed in pre-specified locations in the right and/or left ventricle. The successful sites of ablation and the pacing locations were compared to VIVO predicted locations. The results were adjudicated by physician experts in a blinded fashion. ResultsSeven patients were excluded from analyses. VIVO accurately identified the origin of the clinical premature ventricular contractions in 44/44 patients (100.00%). The accuracy in identifying the paced location for all patients (right and left sides of the heart) was 99.5% using the VIVO system. No adverse events were reported. ConclusionsVIVO is a novel noninvasive system that could be used to help guide ablation procedures with a high degree of accuracy. The VIVO algorithm is easy to use and may be useful in the workflow for ventricular arrhythmia ablation.

Characteristics of burned phytolith from representative plants in Northeast China and implications for paleo-fire reconstruction

Studies of the burned phytolith identification have provided a theoretical basis for paleo-fire reconstruction. However, as the most widely used method, the applicability of the visual identification method is still controversial due to its subjectivity. To gain a better identification of burned phytolith, this study used CIELAB color model to quantitatively analyze and distinguish the color characteristics of phytoliths from burned and unburned plant samples (n = 86) in northeast China. The results demonstrate that more than 60% of phytolith in burned plant samples appeared color changes. The burned phytolith percentages (BP/P) of different morphotypes were also with obvious differences, the phytoliths derived from hair cells and stomata have the highest BP/P values while those values of phytoliths from tracheary elements were relatively low, which may be due to the different anatomical origin of phytoliths, and the original cells closer to the outer epidermis were more prone to coloration. After measuring and comparing the chromatism values of phytoliths, it is concluded that the chromatism values of those phytoliths greater than 30 can be regarded as being exposed to fire. Moreover, the various hues from different species may be related to the flammability and combustion adequacy of plants. Finally, we proposed the phytolith morphotypes suitable for paleo-fire reconstruction in the study area according to the above results. Overall, our study provides a reliable basis for the identification of burned phytolith and a reference for reconstructing paleo-fires.

Transcriptional Regulation of Jaw Osteoblasts: Development to Pathology

Craniofacial and jaw bones have unique physiological specificities when compared to axial and appendicular bones. However, the molecular profile of the jaw osteoblast (OB) remains incomplete. The present study aimed to decipher the bone site-specific profiles of transcription factors (TFs) expressed in OBs in vivo. Using RNA sequencing analysis, we mapped the transcriptome of confirmed OBs from 2 different skeletal sites: mandible (Md) and tibia (Tb). The OB transcriptome contains 709 TF genes: 608 are similarly expressed in Md-OB and Tb-OB, referred to as “OB-core”; 54 TF genes are upregulated in Md-OB, referred to as “Md-set”; and 18 TF genes are upregulated in Tb-OB, referred to as “Tb-set.” Notably, the expression of 29 additional TF genes depends on their RNA transcript variants. TF genes with no previously known role in OBs and bone were identified. Bioinformatics analysis combined with review of genetic disease databases and a comprehensive literature search showed a significant contribution of anatomical origin to the OB signatures. Md-set and Tb-set are enriched with site-specific TF genes associated with development and morphogenesis (neural crest vs. mesoderm), and this developmental imprint persists during growth and homeostasis. Jaw and tibia site-specific OB signatures are associated with craniofacial and appendicular skeletal disorders as well as neurocristopathies, dental disorders, and digit malformations. The present study demonstrates the feasibility of a new method to isolate pure OB populations and map their gene expression signature in the context of OB physiological environment, avoiding in vitro culture and its associated biases. Our results provide insights into the site-specific developmental pathways governing OBs and identify new major OB regulators of bone physiology. We also established the importance of the OB transcriptome as a prognostic tool for human rare bone diseases to explore the hidden pathophysiology of craniofacial malformations, among the most prevalent congenital defects in humans.

Guided endodontic treatment in a region of limited mouth opening: a case report of mandibular molar mesial root canals with dystrophic calcification

BackgroundThe endodontic treatment of calcified root canals in molars is a challenging and time-consuming procedure. Even with the aid of a surgical microscope, the risk of root perforation is high, especially in the furcation area. The purpose of this study is to report the Computer-Aided-Design and Manufacturing (CAD–CAM) workflow, the innovative strategies for the template ideation, and the guided endodontic treatment of a mandibular molar with dystrophic calcification in the mesial root canals.Case presentationA 58-year-old female patient, ASA I, was referred to endodontic treatment in the right first mandibular molar for prosthetic reasons. The mesiobuccal and mesiolingual canals appeared obliterated in the radiographic images. The absence of dental crown, tooth inclination, and the limited mouth opening of the region contributed to a poor visual reference of the tooth in the dental arch and the direction of the remaining lumens of the canals. Despite using surgical microscopy, the conventional technique led to the deviation of the mesiobuccal canal towards the furcation area. The obliteration of both mesial root canals was confirmed using the Cone Beam Computer Tomography. The clinical history associated with the tomography diagnosis was compatible with dystrophic calcifications in the pulp canals. The patient was submitted to an intra-oral scanning as well. The Digital Imaging and Communications in Medicine data (DICOM) were segmented. The Standard Tessellation Language (STL) files were processed following the CAD–CAM workflow, aiming to create two different endodontic templates with a new open design concept. The templates with open design allowed direct visualization of the operative field, irrigation, and dentin debris removal. The strategy of the guidance sleeves niche as half-cylinders allowed the drill insertion in a limited mouth opening region.ConclusionsThe digital planning and guided access permitted to overcome the case limitations and then re-establish the glide path following the original anatomy of the root canals. The guided endodontic represents a personalized technique that provides security, reduced risks of root perforation, and a significant decrease of the working time to access obliterated root canals even in the mesial root canal of mandibular molars, a region of limited mouth opening.