Anterior Facing Research Articles

Anatomic Considerations of esophageal button battery ingestion for outcomes and imaging

IntroductionButton batteries (BB) are a source of significant morbidity and mortality in young children. Little data is available regarding associations between esophageal impaction location and outcomes or need for surveillance imaging. MethodsAll patients treated at a single institution following BB ingestion between 2018 and 2022 were included for retrospective chart review. ResultsTwenty patients were treated at our institution BBs were located, or most significant damage observed, in the cervical esophagus (n = 10, 50 %), followed by thoracic esophagus (n = 6, 30 %), and abdominal esophagus (n = 4, 20 %). Patients with cervical esophageal impaction were younger (482 [370–866] days), than those with thoracic (1395 [871–2369] days) or abdominal esophageal impaction (2021.5 [1230.5–3419.5] days) (p = 0.003). Zargar Mucosal Injury Grade was significantly more severe in patients with cervical button battery impaction; 8/10 (80 %) had a ≥Grade IIIB injury, compared to 2/6 (33.3 %) thoracic impactions and 0/4 (0 %) abdominal impactions (p = 0.002). All patients who developed persistent esophageal stenosis (n = 6) had cervical battery impactions (6, 60 %, p = 0.015). Both TEFs (2/2) had anterior facing anode, while both (2/2) esophageal perforations had posterior. Only 1/20 (5 %) patients, and 1/7 (14.3 %) with serious complications, had a serious complication detected on routine, rather than clinically indicated follow-up surveillance. ConclusionsIn our population, cervical BB impaction occurred more frequently in younger children, was associated with more severe mucosal injury, and had higher risk of stenosis. Nearly all complications were detected on clinically indicated rather than postoperative surveillance imaging.

Wnt/β-catenin signalling is required for pole-specific chromatin remodeling during planarian regeneration

For successful regeneration, the identity of the missing tissue must be specified according to the pre-existing tissue. Planarians are ideal for the study of the mechanisms underlying this process; the same field of cells can regrow a head or a tail according to the missing body part. After amputation, the differential activation of the Wnt/β-catenin signal specifies anterior versus posterior identity. Initially, both wnt1 and notum (Wnt inhibitor) are expressed in all wounds, but 48 hours later they are restricted to posterior or anterior facing wounds, respectively, by an unknown mechanism. Here we show that 12 hours after amputation, the chromatin accessibility of cells in the wound region changes according to the polarity of the pre-existing tissue in a Wnt/β-catenin-dependent manner. Genomic analyses suggest that homeobox transcription factors and chromatin-remodeling proteins are direct Wnt/β-catenin targets, which trigger the expression of posterior effectors. Finally, we identify FoxG as a wnt1 up-stream regulator, probably via binding to its first intron enhancer region.

Commissural Malalignment as a Predictor of Coronary Artery Abnormalities in Patients with Transposition of Great Arteries

Abstract Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter/D1+D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value <0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern

Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

BackgroundIn patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy.MethodsWe proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients.ResultsWe had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001).ConclusionsThe C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.

Poly(ADP-Ribose) Polymerase-3 Regulates Regeneration in Planarians.

Protein ADP-ribosylation is a reversible post-translational modification (PTM) process that plays fundamental roles in cell signaling. The covalent attachment of ADP ribose polymers is executed by PAR polymerases (PARP) and it is essential for chromatin organization, DNA repair, cell cycle, transcription, and replication, among other critical cellular events. The process of PARylation or polyADP-ribosylation is dynamic and takes place across many tissues undergoing renewal and repair, but the molecular mechanisms regulating this PTM remain mostly unknown. Here, we introduce the use of the planarian Schmidtea mediterranea as a tractable model to study PARylation in the complexity of the adult body that is under constant renewal and is capable of regenerating damaged tissues. We identified the evolutionary conservation of PARP signaling that is expressed in planarian stem cells and differentiated tissues. We also demonstrate that Smed-PARP-3 homolog is required for proper regeneration of tissues in the anterior region of the animal. Furthermore, our results demonstrate, Smed-PARP-3(RNAi) disrupts the timely location of injury-induced cell death near the anterior facing wounds and also affects the regeneration of the central nervous system. Our work reveals novel roles for PARylation in large-scale regeneration and provides a simplified platform to investigate PARP signaling in the complexity of the adult body.

Novel Observations of Female Genital Anatomy in Classic Bladder Exstrophy Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Understanding the distinct female anatomy in classic bladder exstrophy is crucial for optimal reconstructive and functional outcomes. We present novel quantitative anatomical data in females with classic bladder exstrophy before primary closure. 3-Dimensional reconstruction was performed in patients undergoing pelvic magnetic resonance imaging, and pelvic anatomy was characterized, including measurements of the vagina, cervix and erectile bodies. We examined magnetic resonance imaging of 5 females (mean age 5.5 months) with classic bladder exstrophy and 4 age matched controls (mean age 5.8 months). Mean distance between the anal verge and vaginal introitus was greater in patients with classic bladder exstrophy (2.43 cm) than in controls (1.62cm). Mean total vaginal length in patients with classic bladder exstrophy was half that of controls (1.64 cm vs 3.39 cm). All 4 controls had posterior facing cervical ora, while 4 of 5 females with exstrophy had anterior facing cervical ora located in the anterior vaginal wall. Lateral deviation of the cervical ora was also seen in all 5 patients with classic bladder exstrophy but in only 1 control. Clitoral body length was comparable in both groups (26.2 mm and 28.0 mm). However, the anterior cavernosa-to-posterior (pelvic rami associated) cavernosa ratio was much greater in patients with classic bladder exstrophy (6.4) compared to controls (2.5). This study uncovers the uniquely novel finding that contrary to their male counterparts, females with classic bladder exstrophy have the majority of the clitoral body anterior to the pelvic attachment. This discovery has surgical and embryological implications.

Pulmonary Cusp and Annular Extension Technique for Reconstruction of Right Ventricular Outflow in Tetralogy of Fallot

An alternative pulmonary valve-sparing technique for primary repair of tetralogy of Fallot is presented. Reconstruction of the right ventricular outflow tract was accomplished by augmentation of the anterior facing pulmonary cusp, the pulmonary annulus, and the main pulmonary artery using a single autologous pericardial patch. This valve-sparing technique preserves the coaptation and suspension mechanisms of the native pulmonary cusp and therefore may minimize pulmonary insufficiency in the long term.

Fostering Ambulation for a Preschool Child with Rett Syndrome: A Case Report

ABSTRACTChildren with Rett Syndrome (RS) have neuromotor impairments that impact their mobility. Poor hand function among children with RS limits the selection of an assistive device for ambulation. Purpose: The purpose of this case report is to describe the process of selecting an assistive device for a child with RS to promote ambulation. Method: This single subject case reports on a 5-year-old girl with RS at a suburban mid-western early childhood special education setting. Results: The child in this case was able to walk the farthest distances with a metal toy shopping cart and then with an anterior facing four-wheeled walker. Conclusion: The outcome suggests that physical therapists and health professionals caring for young children with RS consider using a metal toy shopping cart to establish and practice ambulation prior to selection of a longer term, adjustable anterior facing walker like the one in this case report.

The Neanderthal lower arm

Neanderthal forearms have been described as being very powerful. Different individual features in the lower arm bones have been described to distinguish Neanderthals from modern humans. In this study, the overall morphology of the radius and ulna is considered, and morphological differences among Neanderthals, Upper Paleolithic Homo sapiens and recent H. sapiens are described. Comparisons among populations were made using a combination of 3D geometric morphometrics and standard multivariate methods. Comparative material included all available complete radii and ulnae from Neanderthals, early H. sapiens and archaeological and recent human populations, representing a wide geographical and lifestyle range. There are few differences among the populations when features are considered individually. Neanderthals and early H. sapiens fell within the range of modern human variation. When the suite of measurements and shapes were analyzed, differences and similarities became apparent. The Neanderthal radius is more laterally curved, has a more medially placed radial tuberosity, a longer radial neck, a more antero-posteriorly ovoid head and a well-developed proximal interosseous crest. The Neanderthal ulna has a more anterior facing trochlear notch, a lower M. brachialis insertion, larger relative mid-shaft size and a more medio-lateral and antero-posterior sinusoidal shaft. The Neanderthal lower arm morphology reflects a strong cold-adapted short forearm. The forearms of H. sapiens are less powerful in pronation and supination. Many differences between Neanderthals and H. sapiens can be explained as a secondary consequence of the hyper-polar body proportions of the Neanderthals, but also as retentions of the primitive condition of other hominoids.

Determining the Accuracy and Reliability of Computer Generated Pain Location Data From the PainreportIt® Pain Assessment Tool for Sickle Cell Disease (SCD) Patients.

Abstract 4613 AimPAINReportIt® is a computer based, self-reporting pain assessment tool that was designed to serve as a communication tool between patients and medical care providers. Originally developed and validated for the reporting of cancer pain, the application of this tool to sickle cell pain is novel. One aspect of this computer program incorporates a body outline in which patients can indicate specific pain locations by drawing on the anterior and posterior facing body images. However, because of the systemic nature of SCD, affected individuals may experience a wider range in the number of painful sites and their distribution than individual cancer patients. Therefore, the established algorithms within the computer program, which convert a graphic pain representation into a numerical description of the number of painful sites and their anatomic distribution, must be able to account for this variability. The purpose of this study was to ensure the reliability and accuracy of the computer generated data by comparing it to human generated data regarding painful sites, and to account for all factors that may impinge on the accuracy of computer generated data. MethodsIndividual PAINReportIt® body outlines completed by 49 adolescent SCD patients ranging from 14 to 27 years in age (mean=18 +/- 2.6) were analyzed by two researchers based on a specific set of guidelines. The researchers were blinded to the computer generated data as they coded the data following guidelines that defined 1) the method for counting the number of pain sites in each drawing, 2) an ordering hierarchy for assigning a site number to each site, and 3) whether or not a particular body segment was included in each site. The 9 body segments included the head, chest, right and left arms, abdomen, right and left legs, upper back and lower back. A third researcher and consensus discussion resolved coding discrepancies between researchers. Descriptive and t test statistics were used to compare the data results of the researcher and results generated by the computer. ResultsThere was strong accuracy in the interpretation of site number and locations between the researcher's data and the computer-generated data. For example, patients reported a mean value of 3.9 (+/- 3.3) and 3.8 (+/- 3.5) painful sites according to the computer program and researcher, respectively. Also, there was strong accuracy in patients' reports of site assignments for 8 of the 9 body segments. For example, the fraction of painful sites that included the head was found to be 0.2 +/- 0.4 and 0.3 +/- 0.5 by the computer and researcher, respectively. However, a significant difference between the computer and the researcher was found for inclusion of the lower back segment – 0.1 +/- 0.2 and 0.5 +/- 0.5 of painful sites, respectively (P < 10-3). ConclusionFindings suggest that the algorithms used to interpret patient drawings in the PAINReportIt® computer program generally accounts for the intentions of the patients. The minor discrepancies may reflect ambiguities in the guidelines used by the researcher in identifying involvement of this particular body segment, or an idiosyncrasy in the computer algorithm itself. Analysis of painful site data by multiple independent observers will likely resolve this discrepancy. Findings also indicate that there is still room for adjustment so that differences between the algorithms of the computer program and the specific guidelines used by the researcher can be reconciled to accurately reflect the patient's pain location report. Disclosures:No relevant conflicts of interest to declare.

Lower-Pole Fluoroscopy-Guided Percutaneous Renal Access: Which Calix Is Posterior?

When obtaining fluoroscopy-guided lower-pole percutaneous renal access, knowledge of which calix is posterior is of paramount importance. Textbooks and peer-reviewed articles consistently refer to the most medial calix seen on fluoroscopy as posterior. We undertook this study to determine the orientation of the lower-pole calices to define the optimal site for lower-pole percutaneous renal access via a posterior calix. A retrospective review was performed of 101 renal units for patients who underwent routine contrast-enhanced abdomen/pelvic CT with delayed images for the workup of microscopic hematuria. Delayed images of the renal collecting system that were performed with patients in the supine position were analyzed for the study. Axial and coronal CT scans were evaluated by two observers, and the anatomic details of the lower pole were collected. Specifically, the number of minor calices in the lower pole (ie, two or three), the orientation of each minor calix (anterior facing, posterior facing), and the relative orientation of the minor calices (ie, which calix is most anterior, which calix is most posterior) were recorded. Exclusion criteria were: History of nephrolithiasis, history of renal surgery (open, laparoscopic, endoscopic, percutaneous), CT evidence of ipsilateral renal parenchymal or collecting system lesion. CT scans were analyzed for 101 renal units (50 left, 51 right). For the lower pole, 42 (41.6%) renal units had two calices and 59 (58.4%) renal units had three calices. The most medial calix on coronal imaging was anterior facing in 95 (94.1%) kidneys, was the most anterior positioned calix in 84 (83.2%) kidneys, and was the most posterior positioned calix in 9 (8.9%) kidneys. Kidneys were then stratified by number of lower pole calices (two vs three). For the 42 renal units with two lower pole calices, the most medial calix on coronal imaging was anterior facing in 41 (95.2%) kidneys, was the most anterior positioned calix in 39 (92.9%) kidneys, and was the most posterior positioned calix in 2 (7.1%) kidneys. Of the 59 renal units with three lower-pole calices, the most medial calix on coronal imaging was anterior facing in 55 (93.2%) kidneys, was the most anterior positioned calix in 49 (84%) kidneys, and was the most posterior positioned calix in 4 (6.8%) kidneys. For percutaneous lower-pole renal access, the most medial calix on coronal CT imaging and therefore retrograde opacification using fluoroscopy is almost always anterior facing and is the most anterior positioned in the majority of kidneys. Percutaneous lower-pole puncture should be directed at the more lateral calices because their posterior position and orientation provides optimal access to the collecting system for most cases. This anatomic understanding is critical for successful percutaneous nephrolithotomy.

&lt;I&gt;Homalodisca coagulata&lt;/I&gt; (Hemiptera: Cicadellidae) Feeding Posture

The sharpshooter Homalodisca coagulata Say (Hemiptera: Cicadellidae) is a polyphagous insect that feeds primarily from the xylem vessels of host plants. This insect is an efficient vector of the xylem-limited, plant-pathogenic bacterium Xylella fastidiosa Wells, which is the causal agent of several important diseases in ornamental and agricultural crops. In wild populations, H. coagulata have been observed to almost exclusively orient with their anterior facing toward the roots (AFR), regardless of branch position. The orientation of H. coagulata seemed to be chosen before stylet insertion. Neither masking plant chemical and morphological surface cues nor placing test plants in the absence of light affected body posture. The introduction of 1.5-V direct current electricity to the plants resulted in altered body positioning. Removal of both front tarsi influenced body position; however, removal of only the right or left front tarsi had no effect on H. coagulata body position. Removal or masking of right, left, or both antennae resulted in altered body position.

Origin of both coronary arteries from the pulmonary artery.

Origin of both coronary arteries from the pulmonary artery is generally a lethal condition from progressive ventricular failure. We report the clinical and surgical course of two infants, ages 3 and 6 months, with this anomaly. One patient had normal intracardiac anatomy with low pulmonary artery pressures (30/12 mm Hg). The second patient had a restrictive subpulmonic ventricular septal defect with a moderately elevated pulmonary artery pressure (50/13 mm Hg). Left ventricular ejection and shortening fractions were profoundly depressed in both patients. The common coronary trunk arose from the right anterior facing sinus in one patient and from the left posterior facing sinus in the other. Both patients underwent repair by direct coronary implantation to the aorta. Left ventricular function improved with shortening fractions near normal at a follow-up of 6 months for one patient and 1 year for the other. Early diagnosis and prompt repair is compatible with survival and return of normal shortening fraction.

Scanning electron microscopy and comparative micromorphology of the periplast ofHemiselmis rufescens, Chroomonassp.,Chroomonas salinaand members of the genusCryptomonas(Cryptophyceae)

Scanning electron microscopy demonstrated small numbers of longitudinal offset rows of rectangular plates in Hemiselmis rufescens Parke and Chroomonas sp. Chroomonas salina Butcher and all examined strains of Cryptomonas showed numerous rows of smaller hexagonal plates. Regular arrays of peripheral trichocysts are absent in H. rufescens and account for the smooth appearance of the cell surface. In all other described members of the Cryptophyceae two trichocysts, one beneath each corner, are typically associated with the anterior facing edges of each plate. The subapical tubular gullet of the genera Chroomonas and Cryptomonas is absent in H. rufescens where the corresponding region is marked by an oval area without plates and a slightly raised posterior rim. The two anteriorly directed flagella emerge from beneath this rim or the sac-like invagination in Chroomonas and Cryptomonas. Sections of the periplast of H. rufescens and Chroomonas sp. showed the limiting plasma membrane sandwiched between an inner a...