Anterior Part Research Articles

Treatment of an ossifying fibroma of the mandible with endodontic microsurgery and grafting with a biphasic calcium sulfate material: a case report.

Following endodontic surgery placement of osseous graft material via Guided Tissue Regeneration to fill the defect aids to accelerate fill of the defect on a healthy 26-year-old female patient. A case discussing the one-step treatment of an ossifying fibroma of the anterior part of the mandible following endodontic microsurgery with associated retrograde fill of the apex, then site grating with biphasic calcium sulfate (Bond Apatite®) used in regeneration of the osseous defect related to the lesion and resulting surgery. Histologically, the ossifying fibroma is dominated by connective tissue containing cell rich areas with a few fragments of fibrosis. Moreover, in the connective tissue numerous small fragments of spongy and compact bone with areas of partial necrosis present and a significant number of inflammatory cells are observed. Surgical removal of the cyst with thorough curettage of the osseous walls and grafting of the defect provides predictable healing and the desired clinical results sought. Utilization of the biphasic calcium sulfate graft material allows the elimination of the need to overlay the area with a membrane before the flap due to its hard set and the prevention of soft tissue ingrowth into the graft material during the healing phase. Additionally, the hard set of the material allows tenting of the area to maintain the desired volume and ridge contour. Conversion of the graft material depending on the volume placed to host bone occurs over a 3-6 month period. The case report presented, as well as the authors experience mimics the literature on biphasic calcium sulfate in its use as an osseous graft material and is an effective method for the repair of osseous defects that result from the removal of tumors and cysts of the maxilla and mandible. Treatment of an ossifying fibroma is an ideal application of the use of this biphasic calcium sulfate material allowing tenting of the surgical site over the defect created after cyst removal without the need for resorbable collagen membranes. This simplifies its use and decreases material costs that may hamper patient acceptance of treatment without a decrease in expected clinical results.

Effects of occlusal conditions on masseter and temporalis muscle activity: An electromyographic evaluation

IntroductionDental occlusion contributes to the development of temporomandibular disorder. ObjectiveThis case control study examined the influence of different occlusal conditions on the surface electromyography (sEMG) of the superficial part of the masseter muscle (MM) and anterior part of the temporalis muscle (TA) during clenching in the maximum intercuspal position (MIP). Materials and methodsTwelve healthy subjects had their anterior, right posterior, or left posterior teeth added by composite resin to generate the bilateral posterior, unilateral left, or unilateral right posterior tooth losses, respectively. Muscle activity in the resting stage, MM’s and TA’s maximum voluntary clenching (MVC; µV) in MIP, each muscle activity’s symmetry (%), and ipsilateral MM and TA synergy (%) were measured by sEMG. All parameters were analyzed by SPSS version 23.0, and the significance level was set at p < 0.05. ResultsThe MM’s and TA’s sEMG activity at the resting stage significantly differed from those at the other occlusal conditions (p < 0.05). Both muscles’ MVC were highest at the MIP during clenching but lowest during anterior clenching. During unilateral posterior clenching, such MVC was higher at the occluding than at the non-occluding sides. The TA’s symmetry during clenching at the anterior and unilateral posterior teeth was lower than that at the MIP during clenching. No significant difference was seen in the ipsilateral MM and TA synergy. ConclusionDifferent occlusal conditions influenced the MM’s and TA’s sEMG activity. Each masticatory muscle responded differently to the same occlusal conditions.

Clinical features, diagnosis, and treatment of dry eye syndrome in children

AIM: To investigate the etiopathogenesis and clinical features of dry eye syndrome in children, methods for diagnosing the disease, and the treatment algorithm.&#x0D; MATERIAL AND METHODS: One hundred eighty-seven children with dry eye syndrome aged 3 to 17 yr were examined. To diagnose dry eye syndrome in children, the following research methods were used: biomicroscopy of the anterior part of the eye under diffuse illumination and with a cobalt filter after instillation of vital dyes; examination of the height of the lacrimal meniscus; identification of a characteristic discharge in the conjunctival sac, xerosis of the ocular surface; and evaluation of tear production (Schirmer I test) and stability of the tear film.&#x0D; RESULTS: We found that the links in the pathogenesis of dry eye syndrome in children were as follows: diseases of the ocular surface and appendage of the eye, contact correction of ametropia, and surgical operations on the conjunctiva and oculomotor muscles; otogenic neuritis of the facial nerve; rheumatoid arthritis; endocrine ophthalmopathy; lagophthalmos; and thermal and chemical burns. It is now always possible to evaluate tear production and tear film stability in preschool and primary school-aged children. In this case, the main diagnostic method is biomicroscopy. We identified objective clinical symptoms of dry eye syndrome in children using biomicroscopy. Dry eye syndrome was classified into four degrees of severity: mild, moderate, severe, and extremely severe. The subjective and objective clinical signs of each disease severity are described.&#x0D; An individual approach and personalized therapy are required to treat dry eye syndrome in children, focusing on the individual tolerability and effectiveness of the drug. Maximum medical alertness and early and accurate clinical differential diagnosis between dry eye syndrome and infectious inflammatory pathology of the anterior part of the eye are required.&#x0D; CONCLUSION: The features of the etiopathogenesis of dry eye syndrome in children with various nosologies are examined, and the characteristic clinical symptoms and severity of dry eye syndrome, diagnostic methods, and algorithm for treating dry eye syndrome in children are described. The clinical and diagnostic features of dry eye syndrome in children described by us contribute to its early diagnosis, allowing for the initiation of personalized tear replacement and reparative therapy on time, preventing the development of a chronic course of the disease, the occurrence of complications, and the preservation and/or restoration of visual acuity.

SUPRACHIASMATIC NUCLEUS-THE CIRCADIAN PACEMAKER CLOCK IN MAMMALIAN BRAIN

The daily light and dark cycles produce some biological rhythms in almost all living organisms. These rhythms are driven by a tiny endogenous circadian time keeping system mainly located in the anterior part of the mammalian hypothalamus called the suprachiasmatic nucleus (SCN). The SCN receives photic inputs directly from a set of distinct ganglion cells of the retina through the retinohypothalamic tract (RHT). The light and dark intensities regulate periodic expressions of the circadian oscillators of the SCN including clock genes, pineal and adrenal secretions and thereby maintain circadian rhythms of diverse physiological functions.

Suture Tie-down Forces and Cyclic Contractile Forces after Undersized Tricuspid Annuloplasty Using a Tri-Ad Adams Tricuspid Annuloplasty Ring in an Ovine Model.

This study evaluated suture tie-down forces and cyclic contractile forces after undersized tricuspid annuloplasty using a hybrid band. Downsized tricuspid annuloplasty was planned in adult male sheep using eight force transducers attached from the septal to the anterior annular areas of the ring (segments 1 and 2, flexible septal; segments 3 and 4, semi-rigid posterior; segments 5 and 6, semi-rigid anterior; segments 7 and 8, flexible anterior). Cyclic contractile forces were analyzed at three different levels of peak right ventricular pressure: 30, 50, and 70 mmHg. Eight 5-year-old male Corriedale sheep (average body weight = 66.8 kg) were used. The average suture tie-down force was 4.42 (standard deviation: 2.32) N. When the forces were compared, it was lowest in the flexible anterior area and highest in the flexible septal area (p < 0.001). With right ventricular pressure of 30 mmHg, the average cyclic contractile forces was lowest at segment 3 (0.07 [standard deviation: 0.07] N) and highest at segment 7 (0.15 [standard deviation: 0.08] N). The cyclic contractile forces were 0.12 (standard deviation: 0.1) N, 0.09 (standard deviation: 0.12) N, 0.14 (standard deviation: 0.1) N, and 0.13 (standard deviation: 0.09) N in the flexible septal, semi-rigid posterior, semi-rigid anterior, and flexible anterior parts, respectively (p = 0.208). As the peak right ventricular pressure increased to 50 and 70 mmHg, the cyclic contractile forces of each area increased significantly (p < 0.001). Despite this increase, the cyclic contractile forces remained low (0.1 and 0.3 N), and differences in cyclic contractile forces between segments and between annular areas showed similar patterns. The flexible end of the hybrid band reduces the cyclic contractile forces and might prevent annular tears after ring tricuspid annuloplasty, and the risk of tear would be low even in the septal area.

Intraoperative findings in children with transthoracic wrap migration

IntroductionA frequent complication of Nissen fundoplication procedure is the migration of the wrap towards the thorax. The minimal paraesophageal dissection proposed by St. Peter has led to a significant decrease in this complication. This paper aims to report the intraoperative findings in children who presented with transthoracic wrap migration to try to establish the mechanisms that cause this condition. MethodsAn IRB exempt review of children with transthoracic wrap migration. Demographic factors, radiological findings, endoscopic and intraoperative findings were analyzed. Descriptive statistics were employed as measures of relative and central frequency. ResultsIn 10 years, 47 patients were treated. The migration of the wrap occurred at 37.61 months on average. In 95.21% of children, the migration occurred in the anterior part of the hiatus. This was also associated with a short esophagus in 8.5% of patients. DiscussionWe found that in over 90% of patients the migration occurred in the anterior part of the hiatus, which corresponds to the phrenoesophageal ligament. This reinforces the importance of keeping the ligament intact through minimal dissection, or if dissection is absolutely necessary, the phrenoesophageal ligament should be reconstructed. Level of evidenceII-B

Cryptosporidium mortiferum n. sp. (Apicomplexa: Cryptosporidiidae), the species causing lethal cryptosporidiosis in Eurasian red squirrels (Sciurus vulgaris)

BackgroundCryptosporidium spp. are globally distributed parasites that infect epithelial cells in the microvillus border of the gastrointestinal tract of all classes of vertebrates. Cryptosporidium chipmunk genotype I is a common parasite in North American tree squirrels. It was introduced into Europe with eastern gray squirrels and poses an infection risk to native European squirrel species, for which infection is fatal. In this study, the biology and genetic variability of different isolates of chipmunk genotype I were investigated.MethodsThe genetic diversity of Cryptosporidium chipmunk genotype I was analyzed by PCR/sequencing of the SSU rRNA, actin, HSP70, COWP, TRAP-C1 and gp60 genes. The biology of chipmunk genotype I, including oocyst size, localization of the life cycle stages and pathology, was examined by light and electron microscopy and histology. Infectivity to Eurasian red squirrels and eastern gray squirrels was verified experimentally.ResultsPhylogenic analyses at studied genes revealed that chipmunk genotype I is genetically distinct from other Cryptosporidium spp. No detectable infection occurred in chickens and guinea pigs experimentally inoculated with chipmunk genotype I, while in laboratory mice, ferrets, gerbils, Eurasian red squirrels and eastern gray squirrels, oocyst shedding began between 4 and 11 days post infection. While infection in mice, gerbils, ferrets and eastern gray squirrels was asymptomatic or had mild clinical signs, Eurasian red squirrels developed severe cryptosporidiosis that resulted in host death. The rapid onset of clinical signs characterized by severe diarrhea, apathy, loss of appetite and subsequent death of the individual may explain the sporadic occurrence of this Cryptosporidium in field studies and its concurrent spread in the population of native European squirrels. Oocysts obtained from a naturally infected human, the original inoculum, were 5.64 × 5.37 μm and did not differ in size from oocysts obtained from experimentally infected hosts. Cryptosporidium chipmunk genotype I infection was localized exclusively in the cecum and anterior part of the colon.ConclusionsBased on these differences in genetics, host specificity and pathogenicity, we propose the name Cryptosporidium mortiferum n. sp. for this parasite previously known as Cryptosporidium chipmunk genotype I.Graphical

A landmark-based geometric morphometric approach to quantify deviations from bilateral symmetry in polyplacophorans

The class Polyplacophora (chitons) represents a dorsoventrally flattened mollusk group that has an oval-shaped body covered with eight overlapping sclerites providing bilateral symmetry. Chitons show abnormalities (teratologies) that are characterized by symmetry deviations between the right and left sides of their bodies. As these deviations do not result in damage that affects vital functions, chitons are able to reach adult stages. In this study, we quantify the asymmetric condition of the species Chiton articulatus using a landmark-based geometric morphometric approach to assess variation in shape and bilateral symmetry. A geometric configuration of 22 landmarks and 50 semi-landmarks was created to evaluate shape variation in abnormal and deformed specimens compared to normal Chiton articulatus specimens. Vectors of change in the body shape configurations of chitons indicate that the greatest change occurs in the anterior part of the body, with less change in the middle and posterior parts. This gives chitons a widened appearance and provides anatomic compensation to restore the bilateral symmetry of the body scleritome. The diverse abnormalities and deformities had little impact on shape variations and confirmed that the coalescence condition is an intermediate step between a normal condition and the abnormal conditions of hypomerism or hypermerism. The low levels of fluctuating asymmetry expressed in C. articulatus indicate that despite living in areas of high stress, such as the rocky intertidal coast, this species maintains stability in its development and shape. Our results can serve as a model for studying bilateral symmetry deviation in polyplacophorans.

Determination of critical-sized defect of mandible in a rabbit model: Micro-computed tomography, and histological evaluation

ObjectiveTo evaluate a rabbit model of mandibular box-shaped defects created through an intraoral approach and determine the minimum size defect that would not spontaneously heal during the rabbit's natural life (or critical-sized defect, CSD). MethodsForty-five 6-month-old rabbits were randomly divided into five defect size groups (nine each). Mandibular box-shaped defects of different sizes (4, 5, 6, 8, and 10 mm) were created in each hemimandible, with the same width and depth (3 and 2 mm, respectively). Four, 8, and 12 weeks post-surgery, three animals per group were euthanized. New bone formation was assessed using micro-computed tomography (MCT) and histomorphometric analyses. ResultsBox-shaped defects were successfully created in the buccal region between the incisor area and the anterior part of the mental foramen in rabbit mandibles. Twelve weeks post-surgery, MCT analysis showed that the defects in the 4, 5, and 6 mm groups were filled with new bone, while those in the 8 and 10 mm groups remained underfilled. Quantitative analysis revealed that the bone mass recovery percentage in the 8 and 10 mm groups was significantly lower than that in the other groups (p < 0.05). There was no significant difference in the bone mass recovery percentage between the 8 and 10 mm groups (p > 0.05). Histomorphometric analysis indicated that the area of new bone formation in the 8 and 10 mm groups was significantly lower than that in the remaining groups (p < 0.05). There was no significant difference in the new bone area between the 8 and 10 mm groups (p > 0.05). ConclusionsThe dimensions of box-shaped CSD created in the rabbit mandible through an intraoral approach were 8 mm × 3 mm × 2 mm. This model may provide a clinically relevant base for future tissue engineering efforts in the mandible.

Computer navigation-guided transpedicular excision of L4 vertebral body osteoblastoma

Abstract Osteoblastoma is a benign bone tumor that accounts for 10% of all spinal tumors and mostly arises from the posterior spinal elements. Isolated vertebral body osteoblastoma is relatively rare and generally requires extensive surgery. We report a rare case of L4 vertebral body osteoblastoma, which was managed successfully by computer navigation-guided transpedicular excision. A 22-year-old female presented with progressive lower back pain for the past six months. Radiological investigation revealed a sclerotic lesion involving the anterior cortex with a prominent central nidus in the anterior part of the L4 vertebral body. Based on the lesion size, a diagnosis of benign osteoblastoma (Enneking stage 2) was made, and she underwent computer navigation-assisted intralesional excision of the lesion by the bilateral transpedicular route. Histopathological examination confirmed the diagnosis of osteoblastoma. In the immediate postoperative period, the patient was completely relieved of symptoms, and the final follow-up magnetic resonance imaging showed no evidence of recurrence at the end of seven years. The intraoperative 3D navigation technology allowed a transpedicular minimal access approach to excise an osteoblastoma of the L4 vertebral body while preserving intervertebral stability and decreasing morbidity.

Application of a fan type screw to improve the aesthetics of the dentition in the anterior maxilla – a case report

Narrowing of the upper dental arch is one of the most common problems encountered by orthodontists in their practice. This abnormality often affects only the anterior part of the maxilla, while the lateral regions maintain the proper width. The reduced width of the dental arch results in insufficient space for the correct alignment of all teeth, leading to crowding and rotation, which significantly deteriorates the aesthetics of the smile. This paper presents a case of a patient who was found to have hypertonicity of the mental muscle during the extraoral examination, and intraoral examination revealed narrowing of the upper dental arch in the anterior segment and crowding of the upper incisors with a deficit of space for the canines. After the orthodontic diagnostic process was performed, a fan‑type expander was used as the initial treatment. With one daily activation, the desired effect of increasing the anterior maxilla width was achieved after 18 days, and a satisfactory correction of the smile was achieved after 18 months.

Novel Peptides with Dual Properties for Treating Pseudomonas aeruginosa Keratitis: Antibacterial and Corneal Wound Healing.

The corneal epithelium is a layer in the anterior part of eye that contributes to light refraction onto the retina and to the ocular immune defense. Although an intact corneal epithelium is an excellent barrier against microbial pathogens and injuries, corneal abrasions can lead to devastating eye infections. Among them, Pseudomonas aeruginosa-associated keratitis often results in severe deterioration of the corneal tissue and even blindness. Hence, the discovery of new drugs able not only to eradicate ocular infections, which are often resistant to antibiotics, but also to elicit corneal wound repair is highly demanded. Recently, we demonstrated the potent antipseudomonal activity of two peptides, Esc(1-21) and its diastereomer Esc(1-21)-1c. In this study, by means of a mouse model of P. aeruginosa keratitis and an in vivo corneal debridement wound, we discovered the efficacy of these peptides, particularly Esc(1-21)-1c, to cure keratitis and to promote corneal wound healing. This latter property was also supported by in vitro cell scratch and ELISA assays. Overall, the current study highlights Esc peptides as novel ophthalmic agents for treating corneal infection and injury, being able to display a dual function, antimicrobial and wound healing, rarely identified in a single peptide at the same micromolar concentration range.

Hounsfield Unit values on the subchondral bone are related to clinical outcomes in bone marrow stimulation for osteochondral lesions of the talus

BackgroundPoor clinical outcomes in bone marrow stimulation (BMS) for the osteochondral lesion of the talus (OLT) are caused by subchondral bone deterioration. It is reported that microfracture induces endochondral ossification in the subchondral bone, which may affect the subchondral bone condition after BMS. This study analyzed osteosclerotic patterns of the bed in OLTs on computed tomography (CT) images and the relationship between the subchondral bone condition and clinical outcomes of BMS. MethodsSixty-nine ankles in 61 patients with OLT were included. Hounsfield unit (HU) on the bed of OLTs was measured on CT images and the pattern of osteosclerosis or absorption in the bed was analyzed. In these patients, 25 ankles in 24 patients underwent BMS. They were divided into 2 groups according to the presence of bone marrow edema (BME) one year after surgery, and clinical outcomes were compared. ResultsHUs in the anterior region were significantly higher than those of other areas. In patients with BMS, the JSSF scale for BME positive group (88.0 ± 7.7 points) was significantly lower than that for BME negative group (95.0 ± 6.1 points) (p < 0.05) at the final follow-up. On preoperative CT images, HU values of the central region in the BME-positive group were significantly lower than those in the BME-negative group (p < 0.05). ConclusionOsteosclerotic changes in the anterior part of the bed were frequently observed, and BMS for the area with low HU values decreased clinical outcomes. BMS should be performed with attention to subchondral bone condition to obtain good clinical outcomes. Level of evidence4, case series.

Posterior concentration of Wolbachia during the early embryogenesis of the host dynamically shapes the tissue tropism of Wolbachia in host Trichogramma wasps.

The bacterial endosymbiont, Wolbachia spp. induce thelytokous parthenogenesis in certain parasitoid wasps, such as the egg parasitoid wasps Trichogramma spp. To complete the cycle of vertical transmission, Wolbachia displays efficient transovarial transmission by targeting the reproductive tissues and often exhibits strong tissue-specific tropism in their host. The present study aimed to describe the basic Wolbachia distribution patterns that occur during the development of Wolbachia-infected, thelytokous Trichogramma dendrolimi, and T. pretiosum. We used fluorescence in situ hybridization (FISH) to investigate Wolbachia signal dynamics during early embryogenesis (from 30 to 120 min). Wolbachia titers and distributions from the embryo to adult stages of Trichogramma after early embryogenesis were detected by absolute quantitative polymerase chain reaction (AQ-PCR) and FISH. The symmetry ratios (SR) of the Wolbachia signals were calculated using the SR odds ratios in the anterior and posterior parts of the host. The SR was determined to describe Wolbachia tropism during early embryogenesis and various developmental stages of Trichogramma. Wolbachia was concentrated in the posterior part of the embryo during early embryogenesis and the various developmental stages of both T. dendrolimi and T. pretiosum. Wolbachia density increased with the number of nuclei and the initial mitotic division frequency during early embryogenesis. The total Wolbachia titer increased with postembryogenesis development in both T. dendrolimi and T. pretiosum. However, the Wolbachia densities relative to body size were significantly lower at the adult and pupal stages than they were at the embryonic stage. The present work revealed that posterior Wolbachia concentration during early host embryogenesis determined Wolbachia localization in adult wasps. By this mechanism, Wolbachia exhibits efficient vertical transmission across generations by depositing only female Wolbachia-infected offspring. The results of this study describe the dynamics of Wolbachia during the development of their Trichogramma host. The findings of this investigation helped clarify Wolbachia tropism in Trichogramma wasps.

DIFFERENCES OF RIB FRACTURES IN BLUNT TRAUMA PATIENTS ACCORDING TO AGE AND GENDER: A COMPUTED TOMOGRAPHY STUDY

Objective&#x0D; To investigate the difference between rib fractures&#x0D; according to age and sex in blunt trauma patients.&#x0D; Material and Method&#x0D; The patients were classified into 3 age groups:&#x0D; Group-1:18-44 years, Group-2:45-69 years, and&#x0D; Group-3:70 years or more. Rib fractures were&#x0D; classified into 3 groups based on their level on the&#x0D; coronal plane (upper (1st-4th ribs), medium (5th-&#x0D; 8th ribs) and lower (9th-12th ribs)) and axial plane&#x0D; (anterior, lateral and posterior).&#x0D; Results&#x0D; Rib fractures were found to be more common in male&#x0D; (69%) to female (53%) (p=0.002). The incidence of&#x0D; fractures was seen to increase with age (p=0.001;&#x0D; r=615). Rib fractures were most commonly found in&#x0D; the middle ribs (5th-8th ribs) in all-age-groups. The&#x0D; incidence of fractures in the upper ribs was significantly&#x0D; lower in the advanced age than the other age groups&#x0D; (p=0.002). Fractures were least commonly found in the&#x0D; anterior part of the rib in all age groups. Rib fractures&#x0D; were observed at a higher rate in the lateral part in&#x0D; young adults unlike the other age groups (p=0.001).&#x0D; A significant difference was found between the age&#x0D; groups in favor of young adults (group 1) in terms of&#x0D; the presence of parenchymal contusion without rib&#x0D; fracture (p=0.014).&#x0D; Conclusion&#x0D; Rib fracture was seen at a higher rate in male than&#x0D; female in blunt thoracic trauma patients. Fractures&#x0D; possibility of in the upper rib structures is lower in the&#x0D; advanced age group. Unlike other groups, in young&#x0D; people, a higher rate of fractures was detected in&#x0D; the lateral part of the costa. One should be aware of&#x0D; the possibility of parenchymal contusion without a rib&#x0D; fracture in the young age group.

Brain mechanisms associated with facial encoding of affective states.

Affective states are typically accompanied by facial expressions, but these behavioral manifestations are highly variable. Even highly arousing and negative valent experiences, such as pain, show great instability in facial affect encoding. The present study investigated which neural mechanisms are associated with variations in facial affect encoding by focusing on facial encoding of sustained pain experiences. Facial expressions, pain ratings, and brain activity (BOLD-fMRI) during tonic heat pain were recorded in 27 healthy participants. We analyzed facial expressions by using the Facial Action Coding System (FACS) and examined brain activations during epochs of painful stimulation that were accompanied by facial expressions of pain. Epochs of facial expressions of pain were coupled with activity increase in motor areas (M1, premotor and SMA) as well as in areas involved in nociceptive processing, including primary and secondary somatosensory cortex, posterior and anterior insula, and the anterior part of the mid-cingulate cortex. In contrast, prefrontal structures (ventrolateral and medial prefrontal) were less activated during incidences of facial expressions, consistent with a role in down-regulating facial displays. These results indicate that incidences of facial encoding of pain reflect activity within nociceptive pathways interacting or possibly competing with prefrontal inhibitory systems that gate the level of expressiveness.

Commotio cordis – a review of a rare cause of sudden death in young athletes

Commotio cordis, from Latin “agitation of the heart” is a potentially fatal sudden disruption and alteration of heart electric activity. It is usually caused by relatively mild blunt non-penetrating trauma to the specific point on anterior part of the chest wall during beginning of the heart muscle repolarization phase. It leads to ventricular fibrillation presenting as a collapse few seconds after the blow. It can be lethal without taking proper steps of management in a short ammount of time.

Functional connectivity gradients of the cingulate cortex

Heterogeneity of the cingulate cortex is evident in multiple dimensions including anatomy, function, connectivity, and involvement in networks and diseases. Using the recently developed functional connectivity gradient approach and resting-state functional MRI data, we found three functional connectivity gradients that captured distinct dimensions of cingulate hierarchical organization. The principal gradient exhibited a radiating organization with transitions from the middle toward both anterior and posterior parts of the cingulate cortex and was related to canonical functional networks and corresponding behavioral domains. The second gradient showed an anterior–posterior axis across the cingulate cortex and had prominent geometric distance dependence. The third gradient displayed a marked differentiation of subgenual and caudal middle with other parts of the cingulate cortex and was associated with cortical morphology. Aside from providing an updated framework for understanding the multifaceted nature of cingulate heterogeneity, the observed hierarchical organization of the cingulate cortex may constitute a novel research agenda with potential applications in basic and clinical neuroscience.

A novel useful 3D multiplanar reconstruction algorithm to detect the optimal transseptal puncture positioning in percutaneous mitral valve repair

Abstract Funding Acknowledgements Type of funding sources: None. Background in transcatheter edge to edge mitral repair (TEER), the use of transesophageal echocardiography (TEE) guidance is mandatory in every procedural step. The transseptal puncture (TPS) height is measured by TEE using a four chamber view (4CV) in mid-upper esophagus between the catheter tenting in fossa ovalis and the coaptation of the mitral valve (MV) and its correct positioning influence procedural outcome. However, TSP can represents a tricky step, because of poor images, challenging interatrial septa or a malalignment of TEE probe, catheter and mitral coaptation. Aim In this abstract we describe an alternative TEE 3D technique to measure TSP height. Methods Between August 2022 and December 2022 we performed 18 cases of TEER. In all cases we obtained a measure of the height of tenting (HT) with two different techniques: the 2D view (2DV) in 4CV and the 3D reconstruction algorithm (3DA) (fig.1). This 3DA starts with a real-time single-beat 3D volume acquisition from a mid esophagus at 0 degrees view. The 3D dataset should include IAS, aortic valve, and MV. In multiplanar reconstruction (MPR), three 2D planes are reconstructed from the 3D dataset. These MPR planes must be positioned in a predefined manner with the cursors correctly aligned on the catheter tip at the level of the fossa ovalis. The first plan (P1) is an off axis 4CV oriented perpendicular to the IAS exactly on the height of the catheter tip and serves as the orientation plane. This plane allows the exact location of the tenting point and the positioning of the other two MPR planes. The crossing of the axes should be positioned in all planes at the center of the left atrium. The second plane (P2) and the third plane (P3) are oriented perpendicular to the previous one (fig.1) and each other. Rotating and moving those two planes in a stepwise manner a 4CV, including the plane passing by catheter tip and MV coaptation is obtained in P1. In order to identify the exact plane of the coaptation, while in P1 the axis passing through the MV is positioned at the center of the MV, in P2 the axis is adjusted at the point of leaflet coaptation (fig.1). The HT is then measured in P1 thus avoiding the possible foreshortening affecting a simple 2DV. Results In all cases the 3D measure was accomplished but in 3 of 18 cases the 2DV was difficult to obtain because of loss of contact between the esophagus and the probe in retroflection, in those cases the HT was measured in a 0 degrees off axis view from the tenting of the fossa to a very anterior part of the coaptation line or to anterior leaflet. In all those cases the height of tenting was underestimated (fig.2). Conclusion The 3DA described can be useful in obtaining a more precise and reliable measure of the HT even in anatomical challenging patients. A comparative study that consents to investigate the correlation between the two methods and the inter and intra observer agreement is mandatory and planned at our institution.

Difference between Anterior and Posterior Cord Compression and Its Clinical Implication in Patients with Degenerative Cervical Myelopathy.

In degenerative cervical myelopathy (DCM), the low anteroposterior compression ratio of the spinal cord is known to be associated with a neurologic deficit. However, there is little detailed analysis of spinal cord compression. Axial magnetic resonance images of 183 DCM patients at normal C2-C3 and maximal cord compression segments were analyzed. The anterior (A), posterior (P), and anteroposterior length and width (W) of the spinal cord were measured. Correlation analyses between radiographic parameters and each section of Japanese Orthopedic Association (JOA) scores and comparisons of the patients divided by A (below or above 0, 1, or 2 mm) were performed. Between C2-C3 and maximal compression segments, the mean differences of A and P were 2.0 (1.2) and 0.2 (0.8) mm. The mean anteroposterior compression ratios were 0.58 (0.13) at C2-C3 and 0.32 (0.17) at maximal compression. The A and A/W ratio were significantly correlated with four sections and the total JOA scores (p < 0.05), but the P and P/W ratio did not demonstrate any correlations. Patients with A < 1 mm had significantly lower JOA scores than those with A ≥ 1 mm. In patients with DCM, spinal cord compression occurs mainly in the anterior part and the anterior cord length of <1 mm is particularly associated with neurologic deficits.