Anterior Part Research Articles

Intramuscular nerve distribution of the sternocleidomastoid muscle for the botulinum toxin injection.

The aim of this study is to define the intramuscular nerve distribution of the sternocleidomastoid muscle (SCM) and the innervation zones (IZ) to describe the optimal botulinum toxin injection sites. The cricoid cartilage (CC), laryngeal prominence (LP) and hyoid bone (HB) and angle of mandible (AM) were determined as landmarks. The length of the muscles were measured between the sternoclavicular joint and tip of the mastoid process. SCM was evaluated in two parts as anterior and posterior divided by the line where the length of the muscle was measured. Measurements were made to define the relationships of the SCM with common carotid artery, internal and external jugular veins. IZ were described according to these vessels. Afterwards, Modified Sihler's staining technique was applied to expose the intramuscular nerve distribution. The average length of SCM was 160,1mm. Motor entry point of the accessory nerve fibers were between the AM-HB lines, in the range of 30-40% of the muscle length, and in the posterior part of the muscles. IZ were between the HB-CC lines in the anterior and posterior part. When this interval was examined according to the vessels, the optimal injection sites were between the LP-CC lines. This study shows the position of the intramuscular nerve fibers endings of the SCM according to the chosen landmarks and the relationship of the IZ with the vessels to prevent complications. These results can be used as a guide for safe and effective botulinum toxin injections with optimal quantities.

Case report of a new technique for with posterior cruciate ligament avulsion fractures treated with a mini transverse incision

Posterior cruciate ligament (PCL) is a strong stabilising ligament of the knee joint originating from posterior part of Intercondylar eminence oof tibia and attaches to the anterior part of medial surface of lateral condyle of femur. The PCL plays a major role in knee stabilization, and are statistically one of the rarest injuries around the knee. Due to the surrounding neurovascular elements in the popliteal space, very few open approaches to repair such injury were performed. The ‘‘safe transverse mini-incision approach’’ to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.

Elasticity of the Cervix in Relation to Uterus Position.

Strain elastography allows the evaluation of tissue elasticity. Background/Objectives: Tissue elasticity depends on the content and distribution of collagen fibers and is shaped by the applied tensile forces that may differ in uteri with a different angle of flexion of the corpus on the cervix. The objective was to investigate whether the angle of uterine flexion is related to cervical tissue elasticity. Methods: The anterior angle between the longitudinal axis of the uterus corpus and that of the cervix was measured in 275 non-pregnant young women by transvaginal ultrasonography and considered both as an absolute value or categorized as ≤150°, between >150° and ≤210°, and >210°. Strain elastography was used to assess tissue elasticity by placing the probe in the anterior vaginal fornix. Tissue elasticity was evaluated in the middle of the anterior cervical compartment (ACC), in the middle of the posterior cervical compartment (PCC), in the middle portion of the cervical canal (MCC), and at the internal cervical os (ICO). In a sagittal plane MCC was evaluated across the cervical canal, and ACC and PCC at a distance equal between the cervical canal and the outer anterior or posterior part of the cervix. MCC, ACC and PCC were evaluated at equal distance between the ICO and the external cervical os. Elasticity was expressed as a color score ranging from 0.1 (low elasticity) to 3 (high elasticity). Results: The angle of uterine flexion show a negative linear relation with the elasticity of the ACC (p = 0.001) and MCC (p = 0.002) and a positive relation with the elasticity of the PCC (p = 0.054). In comparison to uteri with an angle of flexion of <150°, those with an angle of flexion of >210° had lower elasticity of the ACC (p = 0.001) and MCC (p = 0.001) and higher elasticity of the PCC (p = 0.004). The ACC/PCC and PCC/MCC elasticity ratios were also significantly different (p = 0.001). Conclusions: The angle of uterine flexion is associated with changes in cervix elasticity. Retroflexion is associated with stiffer ACC and MCC and a more elastic PCC. Differences in tissue elasticity suggest structural changes of the cervix that may have implication in variate obstetric and gynecological conditions.

Slitrk4 is required for the development of inhibitory neurons in the fear memory circuit of the lateral amygdala.

The Slitrk family consists of six synaptic adhesion molecules, some of which are associated with neuropsychiatric disorders. In this study, we aimed to investigate the physiological role of Slitrk4 by analyzing Slitrk4 knockout (KO) mice. The Slitrk4 protein was widely detected in the brain and was abundant in the olfactory bulb and amygdala. In a systematic behavioral analysis, male Slitrk4 KO mice exhibited an enhanced fear memory acquisition in a cued test for classical fear conditioning, and social behavior deficits in reciprocal social interaction tests. In an electrophysiological analysis using amygdala slices, Slitrk4 KO mice showed enhanced long-term potentiation in the thalamo-amygdala afferents and reduced feedback inhibition. In the molecular marker analysis of Slitrk4 KO brains, the number of calretinin (CR)-positive interneurons was decreased in the anterior part of the lateral amygdala nuclei at the adult stage. In in vitro experiments for neuronal differentiation, Slitrk4-deficient embryonic stem cells were defective in inducing GABAergic interneurons with an altered response to sonic hedgehog signaling activation that was involved in the generation of GABAergic interneuron subsets. These results indicate that Slitrk4 function is related to the development of inhibitory neurons in the fear memory circuit and would contribute to a better understanding of osttraumatic stress disorder, in which an altered expression of Slitrk4 has been reported.

Organization of the blood system of rhynchonellid brachiopod Hemithiris psittacea (Brachiopoda: Rhynchonelliformea).

The brachiopods are sessile invertebrates with an unusual blood system, which consists of a long-branched dorsal vessel. It is still unknown how blood circulates in this system. In the present study, for the first time we propose the circulation of blood in brachiopod Hemithiris psittacea based on morphological and experimental data. The main heart is located on the dorsal side of the stomach and divides the dorsal vessel into anterior and posterior parts. The anterior part enters the lophophore, where it gives off blind branches to each tentacle. The posterior part passes by the funnels of the nephridia and forms a blindly closed network in the gonads. We suggest that the circulation of blood includes three successive stages. During the first phase of systole of the main heart, blood flows through the anterior dorsal vessel. During the second phase of systole, blood flows through the posterior dorsal vessel. During diastole, blood flows from the anterior and posterior vessels and fills the main heart. The origin of a peculiar blood system in brachiopods can be explained by reduction of the ventral vessel, which is probably correlates with the reduction of the ventral side of the brachiopod ancestor's body. Another peculiarity of brachiopod blood system is the presence of an ampullar heart, which functions as a blood depot and allows blood to move in the vessels in two directions in an oscillatory mode. The brachiopod blood system contains vessels lacking true endothelium and can be classified as an "incompletely closed" type.

Role of the medial agranular cortex in unilateral spatial neglect.

Unilateral spatial neglect (USN) results from impaired attentional networks and can affect various sensory modalities, such as visual and somatosensory. The rodent medial agranular cortex (AGm), located in the medial part of the forebrain from rostral to caudal direction, is considered a region associated with spatial attention. The AGm selectively receives multisensory input with the rostral AGm receiving somatosensory input and caudal part receiving visual input. Our previous study showed slower recovery from neglect with anterior AGm lesion using the somatosensory neglect assessment. Conversely, the functional differences in spatial attention across the entire AGm locations (anterior, intermediate, and posterior parts) are unknown. Here, we investigated the relationship between the severity of neglect and various locations across the entire AGm in a mouse stroke model using a newly developed program-based analysis method that does not require human intervention. Among various positions of the lesions, the recovery from USN during recovery periods (postoperative day; POD 10-18) tended to be slower in cases with more rostral lesions in the AGm (r = - 0.302; p = 0.028). Moreover, the total number of arm entries and maximum moving speed did not significantly differ between before and after AGm infarction. According to these results, the anterior lesions may slowly recover from USN-like behavior, and there may be a weak association between the AGm infarct site and recovery rate. In addition, all unilateral focal infarctions in the AGm induced USN-like behavior without motor deficits.

Management of oronasal fistula using L-PRF and palatal flap due to residual cyst in maxilla: A case report

Study Design: Case Report. Oronasal communication can be a result of congenital disorders, pathological lesions, or inadequate treatment. It consists of abnormal communication between the nasal and oral cavities. Objective: This paper aims to present a case report of a female patient who intended for dental implants but was referred to the maxillofacial surgery department presenting a cone beam computed tomography with incidental finding in the anterior part of the maxilla. Methods: The first surgical procedure consisted of the resection of the lesion associated with bone graft with buccal fat pad flap and posterior histopathological study. After three months the patient developed an oronasal fistula. During the second surgical management, the authors chose platelet concentrates (L-PRF) to fill the bone defects associated with the palatal flap. Results: After one year of follow-up, the patient presented definitive soft tissue healing, no exposure of bone tissue, and the closure of oronasal communication. The new CT scan and panoramic x-ray showed satisfactory bone healing. Conclusion: The present study demonstrated the association of L-PRF with xenograft and palatal flap can be a viable method for the management of patients with oronasal fistula. This report adheres to the SCARE guidelines for the reporting of surgical cases in medical literature.

Lateral rectus pulley concerning the orbital wall. Area of a stereotyped bony insertion

PurposeTo examine the lateral rectus muscle pulley and its bony insertion concerning the orbital rim and periorbita. DesignProspective. An observational anatomic study. MethodsStudy population: Twenty postmortem orbits (10 right, 10 left) of 10 Caucasian cadavers (8 females, 2 males; age range at death, 57–100 years; median age, 79.5 years) fixed by the Thiel method.Intervention: The floor of the temporal fossa was exposed, and a bone window on the lateral wall of the orbit, posterior to the sphenozygomatic suture, was created, keeping the periorbita intact. The lateral canthus and lateral palpebral ligament were isolated and opened, and the eyelids were folded back. The frontozygomatic suture was identified, and the orbital septum opened adjacent to the orbital rim. The conjunctiva was opened at the limbus, and the lateral rectus insertion was isolated. The bone pillar containing the frontozygomatic suture and the insertion of the periorbita and the pulley was isolated and removed en bloc. The lateral rectus muscle was isolated and excised.Main outcome measures: Position of the pulley ring on the lateral rectus muscle belly and its bony attachment area in the lateral wall of the orbit. ResultsThe pulley bony attachment was roughly quadrilateral with an approximate area of 90 mm2, 3 mm (mean, range 1–5 mm) posteroinferior to the frontozygomatic suture and 1 mm posterior to the orbital rim. The anterior margin of the pulley sleeve was found at 21.0 mm (median, p25-75 20.0–22.8) from the scleral insertion. ConclusionsThe lateral rectus pulley is stereotyped in its position in the muscle belly and its bony insertion, coinciding with the point of greatest adhesion of the periorbita to the anterior part of the lateral wall of the orbit.

Binder Phenotype—Prenatal Diagnosis, Management, and Postnatal Outcome: Insights from a Case Series and Updated Review of the Literature

AbstractBinder phenotype (BP) or maxillonasal dysplasia is a developmental disorder of the anterior part of the maxilla and nasal complex and is characterized by a short nose with a flat nasal bridge, short columella, acute nasolabial angle, perialar flatness, convex upper lip, and tendency to a class III malocclusion. The etiology of BP is heterogeneous with diverse features and outcomes. The ultrasound features of BP are midfacial hypoplasia with verticalized nasal bones, short columella with flattened tip and alar wings, and the nasofrontal angle measuring &gt;140 degrees. In this case series, we present seven cases of BP detected antenatally, their varied etiology, management, and outcomes with a 2-year follow-up. We conclude that the diagnosis of facial dysmorphisms, such as BP, brings a lot of apprehension and agony in the parents amounting to multiple tests and counseling sessions. Physiognomy which is the normal familial appearance should be considered before concluding whether the observed feature is normal or pathological. Accurate diagnosis, adequate testing, and personalized counseling will help in the prevention of needless termination of pregnancies and ensure an optimal perinatal outcome.

Investigating palatal rugae diversity – a comparative analysis of Bilaspur and Nagpur regions

Forensic odontology plays a key role in person identification in case of mass disasters, criminal investigations, and ethnicity studies, and in identifying decomposed and disfigured bodies, fire victims, and victims of motor vehicle accidents. Rugoscopy is an important specialty, which has been an area of interest for many forensic odontologists. As palatal Rugae are present in all victims and resistant to change (aging, trauma, and so forth) so they act as an ideal for identification. Palatal Rugae are also named Plicae Palatinae transverse or Rugae Palatine. The Palatal Rugae are generally transverse ridges placed in the anterior part of the palatine mucosa. Palatal Rugae are resistant to thermal effects (heat and burn) and decomposition changes because of their internal position in the head. They are used in cases where dental identification is not possible and in patients where other body parts are burnt or decomposed.: Aim of the study is to identify and analyze different patterns of palatal rugae and gender differences in Bilaspur and Nagpur populations. : This study will include a total of 80 dental casts — 40 males and 40 females.: The analysis of palatal rugae concerning the number of rugae, shape, length, and unification will be done.

Thickness and width of the menisci of adult knee joint: a descriptive cross-sectional observational study in cadavers.

The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens. The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper. The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively. It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.

Posterolateral Paramass Approach to Lesions Located at the Anterior C1-2 Level: A Cadaver Study

A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, unilateral C1- C2 screw was placed. Group 5: In addition, bilateral C1-C2 screw was placed. The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 ± 2.88mm. The average width of C1 lateral mass was 13.4±2.4mm. After the lateral mass was drilled, its width decreased to 10,2mm.This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. It is possible to access the anterior C1-C2 via a posterolateral paramass approach by drilling 20%-30% of the lateral mass, providing an open pathway for easy intervention in C1-C2 intradural lesions. It is also possible to perform odontoid resection using this approach.

Effects of upper-limb exoskeleton on muscle activity in tasks requiring arm elevation: Part II - In-field experiments in construction industry settings.

The body of literature regarding the use of an upper limb exoskeleton during authentic working conditions is sparse. The aim of this study was to evaluate the effectiveness of an upper limb exoskeleton in reducing muscle strain during authentic industrial construction work. Fifteen male participants, comprising of roofers, scaffolders, builders, bricklayers, and graders performing overhead work participated in the study. During work without (REF) and with exoskeleton (EXO), muscle activity from 8 muscles, heart rate (HR), metabolic equivalent (MET), and upper arm elevation angles were recorded. When using the exoskeleton, a significant reduction of 20.2% in average muscle activity of 8 muscles was found. The largest effect focused on m. deltoideus, where 46.2 and 32.2% reduction occurred in medial and anterior parts of the muscle, respectively. HR and MET were unaffected. Upper arm elevation angles were similar between REF and EXO, indicating equal biomechanical loading. This study indicates that exoskeletons show great promise in reducing the potential for musculoskeletal strain during authentic overhead construction work.

ANATOMICAL AND FUNCTIONAL OUTCOME IN THE MANAGEMENT OF NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY

Introduction: Non-arteritic anterior Ischemic optic neuropathy refers to condition in which damage to the anterior optic nerve is presumed to be secondary to ischemia of the anterior part of the optic nerve. This condition is irreversible, and the visual prognosis is generally guarded. To date, there is no definitive high-grade evidence for an effective treatment of NAION. The purpose of this literature review is to assess the results of currently published literatures regarding the management of non-arteritic anterior ischemic optic neuropathy, taking anatomical and functional outcomes into consideration. Methods: A comprehensive literature search was conducted using online databases (PubMed, EBSCO, Clinical Key, and Google Scholar) using relevant search terms. Included studies were selected based on predefined inclusion criteria. Results: Systemic and locally-administered corticosteroid indicated various responses, as well as anti-VEGF, however suggesting no positive effects. Rho-kinase as a vasodilator improved visual acuity in a small study. Erythropoietin and cytidine diphosphocoline (citicoline) suggested visual acuity improvement, while only citicoline improved visual field improvement and prevent further RNFL thinning, in non-randomized controlled studies. Conclusion: No high-quality evidence of intervention has been shown to enhance both anatomical and functional outcome. Many studies were also insufficient to conclude. Further studies are needed, including neuroprotective and novel vasodilator agents.

Atypical case of anterograde amnesia after cerebral infarction and anti-NMDA encephalitis post Covid 19 infection: A complex clinical case

IntroductionOnly a few cases of primary anterograde amnesia with confabulation after severe complex brain damage have been described in the literature.ObjectivesTo describe a case of anterograde amnesia with confabulation in a patient with severe and extensive brain damage.Methodscase reportResultsCase presentation: A 48-year-old male patient with a medical history of diabetes mellitus type II, hypertension, presented to a psychiatric clinic for the first time. He was admitted to the hospital due to the manifestation of disruptive aggressive behaviour, aimless wandering, and excessive, impulsive expenditure of financial resources. At the time of hospitalization and during the hospital stay, the patient exhibited a state of elevated mood and anterograde amnesia compounded by the presence of prominent confabulation, easily irritable mood with a tendency to conflict. No physical limitations.Background: The patient is an active long-distance driver for 15 years. A year before hospitalization in psychiatric clinic, he was travelling to Moscow, he had episode of headache and unconsciousness after which hospitalization. Diagnosed with multiple infarcts of embolic origin in the right frontal lobes, both cortical and subcortical, on the right side at the level of the uncus, in the medial anterior parts of the right occipital lobe, on the left side in the insula and at the level of the capsula externa, in the anterior basal part of the left temporal lobe. After hemodynamic stabilization, he was repatriated to Latvia. Stationary positive SARS-CoV-2 PCR, O2 support therapy required. The patient develops auditory and visual hallucinations, which do not correct on antipsychotic therapy. Lumbar puncture was performed, which showed positive anti-NMDA antibodies, magnetic resonance - autoimmune limbic encephalitis with damage to the gyrus cinguli of the insula cortex of both temporal lobes and the right subfrontal part with spread throughout the right temporal lobe, bilaterally in the mediobasal structures of the temporal lobes and the right thalamus with progressive changes. The patient receives immunomodulatory therapy, plasma exchange and immune globulin. Hallucinations decrease on the background of therapy. At discharge - moderate ataxia in the legs, disorientation in time, severe short-term memory disorders.The patient in his mind lives like nothing has happened and the same life continues.Image:Image 2:ConclusionsThe long-term prognosis for the patient remains uncertain, given the multifaceted nature of the condition and the extent of brain damage. Continuous monitoring, rehabilitation, and ongoing support will be essential to assess cognitive recovery and improve the patient’s quality of life.Disclosure of InterestNone Declared

Duox activation in Drosophila Malpighian tubules stimulates intestinal epithelial renewal through a countercurrent flow

The gut must perform a dual role of protecting the host against toxins and pathogens while harboring mutualistic microbiota. Previous studies suggested that the NADPH oxidase Duox contributes to intestinal homeostasis in Drosophila by producing reactive oxygen species (ROS) in the gut that stimulate epithelial renewal. We find instead that the ROS generated by Duox in the Malpighian tubules leads to the production of Upd3, which enters the gut and stimulates stem cell proliferation. We describe in Drosophila the existence of a countercurrent flow system, which pushes tubule-derived Upd3 to the anterior part of the gut and stimulates epithelial renewal at a distance. Thus, our paper clarifies the role of Duox in gut homeostasis and describes the existence of retrograde fluid flow in the gut, collectively revealing a fascinating example of inter-organ communication.

A Novel Ligamentous Complex in the Anteromedial Region of the Knee: A Cadaveric Study.

The medial knee structures have a primary role in stabilizing valgus and rotational stress, which makes them important in assessing the ligament-injured knee globally and choosing the most adequate treatment. To conduct a layer-by-layer dissection of the knee's anteromedial side and provide a qualitative and quantitative description of the anatomy and histology of a ligament in the anteromedial region of the knee, which we have termed the anterior oblique ligament (AOL). Also, to describe the AOL relationship with what we have termed the medial cross-a ligament complex that stabilizes the medial pivot. Descriptive laboratory study. A total of 35 fresh-frozen knees from transfemoral amputations that were exclusively performed for vascular reasons were dissected. Structures were identified after meticulous dissection, respecting the same protocol, measured with a digital caliper rule, and histologically studied for data. The AOL was found in all dissected knees, with a mean length of 31.47 ± 5.06 mm. This structure presented a ligament histology with densely organized collagen fibrils. The medial cross was represented by the superficial medial collateral ligament, AOL (anterior region), and posterior oblique ligament. This study demonstrated the presence of a ligament in the anteromedial region of the knee, termed the AOL. This structure was in the anterior part of a ligament complex-the medial cross. Studying and revisiting the medial compartment can provide important information for understanding joint instability and promoting better results in ligament reconstructions.

Change in taste sensation after orthognathic surgery

ObjectiveThe objective of this study was to evaluate the effect of orthognathic surgery on taste sensation.Materials and methodsThirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups.ResultsThere were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05).ConclusionTaste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions.Clinical relevanceMaxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly.The trial registration number (TRN)NCT06103422/Date of registration: 10.17.2023 (retrospectively registered).

Нейровізуалізаційні особливості нервової системи в дітей раннього віку з епілептичними енцефалопатіями за даними МР-трактографії

The aim is to analyze neuroimaging changes in the nervous system of children of an early and preschool age with epileptic encephalopathies (EE) according to MR-tractography to improve the diagnosis of these conditions. Materials and methods. 157 children aged 0 to 6 years with EE, epileptiform and developmental encephalopathies (DEE) were examined. The study included MR-tractography using a 3 Tesla MR scanner. Fractional anisotropy (FA) and average diffusion coefficient (ADC) were determined in Broca's and Wernicke's areas, left arcuate tract, both uncinate tracts, corpus callosum and thalamus. The examined children were divided into 3 groups: I - 75 children with EE, with the onset of seizures before 1 year of age; II - 44 children with EE, with the onset of seizures at the age of 1-3 years; III - 38 children with DEE. Differences between groups were assessed using the Kruskal-Wallis test and Pearson's Chi-square (χ²) test. Results. In children with EE from groups I and II, there was a significant decrease in FA and an increase in ADC in the areas of both language centers and the right uncinate tract in comparison with children of group III (p&lt;0.05). In the group I with EE, there was a significant decrease in FA in the left uncinate tract, knee and trunk of the MT in comparison with the groups II and III of children (p&lt;0.05). It was found that more than 60% of children from group I had destruction of the fibers of the arcuate tract and in the area of one of the speech centers, and 70% had hypoplasia and destruction of the left uncinate tract. In the children of group II with EE, hypoplasia of the anterior (63.6%) and posterior (65.9%) parts of the arcuate tract and the right uncinate tract (81.8%) was detected. Among children from group III, more than 60% had an abnormal location of Broca's speech center, and more than 70 % had an abnormal location of Wernicke's center, almost 80 % had an abnormal location of the left uncinate tract. Conclusions. It was found that in children with EE and DEE, according to MR tractography, there is a decrease in FA indicators and an increase in ADC in all studied structures (arcuate and uncinate tract, corpus callosum, thalamus) in comparison with the reference values given in the scientific literature. The detected changes indicate a violation of the structural integrity of the white matter in Broca's and Wernicke's centers and associative pathways, which will lead to the optimization of early diagnosis and prognosis of consequences in children with EE and DEE. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committees of the institutions indicated in the work. The informed consent of the children's parents was obtained for conducting the research. No conflict of interest was declared by the authors.

The Origin and Course of the Blood Supply to the Lower Eyelid Orbital Fat: Anatomical Study and Clinical Significance.

The aim of this study is to investigate the origin and course of the orbital fat arterial supply in the lower eyelid using traditional anatomy and three-dimensional computed tomography (CT). Twenty-seven cadaver heads were infused with mercury sulfide contrast media through the ophthalmic artery, maxillary artery, transverse facial artery, and facial artery. CT images were obtained after contrast agent injection, three-dimensional CT scans were reconstructed, and the cadaver heads were dissected. Forty-five qualified hemifaces showed that the orbital fat arterial supply in the lower eyelid originates primarily from the inferomedial muscular trunk (IMT) of the ophthalmic artery and the orbital branch of the infraorbital artery. The medial branch of the IMT terminated at the medial fat pad (35.6%) or the orbital floor (64.4%). The lateral branch terminated at the inferior oblique (IO) muscle (28.9%) or the central and lateral fat pads (17.8%). In 53.3%, the lateral branch extended to the anterior part of the lateral fat pad and terminated in the orbital wall or the zygomaticoorbital foramina. The orbital branch of the infraorbital artery coursed between the orbital floor and the orbital fat, providing supply to the IO muscle, inferior rectus (IR) muscle, nasolacrimal duct, and orbital fat. This study elucidated the origin and course of the orbital fat arterial supply in the lower eyelid, which may help to avoid reducing the blood supply of the orbital fat pedicles during surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .