Anterior Portion Research Articles

Multi-gene-based investigation on the molecular phylogeny of the hypotrichous family Strongylidiidae (Protista, Ciliophora), with notes on the ontogeny of a new genus and new species

Ciliates in the subclass Hypotrichia have long been difficult to classify as they are one of the most polymorphic and highly differentiated groups, leading to their systematics remaining unresolved. Phylogenetic relationships within the hypotrich family Strongylidiidae have been ambiguous due to discordance between the morphological and genetic data. In this study, a new strongylidiid genus Heterouroleptus is established, mainly based on the novel mode of origin of the ventral cirral rows: left ventral cirral row (LVR) originates from frontal–ventral–transverse cirral anlagen (FVTA) III (anterior portion), IV (middle portion), and V (rear portion); right ventral cirral row comes from the entire FVTA VI. A new species, Heterouroleptus weishanensis gen. nov., sp. nov., is investigated along with the morphometric and molecular data from a population of Strongylidium wuhanense. Eight new sequences and nuclear gene markers (single-gene and multi-gene) are provided to analyze the phylogenetic relationships of strongylidiids, with the COI gene utilized to uncover further genetic information at species level and below. The results reveal that: (1) Strongylidiidae is monophyletic and has a close relationship with Dorsomarginalia; (2) Heterouroleptus gen. nov. forms a clade that is sister to all the other strongylidiids; (3) Hemiamphisiella Foissner, 1988 and Pseudouroleptus Hemberger, 1985 should not be synonyms, and both genera should be subdivided due to their variable morphological characteristics; (4) LVR originating from three anlagen is a plesiomorphy of Strongylidiidae. The discovery of the origin of the LVR not only contributes to the establishment of the genus Heterouroleptus, but also helps to improve the diagnosis of the family Strongylidiidae.

Evaluation of the Articular Disc Using the Magnetic Resonance Cartigram in Asymptomatic and Symptomatic Temporomandibular Disorders

Abstract Objectives The study is aimed to perform magnetic resonance (MR) cartigram of the articular disc in patients with asymptomatic and symptomatic temporomandibular disorders (TMD). Methods Thirty-nine volunteers were divided into three groups: 16 symptomatic TMD, 16 asymptomatic TMD, and 7 controls. The articular disc was divided into three segments (anterior, middle, and posterior) and analyzed using morphological magnetic resonance imaging (MRI) and T2 mapping sequences. T2 relaxation values were measured and assessed by an experienced radiologist and two observers. The T2 values in the discs were compared between the control, asymptomatic, and symptomatic groups using the Kruskal–Wallis test. The right and left discs were compared using the Wilcoxon signed rank test. Inter-examiner reliability among different examiners was evaluated. Results The controls had the highest T2 values compared with the other groups. The comparison among the right and left sides of all the groups revealed statistically significant results in the anterior portion in the asymptomatic group and the middle portion in the symptomatic group (p < 0.05). The inter-examiner reliability coefficients among the three examiners were consistently high, with values of 0.921, 0.920, and 0.930. Conclusion Our study found the T2 relaxation time span was shorter than that reported in previous studies, which could be attributed to the early stage of cartilage deterioration in the individuals with TMD inferring treatment at this phase may be eventually effective with a good prognosis.

An in-vivo Analysis of the Positional Relationship of Palatal Rugae with Maxillary Teeth in Different Arch Forms Among Young Dentulous Gujarati Individuals-A Pilot Study

Background- The palatal rugae are transverse folds of tissue located in the anterior portion of the hard palate. They are considered to be reliable landmarks with manifold uses in the field of orthodontics and forensics. The current study was carried out with the aim of determining if a positional relationship of palatal rugae exists with the maxillary teeth in individuals with different maxillary arch forms. Material and method- The study was carried out in 100 participitants (87 females and 13 males) . Irreversible hydrocolloid impressions were made and casts were poured in Type 3 dental stone. The casts were divided according to arch forms as taper, ovoid and square. Palatal rugae on the casts were assessed digitally and the position of the most posterior rugae evaluated in relation with the adjacent maxillary teeth. Results –It was observed that the palatal rugae had a higly significant positional relationship with the maxillary posterior teeth(p value <0.0001) . In the ovoid and square arches, majority of the individuals had the most posterior rugae lying at the level of distal margin of 2nd premolar while in cases of taper dental arches, maximum number of individuals had the distal margin of 1st premolar coincide with the most posteriorly located rugae. Conclusion- Hence, it can be concluded that the most posterior limit of the rugae may serve as a reliable guide for the arrangement of the maxillary teeth in different arch forms. Key Words- Palatal Rugae, maxillary anterior teeth , denture aesthetics

A novel approach to terminate roof-dependent atrial flutter with epicardial conduction through septopulmonary bundle

Atrial flutter, a prevalent cardiac arrhythmia, is primarily characterized by reentrant circuits in the right atrium. However, atypical forms of atrial flutter present distinct challenges in terms of diagnosis and treatment. In this study, we examine three noteworthy clinical cases of atypical atrial flutter, which offer compelling evidence indicating the implication of the lesser-known Septopulmonary Bundle (SPB). This inference is based on the identification of distinct electrocardiographic patterns observed in these patients and their favorable response to catheter ablation, which is a standard treatment for atrial flutter. Remarkably, in each case, targeted ablation at the anterior portion of the left atrial roof effectively terminated the arrhythmia, thus providing further support for the hypothesis of SPB involvement. These insightful observations shed light on the potential significance of the SPB in the etiology of atypical atrial flutter and introduce a promising therapeutic target. We anticipate that this paper will stimulate further exploration into the role of the SPB in atrial flutter and pave the way for the development of targeted ablation strategies.

Bulbar urethroplasty techniques and stricture recurrence: differences between end-to-end urethroplasty versus the use of graft.

Urethral stricture (US) affects most commonly the anterior portion of the urethra, concretely the bulbar, with a significant incidence in men. Open urethroplasty is the gold standard treatment. However, stricture recurrence (SR) remains a current subject of concern. The aim of the present review is to provide an updated literature summary on surgical urethroplasty techniques for bulbar US and prognostic factors for SR, comparing the different approaches. For short strictures, excision and primary anastomosis (EPA) is the preferred option, with success rates exceeding 90%. Substitution techniques are usually required for longer strictures (>2-3cm). Buccal mucosa graft (BMG) remains the first choice as it complies with ideal features, with no significant differences regarding the site of graft implantation. Stricture length, time since urethroplasty and number of previous urethral interventions are risk factors for failure. Also, surgeon's experience affects technique selection and future outcomes. There seems to be consensus on a higher SR rate following substitution techniques compared to EPA, which appears to be influenced by the stricture length, usually longer in the former group. Furthermore, there is a trend in favor of endoscopic management of SR, except for long and complex recurrences where grafts should be used. In conclusion, multiple urethroplasty techniques are available and selection must be carefully individualized, focusing on stricture characteristics, patient's history, and surgeon's experience. Well-designed studies with clear definitions and follow-up protocols are still necessary to develop standardized guidelines on the management of bulbar US.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation

ObjectivesCurrent recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation.MethodsPatients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol.ResultsWe analyzed 103 patients who underwent PRFCA 105 ± 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS).ConclusionsThe effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

Management of traumatic incomplete lacerating rectus muscle injuries using multimodal imaging approach (ASOCT and CT/MRI)

ABSTRACT Purpose: To describe the pathophysiology, importance of multimodal imaging approach, and the clinical outcomes of incomplete lacerating rectus muscle injuries. Methods: A retrospective review was conducted to identify patients with ocular deviation secondary to rectus muscle injuries. Between 2019 and 2022, a total of 30 patients were identified, amongst whom eleven patients had incompletely lacerated rectus muscles (secondary to penetrating adnexal trauma and sino-orbital surgeries). Patients’ demography, nature of injury, computed tomography/magnetic resonance imaging, anterior segment optical coherence tomography features, intra-operative findings, and post-operative outcomes were reviewed. Results: The mean age of 11 patients was 31.36 ± 14.38 years. All patients had external trauma which severed the muscle in its anterior portion. Five patients had isolated inferior rectus muscle injury (45.45%), three had inferior and medial rectus muscle injuries together (27.27%), two had isolated lateral rectus muscle injury (18.18%), and one remaining patient had isolated medial rectus muscle injury (9.05%). In ten patients (90.90%) CT/MRI revealed features suggestive of muscle injury, however details with respect to muscle insertion and scleral course were lacking. In this difficult scenario, ASOCT filled these lacunae in nearly 90% of the patients by providing surgically useful details. Moreover, when CT/MRI-ASOCT imaging features were combined, the management and outcomes were even more predictable. Conclusions: Penetrating rectus muscle injuries can be better identified as incompletely lacerated muscle using multimodal imaging approach. This simple image correlation process customizes the treatment approach and hence the clinical outcomes.

Arthroscopic anterior deltoid plication with bone anchor is an effective procedure to control residual talar anterior translation after lateral ligament repair.

Residual symptoms can be observed after ankle lateral ligament repairs commonly due to hyperlaxity, severe ankle instability or a failed stabilization. In order to increase joint stability, ligament or capsular-ligament plication has been used in other joints. Given that the anterior portion of the deltoid is a stabilizer against anterior talar translation, it could be used as an augmentation to restrict anterior talar translation. The aim of this study was to describe an arthroscopic anterior deltoid plication with a bony anchor as an augmentation to the lateral stabilization. The results in a series of eight patients were presented. Eight patients (seven males, median age 31 [range, 22-43] years) presented residual instability after arthroscopic all inside lateral collateral ligament repair. Arthroscopic anterior deltoid ligament plication was performed in these patients. Median follow-up was 22 (range, 15-27) months. Using an automatic suture passer and a knotless anchor, the anterior deltoid was arthroscopically plicated to the anterior aspect of the medial malleolus. During the arthroscopic procedure, only an isolated detachment of the anterior talofibular ligament was observed without any deltoid open-book injury in any case. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligament repair and the anterior deltoid plication with a bony anchor. On clinical examination, the anterior drawer test was negative in all patients. The median American Orthopedic Foot and Ankle Society score increased from 68 (range, 64-70) preoperatively to 100 (range, 90-100) at final follow-up. The arthroscopic anterior deltoid plication is a feasible procedure to augment stability and control anterior talar translation when treating chronic ankle instability in cases of residual excessive talar translation. Level IV.

Different anatomic patterns of the indirect tendon of the rectus femoris

PurposeThe rectus femoris forms the anterior portion of the quadriceps muscle. It has a proximal tendinous complex, which is constituted by a direct tendon, an indirect tendon, and a variable third tendon. Direct and indirect tendons converge into a common tendon. The purposes of this study are to add anatomical knowledge about the proximal tendinous complex and describe anatomical variants of the indirect tendon and, on these basis, categorize different anatomical patterns.MethodIn this study, 48 hemipelvis from bodies donated to the Universitat Autònoma de Barcelona have been dissected to examine the proximal tendinous complex of the rectus femoris.ResultsThe following anatomical variants of the indirect tendon were described: inferior aponeurotic expansion in 23/48 cases (47.9%); superior aponeurotic expansion in 21/48 cases (43.7%); and an unusual origin of the myotendinous junction of the rectus femoris in the free portion of the indirect tendon in 19/48 cases (39.6%). On the basis of the aponeurotic expansions, the following anatomical patterns of the indirect tendon were defined: standard (19/48 cases, 39.6%), superior and inferior complex (15/48 cases, 31.2%), inferior complex (8/48 cases, 16.7%), and superior complex (6/48 cases, 12.5%).ConclusionWe can categorize four different anatomical patterns of the indirect tendon, three of which are complex. We suggest that complex patterns can cause an increased stiffness of the indirect tendon and so be considered non-modifiable risk factors for rectus femoris injuries. Finally, it would be useful to identify complex patterns and perform injury prevention actions through specific physical preparation programs.

(047) ORGASM ABILITY AND MAPPED EROGENOUS SENSATION DURING RECEPTIVE VAGINAL AND ANAL INTERCOURSE

Abstract Introduction Erogenous sensation zones (ESZs) elicit feelings of sexual arousal in response to touch. Prior research has generated whole-body erogenous sensation maps, but they do not differentiate between individual anatomical structures or assess for erogenous sensation of internal surfaces of the body, such as the vagina and anal canal. There is an even greater paucity of literature on the ability to orgasm from vaginal and anal receptive intercourse. Objective To describe detailed maps of erogenous sensation of the vagina and anal canal amongst cisgender women, and assess for ability to orgasm from receptive intercourse. Methods Respondents were recruited via Qualtrics and completed an anonymous, online questionnaire. They were instructed to indicate ESZs by selecting from predefined areas that bring them pleasure when touched during sex with a partner from anatomic illustrations of the vagina and anal canal. Respondents were also queried on their ability to orgasm from receptive vaginal and anal intercourse. All statistical analyses were completed using Qualtrics Stats iQ software, with p&amp;lt;0.05 indicating statistical significance. ESZ maps were generated based on the proportion of respondents selecting each anatomical structure as erogenous. Results A sample of 441 sexually active cisgender women completed the study survey (mean age 48.9±15.6y). Of the five ESZs of the vagina (Figure 1), the superficial anterior (selected by 48% respondents) and superficial posterior (33%) regions were the most frequently selected areas. The four ESZs of the anal canal further revealed greater erogeneity at the superficial anterior (18%) and superficial posterior (11%) walls (Figure 2). With respect to ability to orgasm from receptive intercourse, 35% of cisgender women reported being able to orgasm from vaginal penetration alone while 45% required simultaneous costimulation of another body part and 10% reported an inability to orgasm during receptive vaginal intercourse, regardless of costimulation (Figure 3a). Additionally, 19% of cisgender women reported an ability to orgasm from receptive anal intercourse alone, while 50% required costimulation and 31% reported an inability to orgasm during receptive anal intercourse, regardless of costimulation (Figure 3b). Conclusions Erogenous sensation of the vagina and anal canal is primarily localized to the superficial walls of both structures, with a greater preference for the superficial anterior zones. These findings support the proposed location of the “G-spot” existing proximal to Skene’s glands in the anterior portion of the vaginal canal. Results from this study further highlight the importance of costimulation in achieving orgasm during receptive vaginal and anal intercourse, with only a minority of respondents reporting an ability to orgasm from vaginal or anal penetration alone. Disclosure No.

The Relationship Between the Circle of Willis Variations and White Matter Hyperintensities in Different Migraine Subtypes

It is known that the Circle of Willis (CoW) variations and white matter hyperintensities (WMHs) are common in migraine. This retrospective study aims to investigate the relationship between the CoW variations and WMHs in migraine without aura (MWoA) (n=38) and migraine with aura (MWA) (n=40) patients. Demographic, clinical and radiological findings (the CoW variations and WMH burden) of the patients were recorded, and the relationship between the variables was evaluated in both groups. The overall incomplete COW, incomplete anterior or vertebrobasilar portion of the CoW, or the presence of fetal PCA showed no significant difference between the MWoA and MWA groups (p &gt; 0.05). An incomplete posterior portion of the CoW was significantly higher in the MWA group than in the MWoA group (p = 0.034). In the WMA group, the visual aura was present in 72% of patients with the overall incomplete CoW; all of these were posterior portion variations of the CoW. When the WMH burden was compared, no significant difference was seen between the MWoA and MWA groups (p &gt; 0.05). Among patients with the CoW variations in the MWoA group, the rate of patients without WMHs was significantly higher (p = 0.030). No significant difference was observed between the CoW variations and WMH burden in the MWA group (p &gt; 0.05). In conclusion incomplete posterior portion of the CoW is common in MWA, and this variation is associated with visual aura but unrelated to WMH burden.

Cross-sectional and longitudinal evaluation of white matter microstructure damage and cognitive correlations by automated fibre quantification in relapsing-remitting multiple sclerosis patients.

The purpose of this study was to characterize whole-brain white matter (WM) fibre tracts by automated fibre quantification (AFQ), capture subtle changes cross-sectionally and longitudinally in relapsing-remitting multiple sclerosis (RRMS) patients and explore correlations between these changes and cognitive performance A total of 114 RRMS patients and 71 healthy controls (HCs) were enrolled and follow-up investigations were conducted on 46 RRMS patients. Fractional anisotropy (FA), mean diffusion (MD), axial diffusivity (AD), and radial diffusivity (RD) at each node along the 20 WM fibre tracts identified by AFQ were investigated cross-sectionally and longitudinally in entire and pointwise manners. Partial correlation analyses were performed between the abnormal metrics and cognitive performance. At baseline, compared with HCs, patients with RRMS showed a widespread decrease in FA and increases in MD, AD, and RD among tracts. In the pointwise comparisons, more detailed abnormalities were localized to specific positions. At follow-up, although there was no significant difference in the entire WM fibre tract, there was a reduction in FA in the posterior portion of the right superior longitudinal fasciculus (R_SLF) and elevations in MD and AD in the anterior and posterior portions of the right arcuate fasciculus (R_AF) in the pointwise analysis. Furthermore, the altered metrics were widely correlated with cognitive performance in RRMS patients. RRMS patients exhibited widespread WM microstructure alterations at baseline and alterations in certain regions at follow-up, and the altered metrics were widely correlated with cognitive performance in RRMS patients, which will enhance our understanding of WM microstructure damage and its cognitive correlation in RRMS patients.

Frustrative nonreward: Detailed c-Fos expression patterns in the amygdala after consummatory successive negative contrast

The amygdala has been implicated in frustrative nonreward induced by unexpected reward downshifts, using paradigms like consummatory successive negative contrast (cSNC). However, existing evidence comes from experiments involving the central and basolateral nuclei on a broad level. Moreover, whether the amygdala’s involvement in reward downshift requires a cSNC effect (i.e., greater suppression in downshifted animals than in unshifted controls) or just consummatory suppression without a cSNC effect, remains unclear. Three groups were exposed to (1) a large reward disparity leading to a cSNC effect (32-to-2% sucrose), (2) a small reward disparity involving consummatory suppression in the absence of a cSNC effect (8-to-2% sucrose), and (3) an unshifted control (2% sucrose). Brains obtained after the first reward downshift session were processed for c-Fos expression, a protein often used as a marker for neural activation. c-Fos-positive cells were counted in the anterior, medial, and posterior portions (A/P axis) of ten regions of the rat basolateral, central, and medial amygdala. c-Fos expression was higher in 32-to-2% sucrose downshift animals than in the other two groups in four regions: the anterior and the medial lateral basal amygdala, the medial capsular central amygdala, and the anterior anterio-ventral medial amygdala. None of the areas exhibited differential c-Fos expression between the 8-to-2% sucrose downshift and the unshifted conditions. Thus, amygdala activation requires exposure to a substantial reward disparity. This approach has identified, for the first time, specific amygdala areas relevant to understand the cSNC effect, suggesting follow-up experiments aimed at testing the function of these regions in reward downshift.

Pulsed field ablation versus very high power short duration radiofrequency ablation in atrial fibrillation: what is better?

Abstract Background The newly introduced non-thermal pulsed field ablation (PFA) is a promising technology for catheter ablation (CA) of atrial fibrillation (AF) with high acute success rates and good safety features. However studies have shown that very high power short duration (VHPSD) ablation is also highly effective and fast with potentially less arrhythmia recurrence compared to conventional radiofrequency ablation. Data comparing this two methods are lacking Objective The aim of this study is to compare two source of energy used for CA of AF in terms of procedural, clinical and outcome data Methods We conduced a retrospective observational study enrolling all patients (pts) from september 2021 to may 2023 who underwent CA of AF with PFA system and VHPSD. In the PFA group pulmonary veins isolation (PVI) was obtained using 2KV with eight application each vein, posterior wall isolation (PWI) of left atrium (LA) was obtained with application in the flower configuration of the catheter and then additional lesion were deployed at the operator’s discretion. In the VHPSD group the encircling of PV was obtained with 90W for 4 seconds radiofrequency pulses in posterior portions of the LA including LA PW, whereas 50W with ablation index target of 500 was used in the anterior portions of the PV and additional lesions. General anesthesia or deep sedation was carried out in all pts Results A total of 205 pts were included, n = 86 (42%) in the PFA group and N = 119 (58%) in the VHPSD group: paroxysmal (n = 62[72%], N = 64[54%]), persistent (n = 19[22%], N = 43[36%]), long standing persistent (n = 5[5%], N = 10[8%]). PVI was successful in all pts and additional lesions were delivered in n = 26 (30%) in PFA group and N = 76 (64%) in HVPSD group, mostly at the PW (n = 24[92%]; N = 50[66%]). The PFA group revealed a shorter procedura duration (80 ± 29 min vs 108 ± 39 min; p = 0,00001) but longer fluoroscopic time (21 ± 8 min vs 14 ± 10 min; p = 0,00001). The VHPSD group revealed more complications (N = 7[6%] vs n = 3[3%]) but without statistically significant difference (p = 0,43), the most frequent in the PFA group was vascular access complications instead in the VHPSD group was post-procedural pericarditis. Only one patient in VHPSD group had major complication with a post-procedural stroke but without residual neurological deficits. At follow-up after median of 14 (26-6) months, n = 61 pts in the PFA group (71%) and N = 91 in the VHPSD group (76%) were free from atrial arrhythmia (p = 0,79). In both group 7 pts recurrenced as atypical atrial flutter (n = 7[28%] PFA; N = 7[25%] VHPSD; p = 0,061) Conclusion PFA and VHPSD are effective and safe to CA of AF with comparable arrhythmia recurrenses. However procedure duration with PFA is significantly shorter and therefore may be of potential benefit in particular for elderly and frail pts. Further research, including randomized controlled trials, is needed to validate and compare these techniques more comprehensively

A Drive Interrupted: Stroke of the Anterior Choroidal Artery – A Case Report

The anterior choroidal artery (AChA) is the most distal branch of the internal carotid artery (ICA) The ACHA is significant because it supplies important structures in the brain, including the optic tract, anterior portion of cerebral peduncle, lateral geniculate body, uncus, globus pallidus, posterior and superficial areas of the thalamus, and the retrolenticular and posterior portions of the internal capsule on the same side as the artery. Isolated strokes involving the AChA are rare and can result in HHH Syndrome, consisting of contralateral hemiplegia, hemisensory loss, and homonymous hemianopia. Features which distinguish an AChA infarction from larger arterial pathology are lack of headache and lack of depressed level of consciousness in subacute infarction, and usually lack of aphasia acutely. The etiology remains controversial, with proposed mechanisms including cardioembolic, large-vessel atherosclerosis, dissection of the ICA, small-vessel occlusion, and cryptogenic causes. Herein, the authors report a case of an isolated AChA infarction resulting in a right-sided, pure motor hemiparesis with no sensory or vision loss, highly suggestive of cardioembolic origin, with the evaluation of the patient, and eventual treatment strategy.

Ammonoid and coleoid jaws from the Upper Cretaceous of northern Siberia (Nizhnyaya Agapa River sections)

The jaws of cephalopods, ammonites and especially coleoids, are rarely met in fossil state. The localities with diversified jaws, belonging to various groups of fossil cephalopods are even less common. We describe a diversified complex of cephalopod jaws from the upper Cenomanian–middle Turonian of Northern Siberia, which include the upper and lower jaws of Placenticeras ammonites (the oldest placenticeratid jaws known to date) and large-sized jaws of octobrachian coleoids. Although the lower jaws of Placenticeras belong to the aptychus type of ammonoid jaw apparatuses, they are characterized by the thickening of an inner organic layer in their anterior part, with a shape resembling a calcified conchorhynch known in the anterior portion of the lower jaws of Mesozoic nautilids and lytoceratid and phylloceratid ammonoids. The presence a conchorhynch-like structure supports the assumption that the feeding function in placenticeratid lower jaws most likely prevailed over the protective one. The upper jaws of Placenticeras show structure, typical for the jaws of aptychophoran ammonites: an inner lamella, divided into two wings, and a pointed outer lamella. Large-sized upper jaws of octobrachian coleoids demonstrate close affinities with the jaws of Octopoda suggesting that they could have belonged to representatives of this order, probably to large-sized gladius-bearing teudopseins. Judging by the jaws' size, both ammonites and octobrachians, which inhabited the marine basin in the Northern Siberia, were characterized by large body size. The cephalopod assemblage remained unchanged throughout the end of the Cenomanian and the first half of the Turonian.

Regional structure-function relationships of lumbar cartilage endplates

Cartilage endplates (CEPs) act as protective mechanical barriers for intervertebral discs (IVDs), yet their heterogeneous structure–function relationships are poorly understood. This study addressed this gap by characterizing and correlating the regional biphasic mechanical properties and biochemical composition of human lumbar CEPs. Samples from central, lateral, anterior, and posterior portions of the disc (n = 8/region) were mechanically tested under confined compression to quantify swelling pressure, equilibrium aggregate modulus, and hydraulic permeability. These properties were correlated with CEP porosity and glycosaminoglycan (s-GAG) content, which were obtained by biochemical assays of the same specimens. Both swelling pressure (142.79 ± 85.89 kPa) and aggregate modulus (1864.10 ± 1240.99 kPa) were found to be regionally dependent (p = 0.0001 and p = 0.0067, respectively) in the CEP and trended lowest in the central location. No significant regional dependence was observed for CEP permeability (1.35 ± 0.97 * 10−16 m4/Ns). Porosity measurements correlated significantly with swelling pressure (r = −0.40, p = 0.0227), aggregate modulus (r = −0.49, p = 0.0046), and permeability (r = 0.36, p = 0.0421), and appeared to be the primary indicator of CEP biphasic mechanical properties. Second harmonic generation microscopy also revealed regional patterns of collagen fiber anchoring, with fibers inserting the CEP perpendicularly in the central region and at off-axial directions in peripheral regions. These results suggest that CEP tissue has regionally dependent mechanical properties which are likely due to the regional variation in porosity and matrix structure. This work advances our understanding of healthy baseline endplate biomechanics and lays a groundwork for further understanding the role of CEPs in IVD degeneration.

Fear learning activated anterior basolateral amygdala neurons modulate anxiety behaviors

Traumatic events may result in development of neuropsychiatric disorders such as post-traumatic stress disorder (PTSD) with symptoms such as anxiety. While a clear connection between fear and anxiety is well established, the neuronal substrates mediating this relationship are understudied. In this study, we investigated the extent to which neurons in the anterior portion of the basolateral amygdala (aBLA), an area implicated in both fear and anxiety behavior, which are activated during fear learning, modulate anxiety-like behavior during testing in the elevated plus maze (EPM) or open field (OF). In TRAP2 transgenic mice, we permanently expressed the photoexcitatory effector channelrhodopsin or the photoinhibitory effector Jaws in aBLA neurons transcriptionally activated ( c-fos) during contextual fear learning (footshocks, fear-TRAP) or exploration of the conditioning chamber (no footshocks, context-TRAP). Three weeks later, we photoexcited or photoinhibited the fear and context-TRAPed mice during EPM or OF exploration. While photostimulation did not alter anxiety-like behavior during EPM or OF testing compared to dummy stimulation in context-TRAPed mice (n=6-10 mice/group, 8 groups), photoexcitation increased and photoinhibition decreased anxiety-like behaviors in fear-TRAPed mice (n=6-11 mice/group, 8 groups). Our results support a model in which fear learning-activated aBLA neurons are not only suffcient to exaggerate, but also contribute to, endogenous anxiety-like behaviors during exploration of novel environments. Thus, the fear learning-activated aBLA population may be a common substrate that couples fear learning to anxiety behaviors and therefore could play a vital role in development/maintenance of fear-related anxiety disorders. MH093320 (LCD &amp; GMT). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.