Anterior Side Research Articles

Clinical use of Gafchromic EBT4 film for in vivo dosimetry for total body irradiation.

In vivo dosimetry is a common requirement to validate dose accuracy/uniformity in total body irradiation (TBI). Several detectors can be used for in vivo dosimetry, including thermoluminescent dosimeters (TLDs), diodes, ion chambers, optically stimulated luminescent dosimeters (OSLDs), and film. TLDs are well established for use in vivo but required expertise and clinical system availability may make them impractical for multifractionated TBI. OSLDs offer quick readout, but recalls have restricted their use. The purpose of this work was to validate the newly available Gafchromic EBT4 film for TBI in vivo dosimetry. Film calibration curves were created under standard conditions (6MV/15MV, 1.5/3.0cm depth, 100cm source-to-surface distance (SSD), 10 × 10 cm2 field), and films were scanned at several time points (0.5-24h) to determine the shortest development time that yielded accurate dose measurements. 4 × 4 cm2 films were placed under 1.5cm thick bolus on the anterior and posterior sides of a solid water phantom to measure entrance and exit dose under TBI conditions (∼600cm SSD, 39.5 × 39.5 cm2 field, 6 MV/15 MV). These measurements were compared to ion chamber and diode readings for validation. Film measurements were also compared to OSLD measurements for three TBI patients. The shortest development time that resulted in accurate dosimetry and allowed for adequate physician review time was 4h (±4% dose accuracy). Film entrance and exit dose measurements were within±3.8% of ion chamber and diode readings for 6MV and 15MV beams. Patient film measurements were within ∼±5% for the majority of anatomical measurement locations; however, film and OSLD readings for some anatomic locations deviated by>10%. These results indicate that EBT4 film can be utilized for accurate in vivo dosimetry for TBI patients and shows good agreement with diode and ion chamber measurements. Further investigation into film and OSLD differences was not possible due to OSLD recalls.

Three-Point Contact Repair Technique for Partial Subscapularis Tears Using U-Stitch and Cow Hitch Knot Loaded on a Single Knotless Anchor: Simple, Reliable and Quick Method

The importance of repairing the subscapularis tendon to facilitate restoration of the rotator cuff force couple is obvious. However, identifying and repairing subscapularis tears can be challenging for surgeons. In this technical note, we present our preferred surgical method for Lafosse type 1, 2, and 3 and Yoo and Rhee type 1-2A and 2B subscapularis tears, providing a 3-point suture contact achieved with FiberTape (Arthrex) and knotless anchors. In this technique, fiber suture is placed into the superolateral edge of the subscapularis tendon as a traction stitch (cow hitch knot). Second, the FiberTape is passed through the medial upper and lower parts of the tendon, just perpendicular to the fibers, using a suture passer. The FiberTape’s free ends remain on the tendon’s anterior side, shaping a U form. The U-shaped FiberTape and traction suture are loaded to a knotless anchor and placed on the footprint area. This creates a 3-point contact between the FiberTape U-suture and the cow hitch knot on the area. We believe that this technique provides fast and reliable fixation due to its 3-point contact application and simplicity.

A Monte Carlo study comparing dead-time losses of a gamma camera between tungsten functional paper and lead sheet for dosimetry in targeted radionuclide therapy with Lu-177.

Dead-time loss is reported to be non-negligible for some patients with a high tumor burden in Lu-177 radionuclide therapy, even if the administered activity is 7.4GBq. Hence, we proposed a simple method to shorten the apparent dead time and reduce dead-time loss using a thin lead sheet in previous work. The collimator surface of the gamma camera was covered with a lead sheet in our proposed method. While allowing the detection of 208-keV gamma photons of Lu-177 that penetrate the sheet, photons with energies lower than 208keV, which cause dead-time loss, were shielded. In this study, we evaluated the usefulness of tungsten functional paper (TFP) for the proposed method using Monte Carlo simulation. The count rates in imaging of Lu-177 administered to patients were simulated with the International Commission on Radiological Protection (ICRP) 110 phantom using the GATE Monte Carlo simulation toolkit. The simulated gamma cameras with a 0.5-mm lead sheet, 1.2-mm TFP, or no filter were positioned closely on the anterior and posterior sides of the phantom. The apparent dead times and dead-time losses at 24h after administration were calculated for an energy window of 208keV ± 10%. Moreover, the dead-time losses at 24-120h were analytically assessed using activity excretion data of Lu-177-DOTATATE. The dead-time loss without a filter was 5% even 120h after administration in patients with a high tumor burden and slow excretion, while those with a lead sheet and TFP were 0.22 and 0.58 times less than those with no filter, respectively. The count rates with the TFP were 1.3 times higher than those with the lead sheet, and the TFP could maintain primary count rates at 91-94% of those without a filter. Although the apparent dead time and dead-time loss with the lead sheet were shorter and less than those with TFP, those with TFP were superior to those without a filter. The advantage of TFP over the lead sheet is that the decrease in primary count rates was less.

Knee Pain, Joint Loading, and Structural Abnormalities on MRI in 13-Year-Old Children in a Population-Based Birth Cohort

Background: Knee pain is a common problem in children and adolescents, and it often has a chronic character. Purpose: To examine the prevalence of knee pain in 13-year-old children and assess associations of knee pain with physical factors and the presence of structural abnormalities on magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the Generation R Study, a population-based birth cohort, were used. Prevalence and characteristics of knee pain were assessed, using a pain mannequin, in children 13 years of age (N = 1849). Patient characteristics and data on physical activity were extracted from questionnaires. The body mass index standard deviation score and waist-hip ratio were calculated from objectively measured weight and height. Structural abnormalities were assessed by MRI. The differences between children with and without knee pain were also analyzed. Results: A prevalence of 8.0% was found for knee pain in children, of which 92.3% persisted for >3 months (ie, chronic); 37.5% of the children experienced pain daily, and the pain was almost always located on the anterior side of the knee (98.6%). Higher body mass index standard deviation scores were seen in children with knee pain than in the children without knee pain. No differences in physical activity were seen between children with and without knee pain. Moreover, in children with knee pain compared with children without knee pain, characteristics of Osgood-Schlatter disease (6.8% vs 1.9%) and bipartite patella type 3 (4.7% vs 0.3%) were more often seen on MRI. Conclusion: This study shows that knee pain is a relatively frequent problem in children. It is almost always located on the anterior aspect, has a chronic character, and is often experienced daily. However, the possible implication of structural abnormalities on MRI in children with knee pain and the possible relationship with the development of future knee complaints are still unclear.

An Individualistic Homoeopathic Approach in a Case of Infected Epidermal Naevus—A Case Report

AbstractNaevi are circumscribed developmental defects or the lack of one or more components of the skin that manifest as overgrowths or hamartomas derived from embryonic ectoderm. The majority of naevi are present at birth or appear soon after birth. Naevi can be infected by various organisms, particularly by Staphylococcus, without other systemic involvement, similar to the skin. A 30-year-old male patient presented with an infected, painful congenital epidermal naevus on the anterior side of his right thigh. He experienced severe itching, burning, and sudden blister formation. After treatment, the infection completely resolved, leaving the naevus without any complications. Possible causal attribution of these changes was determined using the Modified Naranjo Criteria (score: 8 out of 13). No recurrence of further infection was reported in the next year, demonstrating the positive curative role of individualized homeopathic treatment in a case of infected epidermal naevus.

Simultaneous optical imaging of gastric slow waves and contractions in the in vivo porcine stomach.

Gastric peristalsis is governed by electrical "slow waves" generally assumed to travel from proximal to distal stomach (antegrade propagation) in symmetric rings. Although alternative slow-wave patterns have been correlated with gastric disorders, their mechanisms and how they alter contractions remain understudied. Optical electromechanical mapping, a developing field in cardiac electrophysiology, images electrical and mechanical physiology simultaneously. Here, we translate this technology to the in vivo porcine stomach. Stomachs were surgically exposed and a fluorescent dye (di-4-ANEQ(F)PTEA) that transduces the membrane potential (Vm) was injected through the right gastroepiploic artery. Fluorescence was excited by LEDs and imaged with one or two 256 × 256 pixel cameras. Motion artifact was corrected using a marker-based motion-tracking method and excitation ratiometry, which cancels common-mode artifact. Tracking marker displacement also enabled gastric deformation to be measured. We validated detection of electrical activation and Vm morphology against alternative nonoptical technologies. Nonantegrade slow waves and propagation direction differences between the anterior and posterior stomach were commonly present in our data. However, sham experiments suggest they were a feature of the animal preparation and not an artifact of optical mapping. In experiments to demonstrate the method's capabilities, we found that repolarization did not always follow at a fixed time behind activation "wavefronts," which could be a factor in dysrhythmia. Contraction strength and the latency between electrical activation and contraction differed between antegrade and nonantegrade propagation. In conclusion, optical electromechanical mapping, which simultaneously images electrical and mechanical activity, enables novel questions regarding normal and abnormal gastric physiology to be explored.NEW & NOTEWORTHY This article introduces a novel method for imaging gastric electrophysiology and mechanical function simultaneously in anesthetized, open-abdomen pigs. We demonstrate it by observing propagating slow-wave depolarization and repolarization along with the strength, spatial distribution, and direction of contractions. In addition, we observe that in this animal preparation, slow waves often do not propagate from the proximal to distal stomach and are frequently asymmetric between the anterior and posterior sides of the stomach.

Urachus carcinoma initially presenting only as a liver metastasis, a diagnostic and therapeutic challenge: First case in literature

Introduction: Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%). Presentation: We report a case of a 71-year-old female patient initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were non-specific with abdominal discomfort. The final diagnosis of Urachal Adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment. Discussion: About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC. Conclusion: This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer.

Effects of organ dose modulation applied to a part of the scan range on radiation dose in computed tomography of the body

In computed tomography (CT), organ dose modulation (ODM) reduces radiation exposure from the anterior side to reduce radiation dose received by the radiosensitive organs located anteriorly. We investigated the effects of ODM applied to a part of the scan range on radiation dose in body CT. The thorax and thoraco-abdominopelvic region of an anthropomorphic whole-body phantom were imaged with and without ODM. ODM was applied to various regions, and the tube current modulation curves were compared. Additionally, the dose indices were compared with and without ODM in thoracic and thoraco-abdominopelvic CTs in 800 patients. ODM was applied to the thyroid in male patients and to the thyroid and breast in female patients. In phantom imaging of the thorax, the application of ODM below the scan range decreased the tube current, and that to the breast showed a further decrease. Decreased tube current was also observed in phantom imaging of the thoraco-abdominopelvic regions with ODM below the scan range, and the application of ODM to the whole scan range, thyroid, breast, and both thyroid and breast further reduced the tube current in the region to which ODM was applied. In patient imaging, the dose indices were significantly lower with ODM than without ODM, regardless of the scan range or sex. The absolute reduction in dose-length product was larger for thoraco-abdominopelvic CT (male, 43.2 mGy cm; female, 59.7 mGy cm) than for thoracic CT (male, 30.8 mGy cm; female, 37.6 mGy cm) in both sexes, indicating dose reduction in the abdominopelvic region to which ODM was not applied. In conclusion, The application of ODM in body CT reduces radiation dose not only in the region to which ODM is applied but also outside the region. In radiation dose management, it should be considered that even ODM applied to a limited region affects the dose indices.

The evaluation of pathologic fracture risk and residual bone height in unicortical and bicortical mandibular corpus defects: A 3D finite analysis

ObjectiveMandibular bone defects are a common problem and difficult to manage. A defected area mostly left to heal spontaneously. It doesn’t have a definite protocol in the literature, when the area will be left to heal spontaneously or when supported with materials such as plates, screws, grafts, especially in intermediate-sized defects. In this study, it was aimed to determine by examining the areas where the stresses due to chewing forces are concentrated on the mandible bone and the risk of fracture in intermediate size unicortical and bicortical defects. Material and MethodsThe all defect models which was the residual bone heights were 6, 8, 10 mm in mandibular corpus region were created. Two different loading scenarios were applied anterior and defected premolar side. Von Mises, Pmax and Pmin stresses in models were evaluated by three-dimensional finite element analysis method. ResultsThe study found higher stress accumulation on the buccal anterior side of defects in both unicortical and bicortical models, with the most stress concentrated at the buccal corners. Under Loading 1, bicortical defects with 10 mm residual bone height showed slightly higher stress accumulations than unicortical defects, while bicortical defects with 8 and 6 mm residual bone height exhibited significantly higher stress values. Under Loading 2, stress accumulations in bicortical defects were higher than in unicortical defects, with bicortical defects at 6 mm residual bone height showing almost double the stress values. Pmax stress values were higher in bicortical defects under both loadings, especially when the residual bone height decreased. Pmin stress values were comparable in unicortical defects but were higher in bicortical defects, particularly at 6 mm residual bone height, under both loading conditions. ConclusionThis study was presented that mandibular resistance decreases significantly when residual bone height is less than 10 mm for bicortical defects and less than 8 mm at unicortical defects. In these conditions it may need supported with materials to prevent fractures. However, in vivo and in vitro studies are necessary for definitive conclusions.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report

BackgroundDue to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.Case presentationA 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.ConclusionIn this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

A new theropod dinosaur from the Callovian Balabansai Formation of Kyrgyzstan

Abstract Recent fieldwork in the late Middle Jurassic Balabansai Formation of Kyrgyzstan has yielded a partial skeleton of a large theropod dinosaur. The material includes a few bones of the skull (postorbital, quadratojugal), dorsal and sacral vertebrae, fragments of the pectoral girdle and forelimbs, and an almost complete pelvic girdle and hindlimbs, and is here made the type of a new theropod taxon, Alpkarakush kyrgyzicus gen. et sp. nov. Alpkarakush can be diagnosed by an extremely developed orbital brow on the postorbital, a pneumatic opening leading into cavities in the neural arch from the centroprezygodiapophyseal fossa in the posterior dorsal vertebrae, an almost enclosed ventral sulcus in manual phalanx II-1, a narrow and deep intercondylar groove on the anterior side of the distal femur, and an epicondylar crest on the distal femur that is offset from the distal end. A second, fragmentary, and smaller specimen from the same site represents the same taxon. Based on long bone histology, the type of Alpkarakush represents a late subadult individual, whereas the smaller specimen is a juvenile, possibly indicating gregarious behaviour. Phylogenetic analysis places Alpkarakush in the Metriacanthosauridae, underlining the diversity and wide distribution of this clade in the Jurassic of Asia.

Endoscopic resection for gastric submucosal tumors: A single-center experience in Japan.

Endoscopic resection (ER) for gastric submucosal tumors (SMTs) has gained prominence in recent years, with studies emerging from various countries. However, there is a paucity of reports from Japan. We aimed to elucidate the efficacy and safety of ER for gastric SMT in Japan. In this retrospective observational study, we investigated the outcomes of consecutive patients who underwent ER for gastric SMT from January 2017 to May 2023. The outcome variables assessed included the complete resection rate, procedure time, closure-related outcomes, and the incidence of adverse events. A total of 13 patients were included in the analysis. The median procedure time was 163 (55-283) min. Complete full-thickness resection was performed in seven cases, while in four cases, the serosa remained, and in two cases, the outer layer of the muscularis propria remained. In two cases where the SMT was located on the anterior side, conversion to laparoscopic surgery became necessary, resulting in a procedural success rate of 84.6% (11/13). Excluding these two cases, endoscopic closure of the defect was successfully accomplished in the remaining 11 cases. R0 resection was achieved in 12 out of 13 cases (92.3%). Although one patient had peritonitis, which was successfully treated conservatively, no other treatment-related adverse events were encountered. Although ER for SMT on the anterior side may be challenging, our experience revealed that ER is a safe and efficacious approach for gastric SMT.

Measurement of Orbital Dimensions and Its Gender Related Differences in Various Ages of Pakistani Children

Purpose: To measure the orbital dimensions and their gender related differences at various ages in Pakistani children from birth to 12 years of age. Study Design: Cross sectional observational. Place and Duration of Study: Tibri Medical College and Hospital Karachi and National Institute of Child Health, Karachi from June 2022 to February 2023. Methods: Patients who underwent CT Scan head for any reason but with normal orbits were included in the study. The vertical and horizontal measurements were made for anterior, middle and posterior orbit in sagittal and axial views. Results: The mean age of the total sample of 176 children was 6.45±3.40 years. The mean horizontal dimension of the anterior side of the orbit was 28.31 mm for children aged 1-3 years, 30.63 mm for those aged 4-6 years, 32.22 mm for ages 6-9 years, and 32.93 mm for ages 10-12 years. These differences were statistically significant (p<0.05). A significant difference was observed in the mean vertical dimension for the middle and posterior sides across different age groups. There were significant differences in the vertical and horizontal dimensions of the anterior and middle sides of the orbits for children aged 1-3 years (p<0.05). However, for children aged 4-6 years, there were no significant differences between genders in any measured dimension (horizontal, vertical, or depth) (p>0.05). Conclusion: There is a phase of rapid growth from birth to 3 years of age, after which the orbit continues to grow slowly. Gender-related differences were more pronounced during this phase.

Comparative analysis of mechanical wall shear stress and hemodynamics to study the influence of asymmetry in abdominal aortic aneurysm and descending thoracic aortic aneurysm

An aneurysm's rupture is commonly associated with its maximum diameter, yet biomechanical studies emphasize the significant influence of mechanical wall shear stress (WSS) in this process. This study focuses on two models of aortic aneurysms: abdominal aortic aneurysm and descending thoracic aortic aneurysm. Five cases, comprising two for model 1 and three for model 2, are examined to explore both axisymmetric and asymmetric shapes, as patient geometry may manifest as either fusiform (axisymmetric) or saccular (asymmetric), while maintaining a consistent aneurysm diameter and adjusting the bulge shape factor to induce asymmetry. Hemodynamic factors, including WSS and wall shear stress gradient, are computed to evaluate thrombus formation and rupture risk within the aneurysms. Our results indicate the presence of recirculation zones in both the medial and transverse planes, generating vortices within the aneurysm. These vortices are more prominent in asymmetric cases compared to axisymmetric cases, leading to increased blood residence time within the aneurysm and a higher likelihood of thrombus formation. Thrombus formation can further impede blood flow, heightening the risk of embolism or ischemic events. Rupture occurs when the WSS surpasses tissue strength; thus, if the tissue strength of all aneurysms is same, our findings suggest that rupture risk varies according to asymmetry. In the transverse direction, our results demonstrate that in model 1, case 1 exhibits uniform WSS on both sides, while in case 2, WSS is higher at the posterior sides of the aneurysm sac. Conversely, in model 2, WSS is higher at the anterior side of the aneurysm. In the medial direction of the aneurysm, WSS is highest for case 5, followed by case 3, case 4, case 2, and case 1, respectively, indicating elevated WSS when the anterior bulge dominates over the posterior bulge for each model. Overall, a higher rupture risk is observed in model 2 compared to model 1 due to increased mechanical stresses.

Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical–morphological study

ObjectiveTo digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population.MethodsPelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure.ResultsThe combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05).ConclusionsThe pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.

Anatomical features of the proximal end of the radius and its implications for implant design.

The proximal radio-ulnar joint allows supination and pronation of the forearm and the humeroradial joint allows flexion and extension movements at the elbow joint. Although the proximal end of the radius is less common than other fractures, it is more common nowadays due to the prolongation of life expectancy, increased incidence of osteoporosis. There have been reports in the literature that success has not been achieved due to the lack of anatomical fit of the prosthesis. Knowledge of the morphometric features of the proximal end of the radius is important for the design of anatomically and biomechanically appropriate prostheses. In this study, measurements of head and neck of radius, and radial tuberosity were measured in 80 dry radii. Parameters important for prosthesis design were analysed and their correlations examined. The shapes of radial head was found 36% oval and 64% circular. The mean heights of the radial head at anterior, posterior, medial, and lateral sides were 8.52 ± 1.32mm, 9.02 ± 1.23mm, 9.20 ± 1.59mm, 8.05 ± 1.13mm, respectively. The mean depth of articular facet were 1.85 ± 0.37mm. It was determined that there was no high correlation between the parameters affecting the prosthesis design. Morphological and morphometric features of the proximal radius are important for prosthesis design and implantation. The ideal radial head prosthesis design is challenging due to numerous parameters, wide ranges and low correlation, although modular designs facilitate compatibility. The widespread use of 3D printing technologies is expected to reduce the potential complications associated with prosthesis applications.

An anatomic consideration of the femoral nerve during direct anterior hip approach: A cadaveric study.

This study aimed to investigate the distance and correlation between the anatomy of the anterior side of the hip joint and the femoral nerve. Using ten fresh-frozen cadavers with twenty hip joints. We dissected and marked the femoral nerve in the inguinal area. Employing the direct anterior approach, we identified and marked study points, including the superior and inferior points of the anterior rim of the acetabulum, ¼ point, half point, and ¾ point along an imagined line connecting the formers, the inferomedial and mid aspect of the femoral neck, and the soft spot. Coronal plane measurements gauged the distance between these points and the femoral nerve. The collected data were analyzed to assess the distance and correlation. In the coronal plane, the median distance between the inferior point of the anterior rim of the acetabulum and the femoral nerve was 0 millimeters (interquartile range [IQR] 0-0). Likewise, the median distance between the mid aspect of the medial side of the femoral neck and the femoral nerve was 0 millimeters (IQR 0-0). Additionally, the mean distance between the soft spot and the femoral nerve was 1.18cm (SD 0.63). Surgeons approaching the hip joint via the direct anterior approach should be cautious at the inferior point of the anterior rim of the acetabulum and the mid aspect of the femoral neck. The soft spot at the anterior rim of the acetabulum remains safe from direct injury when surgeons use the correct technique during anterior retractor insertion.

Magnetic Resonance Imaging (MRI) Images in Tuberculosis Spondylitis Patients at the Central General Hospital Prof. Dr. I.G.N.G. Ngoerah Year 2021-2023

Background: Tuberculous spondylitis is extrapulmonary tuberculosis that attacks the spine. The incidence of tuberculosis has decreased. However, the prevalence of deaths due to tuberculosis is still high, so it requires appropriate management. Method: This study used a cross-sectional descriptive method, the research population was tuberculous spondylitis patients diagnosed at RSUP Prof. Dr. I.G.N.G Ngoerah 2021-2023. The research data source is PACS MRI data, with a sample size of 25. This research uses a consecutive sampling technique. Data analysis uses univariate analysis. Result: The research results showed that 25 samples met the inclusion criteria. Patients in the largest age group were 19 – 39 (36%) years and 40 – 59 years (36%) and the largest sex was female (56%). The most common location of vertebral MR Imaging was found in the thoracic (36%), intervertebral disc involvement was (52%) with normal discs and (48%) with disc destruction, there was endplate defect and paravertebral abscess in all samples (100%), the presence of gibbus deformity As many as (88%) of the sample, spinal cord compression was (96%), the most destruction of the corpus vertebral was on the anterior side (64%), and the most change in intensity of the interverbal disc was without contrast enhancement (60%). Conclusion: There are more women than men. The largest age groups are 19 - 39 years and 40 - 59 years with the most MR Imaging, namely in the thoracic location, normal intervertebral discs, endplatedefect, and paravertebral abscesses in all samples, gibbus deformity, spinal cord compression, anterior corpus vertebral destruction, and changes in intensity, intervertebral disc without contrast enhancement. Keywords: Tuberculous spondylitis, MRI, Bali

Development and reproductive biology of Dermaptera: a comparative study of thirteen species from eight families

Abstract We examine and describe the embryonic development of 13 species from eight families of Dermaptera, i.e., all families excluding Karschiellidae, Hemimeridae, and Arixeniidae: Diplatys flavicollis (Diplatyidae), Cranopygia sp., Echinosoma sp., and Parapsalis infernalis (Pygidicranidae), Apachyus chartaceus (Apachyidae), Anisolabis maritima and Euborellia pallipes (Anisolabididae), Labidura riparia (Labiduridae), Forficula scudderi and Anechura harmandi (Forficulidae), Paralabella curvicauda (Spongiphoridae), and Proreus simulans and chelisochid gen. sp. (Chelisochidae). We also provide new findings on the reproductive biology of the Pygidicranidae and the postembryonic development of the Apachyidae. Based on information from the present and previous studies, we reconstruct the developmental and reproductive-biological groundplan for Dermaptera and discuss phylogenetic issues related to this order. We confirmed that Dermaptera possesses the embryological features (related to mode of embryonic formation and manner of blastokinesis) that are regarded as autapomorphies of Polyneoptera. Eudermaptera is characterized by the extraordinarily great length of the embryo which attains its maximum length in anatrepsis period, the positioning of its posterior end at the egg’s anterior ventral side, the type of egg tooth, and four larval instars. Anisolabididae, Labiduridae, and Eudermaptera share an elongation ratio of embryos in the anatrepsis period (ERE) of 160% or less and a larval instar number of five or less, whereas Protodermaptera is characterized by an ERE of 210% or more, a ratio of embryonic primordium relative to the egg’s longitudinal circumference (IL) of 40% or less, and a larval instar number of six or more. Notably, the ERE, IL, and larval instar number of Apachyidae are within the ranges observed in Protodermaptera.

Anterior Lateral Approach for Anterior Decompression, Corpectomy, and Fixation with Webb Morley Procedure for Dorsolumbar Spinal Fracture

Objective: Efficacy of anterolateral approach Webb Morley procedure in a low-income country. Materials &amp; Methods: A descriptive study was conducted at the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro. Patients of any gender presented to us with dorsal or lumber injury, plus a presentation on X-ray / MRI as spinal fractures having bone fragments pressing the cord, especially from the anterior side were included in the study. The assessed tool was based on clinical findings of Frankel's grading. Results: We had 64 patients, who had dorsal and lumber fractures and went through the procedure of Webb Morley 43 were male and 31 were female patients The male-to-female ratio was 2:1 and the mean age was 39±3 yrs. with a median age was 42.5yrs. Fall (n = 34, 53.12%) was the common cause, road traffic accidents were (n = 16, 25%), fall of heavy objects (n = 11, 17.18%), and assault (n = 03, 4.68%). Conclusion: Based on the current study of our Centre the anterior lateral approach for lower dorsal and upper lumber level with decompression and fixation with Webb-Morley procedure is a safe and effective method.