Asymmetrical Appearance Research Articles

Radiolarians from Cambrian Series 2 Niujiaohe Formation in southern Jiangxi, South China

The origin and early evolution of radiolarian fossils have always provoked great interest among paleontologists. Yet, little is known about the earliest morphological and evolutionary characteristics of radiolarians largely due to the lack of documentation of early Cambrian radiolarian fossils. Herein, we conduct a thorough examination of the basinal Niujiaohe Formation in Chongyi County of southern Jiangxi and report two types of radiolarians: a large number of spherical radiolarians and a minor occurrence of ellipsoidal radiolarian fossils with bipolar rodded spines. The lengths of the spines on ellipsoid radiolarian fossils vary, and typically, the main spines are slightly offset from the polar axis, resulting in an asymmetrical appearance in some specimens. Through systematic taxonomic examination, this radiolarian fossil form is tentatively identified as Beothuka sp. of the spherical polycystine group. The genus Beothuka is commonly found in the Early Ordovician and has not yet been reported in the early Cambrian. Combined with previous reports, four species of radiolarians in three genera are identified from the Niujiaohe Formation in South China, including Paraantygopora porosa, Paraantygopora sp., spherical radiolarian, and Beothuka sp. Overall, the radiolarian fossils in the Niujiaohe Formation are characterized by low diversity and small size, in contrast to the relatively more diverse fauna found in the contemporary shallow-water Shuijingtuo Formation. Therefore, we speculate that radiolarians may have initially originated in shallow water areas and gradually expanded to deep water. This study further enriches the fossil record of the Cambrian Series 2 radiolarians. Combined with relevant data from South China, the radiolarian fauna began to exhibit diversity and complex morphology, indicating the presence of various, advanced spherical-skeletons in early radiolarians, and radiolarians from the early Cambrian appeared to display multiple evolutionary trends.

Re-establishing Facial Aesthetics - Patient-specific Orbital Implant for Post-traumatic Deformity

Abstract Rationale: Complex fractures of the maxillofacial region can require staged interventions to achieve optimal outcomes. A significant example of this are complex fractures of the orbital floor, which may be difficult to restore during primary treatment. The secondary correction is often required which can be using stock- or customised implants. Patient Concerns: A previously operated case of panfacial trauma presented with an aesthetic concern regarding the asymmetrical appearance of his eyes. Diagnosis: On clinical and radiological evaluation, the patient was diagnosed with enophthalmos of the left eye secondary to orbital floor fracture. Treatment: A patient-specific implant (PSI) was fabricated and placed for orbital floor reconstruction. Outcomes: Postoperatively, aesthetic and functional outcomes were satisfactory. Take-away Lessons: This case report highlights the use of PSIs in orbital floor reconstruction, made possible due to the advent of virtual surgical planning and three-dimensional printing in the field of oral and maxillofacial surgery.

Comparison of growth factors isolated from exosomes present in maternal blood of cleft and non-cleft infants for identification and quantification of growth factors involved in the growth and development of cartilage.

Background Cleft lip and palate (C.L.P.) is a common congenital condition which affects the orofacial region. The aetiology of C.L.P. is multifaceted and involves genetic and environmental factors that impact the shape and position of the nasal cartilage, resulting in an asymmetrical appearance of the nose. Growth factors are crucial in regulating cartilage synthesis and repair. Exosomes have emerged as a promising cell-free drug delivery system that facilitates intercellular communication and maintains tissue homeostasis. This study identifies and quantifies the growth factors present in exosomes derived from lactating maternal blood of cleft and non-cleft infants and compares them to evaluate the differences. The study aims to assess the potential of these exosomes as a therapeutic approach for C.L.P. management. Methods Blood samples were collected from lactating mothers at Sharad Pawar Dental College and isolating plasma using centrifugation. Exosome and total protein isolation will be conducted in the laboratory, and immunoblotting will evaluate growth factors. Quantitative and comparative protein and growth factor analysis will be conducted separately for maternal blood samples. Results The growth factors responsible for cartilage growth and development will be present in maternal exosomes, potentially leading to novel therapies for C.L.P. management. The study aims to demonstrate the therapeutic potential of exosomes, as carriers of intra-cellular factors, in transporting growth factors to the required site for managing C.L.P. Conclusions Overall, by understanding the roles played by growth factors, intercellular communication, and genetic and environmental factors in the aetiology of C.L.P., this research can contribute to creating effective treatment strategies for C.L.P. management. Finding growth factors in exosomes made from the blood of nursing mothers could be a cutting-edge therapeutic strategy for treating C.L.P.

Radiographic imagery of aggressive plexiform-type ameloblastoma in the mandible: a case report

Objectives: This case report aims to describe the radiographic characteristics of plexiform ameloblastoma and its impact on surrounding tissues in a middle-aged female patient using panoramic radiography and CBCT, along with case management. Case Report: A 43-year-old female patient presented to the Dental Radiology Unit of RSGMP UNHAS with a panoramic referral letter, diagnosed clinically with anterior mandibular ameloblastoma. Extraoral examination revealed an asymmetrical facial appearance with anterior mandibular enlargement. Intraoral examination showed mucus membrane enlargement in the anterior mandible region (teeth 37-45), soft consistency, absence of crepitus, no palpation tenderness, and mobility in several anterior mandibular teeth. The first panoramic radiograph (March 16, 2022) exhibited a unilocular radiolucent lesion, well-defined, with scalloped margins in the anteroposterior mandibular region. The second panoramic examination (May 23, 2022) indicated a more aggressive lesion expansion, with evidence of root resorption and destruction of the inferior mandibular cortex approaching the mandibular angle. CBCT findings demonstrated a hypodense/radiolucent lesion extending anteroposteriorly, superiorly, and inferiorly, leading to displacement, root resorption, and destruction of the inferior mandibular cortex in the inferior direction. Conclusion: Based on the characteristics and structure of the lesion observed through various radiographic examinations, a unilocular ameloblastoma was suspected. Histopathological examination confirmed the plexiform-type ameloblastoma.

Comparison of growth factors isolated from exosomes present in maternal blood of cleft and non-cleft infants for identification and quantification of growth factors involved in the growth and development of cartilage.

Background: Cleft lip and palate (C.L.P.) is a common congenital condition which affects the orofacial region. The aetiology of C.L.P. is multifaceted and involves genetic and environmental factors that impact the shape and position of the nasal cartilage, resulting in an asymmetrical appearance of the nose. Growth factors are crucial in regulating cartilage synthesis and repair. Exosomes have emerged as a promising cell-free drug delivery system that facilitates intercellular communication and maintains tissue homeostasis. This study identifies and quantifies the growth factors present in exosomes derived from lactating maternal blood of cleft and non-cleft infants and compares them to evaluate the differences. The study aims to assess the potential of these exosomes as a therapeutic approach for C.L.P. management. Methods: Blood samples were collected from lactating mothers at Sharad Pawar Dental College and isolating plasma using centrifugation. Exosome and total protein isolation will be conducted in the laboratory, and immunoblotting will evaluate growth factors. Quantitative and comparative protein and growth factor analysis will be conducted separately for maternal blood samples. Results: The growth factors responsible for cartilage growth and development will be present in maternal exosomes, potentially leading to novel therapies for C.L.P. management. The study aims to demonstrate the therapeutic potential of exosomes, as carriers of intra-cellular factors, in transporting growth factors to the required site for managing C.L.P. Conclusions: Overall, by understanding the roles played by growth factors, intercellular communication, and genetic and environmental factors in the aetiology of C.L.P., this research can contribute to creating effective treatment strategies for C.L.P. management. Finding growth factors in exosomes made from the blood of nursing mothers could be a cutting-edge therapeutic strategy for treating C.L.P.

Investigation of pollen morphology of the genera Grammosciadium, Vinogradovia and Caropodium (Apiaceae)

In this study, detailed light microscopy (LM) and scanning-electron microscopy (SEM) analyses of pollen grains belonging to 11 taxa of genera Grammosciadium, Vinogradovia and Caropodium were performed. The pollen is radially symmetrical and generally isopolar with the exception of Grammosciadium macrodan ssp. nezaketiae where 65% of the grains have asymmetrical appearance. All the taxa are tricolporate. Ectoapertures are discontinuous (colpus length: 14.7 ± 0.8 and colpus width: 21.20 ± 2.28) with narrow and acute at the ends extending to the subpolar region. Endoapertures are in the mid-section of the ectoapertures, which is lolangate, prolate-spheroidal in Grammosciadium scabridum, while lalongate, ellipsoidal, oblate or suboblate in the other taxa. Pollen shape is triangular and semi-triangular in polar-view. Pollen outline in equatorial view is subrectangular-straight in G. scabridum and Caropodium platycarpum, however, those were subrectangular and slightly constricted in equatorial region in all others. Based on the P/E ratio, it is prolate in G. macrodon ssp. macrodon while it is perprolate in the other taxa. Ornamentation variation (i.e. psilate, psilate-perforate, psilate-rugulate, rugulate and rugulate-perforate) was observed around the apertural, equatorial and polar regions. This character has been found as taxonomically important for the studied taxa.

Effect of Fasting and Postprandial Blood Samples in Results of Thyroid Function Tests Among Euthyroid People and Patients with Thyroid Problems: A Systematic Review and Meta-Analysis

Abstract Introduction/Objective Thyroid disorders are considered to have a significant global health impact, affecting around 200 million people, and about 5% of all populations are diagnosed with hypothyroidism. Thyroid problems are mainly diagnosed by the laboratory’s thyroid function tests (TSH, FT4, and FT3), and currently, there is no special guideline for a preferred sample to test the thyroid functions. Aim To investigate whether using a fasting serum sample or postprandial serum sample could affect the results of the thyroid function tests in both euthyroid people and patients with thyroid problems. Methods/Case Report • A systematic search was done on PubMed, EMBASE, Google Scholar, Semantic Scholar, and manual searches with cross-referencing. • PECOS framework was used for developing the research question. • PRISMA guidelines used for the methodology. • Two meta-analyses for TSH and FT4 were done based on the participant’s thyroid status, and one meta-analysis done for the FT3 for all. • Statistical analyses were done using Revman5 software. Results (if a Case Study enter NA) • Ten full-text studies and three abstracts were included for the systematic review, and for meta-analysis, nine full-text studies and two abstracts. • Based on the Cochrane rule of thumbs of the effect size interpretations, the meta-analyses result showed a statistically significant moderate effect for TSH mean differences; Mean of fasting blood sample > mean of the postprandial sample. • TSH effect for euthyroid people based on results of 9 studies from 641 participants (MD, 0.58; Fixed, 95% CI: [0.44 to 0.73], p. <.00001). • TSH results for all based on results of 11 studies from 921 participants (SMD, 0.46; Random, 95% CI: [0.31 to 0.61], p. <.00001). • No statistically significant effect for FT4 and FT3 mean differences results. • Publication bias is suggested for TSH and FT3 results due to the asymmetrical appearance, but not for FT4. Conclusion • In conclusion, the use of fasting blood samples would have a significantly higher TSH result value compared to the postprandial blood samples. Hence, it may help introduce a new guideline to standardize the blood sampling status for the TSH test screening and diagnosis. Alternatively, different reference ranges depending on the sampling status might be suggested, which might help promote the patients’ quality of life and reduce healthcare costs.

Application of iodine staining technique for tumor identification in Micro-CT of mouse model with skull base-infratemporal fossa tumor

Objective To establish an animal model with malignant tumor in the skull base-infratemporal region, and to explore the role of iodine staining technique in identifying tumor tissues with Micro-CT data. Methods Sedation anesthesia was carried out on 12 BABL/c nude mice using inhaled isoflurane, and then WSU-HN6 cells that cultured and immortalized from human tongue squamous cell carcinoma were injected into the right infratemporal fossa via the submandibular area. The procedure was carried out under ultrasonographic guidance. The nude mice were sacrificed after 3 weeks observation. The head specimens were fixed and scanned by Micro-CT, and repeated scans were performed after staining with 3.75% compound iodine solution. Following decalcification in 20% EDTA for 2-4 weeks, the head specimens were embedded and sectioned. Hematoxylin and eosin staining and Pan-Keratin immunohistochemical staining were carried out. Bright-field microscopy and stereomicroscopy were used to visualize. The Micro-CT data were analyzed using iPlan software (Brainlab). Results Non-traumatic ultrasonography was used to guide HN-6 cells injection and confirm skull-base tumor formation in all the animals. Ultrasonographic guidance reduced the risk of cervical vessel injury when transferring tumor cells into the skull base space. An obvious asymmetrical appearance was detected via ultrasonography 3 weeks after tumor cell injection. The Micro-CT analysis showed that the bone was obviously damaged on the right side of the skull base, but the soft tissue image was unrecognizable. After four days staining with compound iodine solution, the morphology of the tumor and surrounding soft tissue could be clearly identified. Hematoxylin and eosin staining showed the tumor formation of the right infratemporal fossa region accompanied by bone destruction. Human keratin immunohistochemical staining showed that the tumor tissue originated from human squamous cell carcinoma, and the polynuclear osteoclasts could be seen at the margin of the skull base bone resorption. Conclusion The animal model with malignant tumor in the skull base-infratemporal region could be successfully established via submandibular injection under ultrasound-guidance. Bone changes of the skull were easily observed on Micro-CT, but the tumor counter was not able to be distinguished from surrounding soft tissue. The 3.75% compound iodine staining of the head specimen could help discern the tumor and surrounding soft tissue in more details.

Experience of applying cosmetic Etafilcon A contact lens in cases with microcornea.

Microcornea is a rare condition that frequently resulets in serious cosmetic concerns due to the resultant asymmetrical appearance of the eye, and its cosmetic rehabilitation is possible with the use of colored contact lenses. This paper aims to present our experiences with the use of cosmetic Etafilcon A contact lenses for microcornea. Eight patients with unilateral microcornea without any systemic involvement were included in this study, and they underwent routine ophthalmological examination, corneal topography, and optical biometry. We applied the cosmetic Etafilcon A contact lens (1-DAY ACUVUE® DEFINE® with Lacreon®) of the same edge color to the patients. The levels of satisfaction in terms of cosmesis and comfort were evaluated with the use of visual analog scales (VAS). In the patients, the corneal diameter asymmetry was acceptably adjusted, and each of the patients reported extreme satisfaction. The mean VAS score was 8.9 ± 1.0 (range: 7-10) for the cosmetic satisfaction rate and 8.4 ± 1.0 (range: 7-10) for the comfort rate. The patients obtained the best-corrected visual acuity without or with additional eye-glasses. None of the patients complained about vision issues under photopic and scotopic conditions. 1-DAY ACUVUE® DEFINE® with Lacreon® lens has promising satisfactory cosmetic outcomes along with visual enhancement in cases of microcornea. This is the first study to report the use of this lens for the cosmetic rehabilitation of patients with microcornea.

Evaluation of pronasale, nasolabial and paranasal asymmetries in patients with unilateral cleft lip and palate using three-dimensional imaging

Objective: Facial symmetry is an important component of a successful treatment of patients with cleft lip and palate. The aim of this retrospective study was to examine the pronasale, nasolabial, and paranasal region asymmetries in patients with nonsyndromic unilateral cleft lip and palate (UCLP) using three-dimensional (3D) facial imaging.Materials and Method: The study group consisted of 29 patients with complete UCLP aged 8–29 years. 3D stereophotogrammetric soft tissue recordings of all patients were analyzed. Measurements were performed on the cleft and noncleft side and compared with each other by the paired t-test.Results: Statistically significant differences were observed between the cleft and noncleft sides. Alar contour-Pronasale distance was longer on the cleft side than on the noncleft side, with the difference between them being statistically significant (p<0.05). The Subnasale-Pronasale / Alar contour-Pronasale ratio was also significantly lower on the cleft side than on the noncleft side (p<0.05).Conclusion: Patients with UCLP did not present significant asymmetries regarding Cheek and Buccal contours and Chelion-Subnasale and Christa Philtry-Subnasale heights. Asymmetrical appearance was prominent on alar base and pronasale regions.

Craneoplastía con implante de polimetilmetacrilato (PMMA) para corregir secuela de trauma. Reporte de caso

Introducción: los defectos del cráneo y las anomalías del hueso craneofacial que requieren reconstrucción son comunes en una variedad de procedimientos neuroquirúrgicos. Después de una craniectomía o de fracturas craneofaciales posteriores a traumatismos cráneoencefálicos, los pacientes pueden desarrollar defectos cosméticos importantes. Algunos de estos son la depresión de la piel y un defecto de hundimiento que lleva a una apariencia asimétrica de la cabeza, sin dejar de lado las repercusiones físicas, neurológicas y psicológicas que estas lesiones conllevan. La reconstrucción craneofacial y la craneoplastía tienen una larga historia, pero las nuevas técnicas quirúrgicas y una multitud de opciones de materiales han impulsado recientemente el avance en esta área. Los implantes de polimetilmetacrilato (PMMA) han demostrado ser estables, biocompatibles, no conductores, radiotransparentes y de bajo costo. Es así que se pueden colocar y modificar fácilmente, con lo que se elimina la morbilidad del sitio donante. Presentación del caso: en este artículo presentamos un caso de craneoplastía de defecto frontal, posterior a traumatismo, cuya reconstrucción fue realizada mediante una prótesis de polimetilmetacrilato (PMMA) en el Hospital General Xoco de la Cuidad de México. Conclusión: se reporta la reducción del tiempo quirúrgico, además de un costo de la prótesis accesible para el paciente; de esta manera, se obtuvieron resultados satisfactorios y mejoras en el contorno estético facial, en tanto se permitió cobertura y protección para el tejido encefálico.La reconstrucción craneofacial y la craneoplastía tienen una larga historia, pero las nuevas técnicas quirúrgicas y una multitud de opciones de materiales han impulsado recientemente el avance en esta área.1 Los implantes de polimetilmetacrilato (PMMA) han demostrado ser estables, biocompatibles, no conductores, radiotransparentes y de bajo costo.6 Se pueden colocar y modificar fácilmente y se elimina la morbilidad del sitio donante. En este artículo presentamos un caso de craneoplastía de defecto frontal posterior a traumatismo realizada mediante una prótesis de polimetilmetacrilato (PMMA) en el Hospital General Xoco de la Cuidad de México, con la cual se logró reducir el tiempo quirúrgico, además el costo de la prótesis fue accesible para el paciente y se obtuvieron resultados satisfactorios.

Influence of texture distribution in magnesium welds on their non-uniform mechanical behavior: A CPFEM study

Recent studies indicate that the texture distribution in friction stir welded (FSW) Mg alloys can be tailored and hence improve the joint performance. In this work, a crystal plasticity finite element modeling (CPFEM) was performed to understand the effects of texture distribution in stir zone (SZ) on the non-uniform plastic deformation and fracture localization. In total, six kinds of observed or purposely tilted texture distributions were modelled. The “concave-convex” appearance, as commonly observed in the tensile sample, was successfully simulated. It reveals that the mirror-symmetrical distribution of basal planes in the region of easy to activate basal slip (EABS) determined the “concave-convex” appearance in SZ-center. The asymmetrical appearance exchanged on plane A and plane B when the directions of basal planes were switched in the two EABS regions. Furthermore, the asymmetrical feature of plastic deformation was changed with varying the texture distribution in SZ. The “embossed” feature became more obvious in SZ-center first, and then gradually weakened with the c-axis rotated away from the weld plate plane. Severe necking was successfully simulated in SZ-center of FSW-H joint and in SZ-side of FSW-L joint. That might determine the observed fracture morphology. We believe that this simulation study is helpful for further improving the performance of FSW Mg joints.

Controlling the Revolving and Rotating Motion Direction of Asymmetric Hexameric Nanomotor by Arginine Finger and Channel Chirality.

Nanomotors in nanotechnology are as important as engines in daily life. Many ATPases are nanoscale biomotors classified into three categories based on the motion mechanisms in transporting substrates: linear, rotating, and the recently discovered revolving motion. Most biomotors adopt a multisubunit ring-shaped structure that hydrolyzes ATP to generate force. How these biomotors control the motion direction and regulate the sequential action of their multiple subunits is intriguing. Many ATPases are hexameric with each monomer containing a conserved arginine finger. This review focuses on recent findings on how the arginine finger controls motion direction and coordinates adjacent subunit interactions in both revolving and rotating biomotors. Mechanisms of intersubunit interactions and sequential movements of individual subunits are evidenced by the asymmetrical appearance of one dimer and four monomers in high-resolution structural complexes. The arginine finger is situated at the interface of two subunits and extends into the ATP binding pocket of the downstream subunit. An arginine finger mutation results in deficiency in ATP binding/hydrolysis, substrate binding, and transport, highlighting the importance of the arginine finger in regulating energy transduction and motor function. Additionally, the roles of channel chirality and channel size are discussed as related to controlling one-way trafficking and differentiating the revolving and rotating mechanisms. Finally, the review concludes by discussing the conformational changes and entropy conversion triggered by ATP binding/hydrolysis, offering a view different from the traditional concept of ATP-mediated mechanochemical energy coupling. The elucidation of the motion mechanism and direction control in ATPases could facilitate nanomotor fabrication in nanotechnology.

Смещение дифракционной картины при движении среды

Diffraction of waves of different physical nature is one of the most important and studied phenomena of nature in connection with its versatile use in devices and measuring techniques. The influence of media motion on the diffraction pattern attracted the attention of researchers in connection with the development of the theory of electrodynamics of moving media and continues to attract attention in connection with a number of unsolved problems of physics. In this paper we consider a model of the diffraction of waves on the slit and lattice, located on a movable substrate (medium). Analytical relations for the calculation of the diffraction pattern intensity distribution are obtained. The significant influence of the medium motion on the diffraction pattern is established. The position of the zero-order maximum does not depend on the motion of the medium, on the one hand, the distance between the diffraction maxima decreases, on the other hand increases, until they disappear. The conditions under which the motion of the medium leads to an asymmetrical appearance of the diffraction intensity distribution, which is not observed in a stationary medium, are established. Generalized conditions of diffraction minima are obtained taking into account the motion of the medium. Shows the effect of the direction of the velocity of motion of the medium on the intensity of the diffraction pattern.

A Revision Mandibuloplasty: Causes, Indications, Surgical Methods and Treatment Outcomes.

This paper aims to propose a classification system to categorize patients undergoing revision mandibuloplasty according to their dissatisfaction types. This paper also introduces various appropriate revision techniques and evaluates their outcomes. Through this classification system and suggested surgical techniques, surgeons can settle the disappointments experienced by patients after their primary mandibuloplasty, by realizing more natural-looking results. The study subjects consisted of 184 patients who underwent a revision mandibuloplasty from October 2010 to March 2016, conducted by a single surgeon at a single institution. The authors were able to classify the dissatisfaction into two primary types-(1) lack of an overall slender frontal facial contour and (2) unnatural and asymmetrical overall facial appearance due to over- or inaccurate resection of the bone. A self-evaluation of patient's subjective satisfaction based on the scale from 1 to 5, both after the primary operation and after revision surgery, was compared. Dissatisfaction type I accounted for 145 patients (78.8 percent). The number of patients classified into dissatisfaction type II was 39 (21.2 percent). Of the patients categorized into type I, those undergoing revision surgeries due to an under-corrected mandibular tubercle and parasymphysis showed the most remarkable improvement in self-satisfaction score after reoperation-from 2.3 to 4.0. To realize a natural-looking outcome in facial look through mandibular contouring, it is important not only to carefully consider the ratio and shape essential for an optimal slender facial contour, but also to minimize unnecessary resection of the bone. 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 .

Dynamic flexion/extension and non-weight bearing ultrasonography is helpful for identifying manica flexoria tears in horses.

Lesions of the manica flexoria are a tenoscopic finding in horses with digital flexor tendon sheath tenosynovitis. This retrospective case series study describes the ultrasonographic findings in seven horses admitted for digital flexor tendon sheath swelling associated with lameness and tenoscopic confirmation of a manica flexoria tear. Six horses had a partial manica flexoria tear, one a complete rupture. The ultrasonographic examination included a static examination on the weight and non-weight bearing limb and a dynamic limb assessment during flexion and extension. The main ultrasonographic finding at the static weight bearing examination in horses with a partial tear was an asymmetrical appearance of the manica flexoria at the level of the junction with the lateral border of the superficial digital flexor tendon, or an incomplete visualization of the manica flexoria in case of complete rupture. The split edges of the completed ruptured manica flexoria were seen floating in the synovial fluid at the examination in flexion. In six of seven cases, the superficial digital flexor tendon slid abnormally relative to the deep digital flexor tendon, during flexion/extension movements, with medial displacement of the superficial digital flexor tendon, appearance of an anechoic gap between the flexor tendons or reduced superficial digital flexor tendon sliding. Because ultrasonographic diagnosis of the manica flexoria tear is considered challenging, detection of these ultrasonographic features is helpful to increase the likelihood of identifying manica flexoria tears prior to tenoscopy. Authors recommend static ultrasonographic examination of the manica flexoria using a flexed limb position and dynamic ultrasonographic examination using flexion and extension positioning for horses with suspected digital sheath injury.

Diagnosis and Management of Acral Lentiginous Melanoma.

Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.

Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

Author(s): Diez, Adrian; Bryczkowski, Christopher | Abstract: ABSTRACT: History of present illness: A 73-year-old female with a past medical history of tracheobronchomalacia, obstructive sleep apnea, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) presented to the emergency department with four days of moderate to severe dyspnea on exertion. She endorsed right calf pain for the last few weeks and bilateral leg swelling, as well as productive cough, orthopnea, and non-radiating chest tightness but denied any hemoptysis. She had no history of thromboembolic disease, nor did she have any family history of clotting disorders. She was not currently on any anticoagulation. The patient lives a sedentary lifestyle at baseline. Upon arrival, her vital signs were as follows: temperature 97.3 F, pulse 60 per min, respirations 34 per min, blood pressure 113/85 mmHg, and oxygen saturation 97% on 4L nasal cannula. Physical exam was notable for jugular venous distension and bilateral lower extremity pitting edema. Lungs were clear to auscultation.Significant findings: Bedside echocardiography four chamber view revealed enlarged right ventricular (RV) to left ventricular (LV) ratio (greater than 1) on apical four-chamber view (see red and blue outlines respectively). The right atrium is not clearly delineated in this image and therefore is not outlined. One can also rule out a large pericardial effusion as the cause of her dyspnea, since there is no large hypoechoic collection surrounding the heart on either four- chamber view or parasternal long view. Discussion: Point of care ultrasound is a powerful tool that can aid in the diagnosis of undifferentiated dyspnea. Right ventricular size is one parameter that can signify right heart strain possibly due to an increase in resistance in the pulmonary vasculature. The normal RV should be approximately two-thirds the size of the left ventricle. Any RV between two-thirds and equal to the size of the LV is considered moderately dilated, and any RV greater in size than the LV is considered severely dilated.1,2 The RV to LV size ratio is best measured from the apical four-chamber view. Right ventricular shape will also change as afterload increases in the pulmonary circuit. As pulmonary vascular resistance increases, the RV (which has significantly less myocardium and thus greater compliance as compared to the LV) begins to lose its typical triangular shape and takes on a more rounded appearance.3 Likewise, the intraventricular septum becomes flattened during early diastole due to higher RV:LV pressures causing the LV to take on a “D” shaped appearance. These findings, collectively referred to as signs of “right heart strain,” typically improve with resolution of the clot burden.4 Unfortunately, while right ventricular dilatation and consequently an asymmetrical LV appearance are commonly encountered findings, they do not help distinguish acute from chronic right heart strain. Evaluation for McConnell’s sign, or right ventricular mid-free wall akinesia with RV apical sparing is important because it is considered to be the most specific finding (94%) for acute right heart strain.5 The decision to anti-coagulate empirically with heparin was delayed until the diagnosis could be confirmed with a CT angiogram of the chest. This patient had other underlying reasons for having a dilated RV (mainly her history of COPD, which can chronically increase afterload in the pulmonary circuit and require higher RV filling pressures to maintain cardiac output).6 As such, patients with COPD can develop cor pulmonale and exhibit right heart strain.7-9 Furthermore, this patient also had no clinical signs of deep venous thrombosis. In a patient with no underlying disease that might cause a chronic RV dilation and no electrocardiographic evidence of RV ischemia or infarction (usually in association with an inferior myocardial infarction),10 a dilated RV on bedside echocardiogram in the acutely dyspneic patient should make one immediately suspicious for acute pulmonary embolism and may even prompt the clinician to begin empiric anticoagulation.The patient’s lab work was significant for an elevated Troponin T of 0.03 ng/mL (normal ≤ 0.02 ng/mL), suggestive of right heart strain. The diagnosis of pulmonary embolism was confirmed on CT angiogram of the chest, which revealed large filling defects in the right and left pulmonary arteries extending into their respective segmental branches. Upon confirmation of the diagnosis, the patient was taken for emergent endovascular catheter-directed tissue plasminogen activator (tPA) and was subsequently admitted to the medical intensive care unit. She had an inferior vena cava (IVC) filter placed after five days and was discharged from the hospital seven days after admission. Topics: Pulmonary embolism, right heart strain, echocardiography, US, POCUS.

Digitalized analysis of philtral anatomy for planning individual treatment

Restoration of the philtral region following traumatic, cleft, and tumor surgeries is often difficult due to influence of this feature to whole facial beauty. The aim of this study is to investigate the types and measurements of the philtrum and its relationship with the upper lip using a software. Standard personal photographs of the philtral region were obtained from 200 young adults participated in this study. Linear analyses (the lengths of philtral column and dimple; the philtral width) and angular analyses (apex and central angles of Cupid's bow) were measured as reference points. As for the shape of the philtral column, it was categorized as four distinct types: parallel, triangular, concave, and unclear type. The philtral width was 11.37 ± 1.9mm in males, 10.21 ± 1.80mm in females. The length of the philtral dimple was 18.16 ± 3.6mm in males, 18.16 ± 3.6mm in females. Compared with women, both of the measured average philtral reference lengths displayed a significantly greater value in men. In the meanwhile, compared to women, the angular measurements of Cupid's bow (i.e., the apex and central angle of Cupid's bow) were smaller in men. It was 127.47 ± 12.74°mm in males, 134.1 ± 11.38°mm in females. The triangular and concave types were associated with a substantial fraction in men, whereas the triangular and parallel types were predominant in women. There were significant gender differences in the esthetic rankings of philtral column shapes. These results suggest digitalized reference values relative to the philtral column which may increase the success of the individual reconstructive treatment of the surgical procedures and reduce possible asymmetrical appearance. With the help of certain software, this research has made possible to investigate the ideal parameters of philtral construction in defining the best surgical solution for the patient.

İNTRAORAL TEDAVİLERİ TAMAMLAYICI PERİORAL BÖLGEDEKİ ESTETİK ÇALIŞMALAR

Patients’ esthetic expectations have increased with the improvements at dentistry field. Dentists are responsible of microesthetics by the applications which are held intraorally. However, patients demand the facial applications which are called macroesthetics. For removing the wrinkles, dermal fillers have been developed as an alternative to the surgery methods. With the treatment of soft tissue augmentation dermal fillers can eradicate the wrinkles, thin lips, asymmetrical facial appearance and buccal depressions. The wrinkles are localized mostly at the 1/3 inferior facial region at face that cause most of the problems to the dentists. For the treatment of these problems, dentists should be educated andthey should do their duty. In this article, the esthtetic applications at perioral region that fulfill intraoral treatments alternatively are reviewed and discussed the mission and responsibility of dentists