Contralateral Side Research Articles

Full Anterior Scoring Otoplasty.

Lop ear deformity is the most common head and neck congenital malformation with an estimated incidence of 5% among newborns. Otoplasty is the surgical procedure designed for its correction. More than 200 surgical techniques have been described so far to treat this condition, most of them including a cartilage weakening maneuver to avoid the relapse of the original auricle shape a few months after surgery. Classic techniques, such as like Mustarde's, describe this maneuver through scoring the posterior side of the cartilage and stabilizing the new shape with sutures. Cartilage biomechanical properties work against posterior scoring since cartilage folding occurs in the contralateral side of the scoring. This critical point may explain the high rates of relapse in the posterior scoring otoplasty techniques. In this paper, we present our surgical otoplasty technique with anterior scoring and we discuss specific tips and its nuances. We believe that the anterior scoring otoplasty technique achieves natural ears with both low complication rates and significant reduced long-term relapses.

The Effect of Arterial Elongation on Isolated Common Iliac Artery Pathologies.

to investigate the effects of vessel geometry on steno-occlusive and dilatative common iliac artery (CIA) pathologies. this single-center, retrospective study included 100 participants, namely 60 participants with a unilateral, isolated CIA pathology who were divided into three pathology-based groups (a stenosis group, n = 20, an occlusion group, n = 20, and an aneurysm group, n = 20) and 40 participants without a CIA pathology (control group). All participants underwent abdominal and pelvic computed tomography angiography. The aortoiliac region of the participants was reconstructed into three-dimensional models. Elongation parameters (tortuosity index (TI) and absolute average curvature (AAC)) and bifurcation parameters (iliac take-off angle, iliac planarity angle, and bifurcation angle) were determined using an in-house-written piece of software. Demographic data, anthropometric data, cardiovascular risk factor data, and medical history data were obtained from participants' electronic health records. The following statistical methods were used: one-way ANOVA, chi-square test, t-tests, Wilcoxon test, Kruskal-Wallis test, and multivariate linear regression. in the occlusion group, both TI and AAC values were significantly higher on the contralateral side than on the ipsilateral side (both p < 0.001), whereas in the aneurysm group the AAC values were significantly higher on the ipsilateral side than on the contralateral side (p = 0.001). The ipsilateral and contralateral TI and AAC values of the iliac arteries were significantly higher in the aneurysm group than in the other three groups (all p < 0.001). Age significantly affected all of the elongation parameters except for the TI of the infrarenal aorta (all p < 0.010 except the TI of the infrarenal aorta). In addition, the AAC values for the iliac arteries were significantly associated with obesity (ipsilateral iliac artery, p = 0.045; contralateral iliac artery, p = 0.047). Aortic bifurcation parameters did not differ significantly either within each group (ipsilateral versus contralateral side) or between the individual groups. occlusions tend to develop in relatively straight iliac arteries, whereas unilateral, isolated CIA aneurysms are more likely to occur in elongated aortoiliac systems.

Total Knee Arthroplasty in Patients With Ankle Osteoarthritis Affects Contralateral Ankle Alignment and Postoperative Outcome of Total Knee Arthroplasty.

This study investigated the impact of total knee arthroplasty (TKA) on the alignment of the ankle joint, focusing on changes in coronal alignment of both ankles. This retrospective study, conducted at our hospital, included 64 patients older than 70 years who underwent TKA for varus knee osteoarthritis (OA). Using full-length standing radiographs of both lower extremities taken preoperatively and 6 months postoperatively, we assessed ankle OA grading based on the Takakura-Tanaka classification and measured mechanical hip-knee-ankle (mHKA) and the tibiotalar angle (TTA) on both the surgical and contralateral side. Additionally, we examined the impact of ankle OA on postoperative clinical scores, the Knee injury and Osteoarthritis Outcome Score, following TKA. Based on the classification, ankle OA stage 2 or higher was present in 13 cases on the surgical side and 13 cases on the contralateral side. On the surgical side, mHKA changed from 12.2 to 1.8 degrees varus (P < .001) and TTA from 1.7 to 1.0 degrees varus (P = .002). On the contralateral side, mHKA changed from 4.0 to 5.4 degrees varus (P = .04), and TTA from 2.7 to 3.0 degrees varus (P < .001). In ankle OA stage 2 or higher patients, contralateral TTA changed from 5.2 to 6.5 degrees varus (P < .001) and unchanged in stage 1 patients. Ankle OA stage 2 or higher patients had worse ADL outcomes than stage 1 patients (score: 67.2 and 78.3, respectively, P = .03). This study suggests an apparent interrelationship between knee and ankle OA and the potential negative influence of TKA on ankle OA.

Analysis of the Surgical Efficacy and Risk Factors of a One-stage Unilateral Approach for Clipping Bilateral MCA Mirror Aneurysms.

Numerous microsurgical approaches are available for treating middle cerebral artery (MCA) mirror aneurysms. However, a definitive conclusion regarding which approach yields the best outcome has yet to be reached. Thirty-three patients with MCA aneurysms were categorized into 2 groups: one-stage unilateral approach and other surgical approaches. Prognostic differences were compared using the Modified Rankin Scale (mRS). In addition, the length of hospital stay and costs were also compared. Among the patients with a proposed preoperative one-stage unilateral approach, they were divided into success and failure groups, and these factors were collected, including Hunt-Hess grade, contralateral aneurysm orientation and maximum diameter, contralateral A1+M1 length, and contralateral ICA bifurcation angle. These parameters were analyzed using multivariate logistic regressions to identify the risk factors. The prognosis of patients in the one-stage unilateral approach group did not differ significantly from that of other surgical approaches. However, patients in the one-stage unilateral approach group experienced shorter hospital stays and incurred lower hospital expenses. In the multivariate regressions, the length of the contralateral A1+M1 was identified as an independent risk factor. The one-stage unilateral pterional approach for clipping bilateral aneurysms is an effective method of treating MCA mirror aneurysms. However, in cases where patients have an excessive length of A1+M1 on the contralateral side, this approach may result in surgical failure.

The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction.

Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA. Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8cm, 61.8 ± 13.2kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee. The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion. MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation.

Congruent Weber-B ankle fractures do not alter tibiotalar contact mechanics.

Current treatment strategy for managing Weber B ankle fractures is mainly governed by mortise congruency, malleolar alignment, deltoid ligament competence and fracture stability. While nonoperative treatment has yielded good functional outcomes in satisfactorily aligned stable injuries, a biomechanical rationale is not firmly established. Furthermore, current radiographic analysis is obscured by observer inaccuracy and beam rotation. This study aimed to utilize weightbearing CT and computational biomechanics to analyse 3D mortise displacement and contact mechanics in Weber-B ankle fractures and compare them with the uninjured contralateral side. 32 patients were included who sustained a Weber-B ankle fracture and underwent bilateral weightbearing CT imaging at injury. Segmentation into 3D models of bone was performed semi-automatically, and individualized cartilage layers were modeled based on a previously validated methodology. The 3D mortise congruency was evaluated by use of following parameters: alpha angle, fibular length, talocrural angle, medial gutter- and tibiofibular clear space- distance mapping. Contact mechanics were evaluated by the mean and maximum contact stress of the tibiotalar articulation. Statistical analysis revealed that there were no significant differences for all anatomical parameters. There was also no significant difference between the mean contact stress of the injured (2.10 ± 0.42 MPa) and uninjured side (2.10 ± 0.41 MPa), nor the maximum contact stress of the injured (7.67 ± 1.55 MPa) and uninjured (7.47 ± 1.67), respectively. Contact mechanics were unaffected in congruent Weber-B fractures. These findings support consideration of nonoperative management in such cases, given their presumably low risk for posttraumatic arthritic development in the long term. Level of Evidence: Level III; retrospective case-control study.

Evaluation of the Rostral Inferior Alveolar Nerve Block via the Mental Foramen in Equids: In Vivo Efficacy Testing.

The use of proper sedative and regional anesthetic protocols is essential when performing equine dental surgical procedures under standing sedation. The efficacy of the rostral inferior alveolar nerve block via the mental foramen has not been previously studied. Aims of this study included determining the efficacy of the block, investigating whether any region (labial mucosa, alveolar mucosa, or teeth) was more reliably anesthetized, and if differences in efficacy existed between bilateral and unilateral blocks. In this blinded trial, 10 horses each were randomly assigned to receive a left unilateral block, right unilateral block or bilateral blocks and 5 horses were bilateral controls. For unilateral groups, the contralateral side of the horse acted as its own unilateral control. Mechanical nociceptive stimulus methods were used to determine response to stimulus at time points pre-sedation, post-sedation, and post-injection at 10, 30, 60, and 90 min. Results were evaluated in 4 groups: unilateral blocks, unilateral controls, bilateral blocks and bilateral controls. Overall, all groups were significantly less likely to respond to stimulus at time points post-sedation, T10, and T30, whereas only blocked sites were less likely to respond at T60 and T90 compared to pre-sedation. There was no significant difference in response to stimuli of blocked sites between the 3 regions at all time points. Overall, at T60 and T90, blocks produced regional anesthesia in 73% and 55% of sites, respectively. This study demonstrated the equine mental foramen regional nerve block has varied efficacy, producing partial or incomplete regional anesthesia in some cases.

Bilateral dimorphism of the auricles in adolescent males in the Lugansk People's Republic

Aim. To identify somatotypological features of linear parameters and bilateral dimorphism of the auricles in adolescent males.Materials and methods. In total, 140 adolescent males (19.05 ± 0.71 years) in the Lugansk People's Republic were examined. Following somatotyping and cephalotyping, the left and right auricles were photographed. Digital photographs were uploaded to the ImageJ software, which was used to determine 20 sizes of the auricle. An ANOVA analysis of the obtained results was carried out. The index of bilateral dimorphism of each auriculometry parameter was determined. Results. All studied parameters of the left auricle, except for its width, exceeded those of the auricle of the contralateral side. Conclusion. The highest values of the bilateral dimorphism index were observed when studying the height of the tragus and antitragus in males, regardless of their cephalotype.

Trapeziometacarpal Joint Arthroplasty: Medium-Term Clinical Outcomes and Survival.

Trapeziometacarpal joint (TMC) arthroplasty (TMA) is a treatment option for failed symptomatic treatment of basal thumb arthritis. This study aimed to evaluate clinical and radiological outcomes and complications of Maïa™ prosthesis (Groupe Lépine, Genay, France) since its introduction in our institution with a minimum of three years follow-up. We performed a retrospective study of patients with TMA treated with Maïa prosthesis. Between 2015 and 2017, 22 patients (21 female and one male patient) were submitted to TMA with Maïa prosthesis, with a mean age of 60.1±6.6(95%CI 57.1, 63.0) years old. According to the Eaton-Littler classification, four patients had rhizarthrosis grade II, and 18 had grade III. The average follow-up was 56.4±6.0 months (95%CI 53.8, 59.1). Mean TMC radial abduction was 53.0±15.9º (95%CI 43.1, 62.3), corresponding to 89%(95%CI 78, 100) of the contralateral side. The mean Kapandji score was 9.5±0.7 (95%CI 9.1, 9.8), corresponding to 98% (95%CI 94,100) of the opposite side. The mean key pinch was 4.7±1.4 kg (95%CI 3.9,5.4), and the mean grip strength was 8 kg (95%CI 4, 12) against 10 kg (95%CI 6, 14), which corresponded to 79%(95%CI 70, 88), and 81%(95%CI 66, 96) of the non-operated side force, respectively. The mean satisfaction score with the procedure was 8.8±2.3(95%CI 7.6, 10.0) out of 10. The mean qDASH (Quick Disabilities of the Arm, Shoulder, and Hand) score was 25.8±30.0 (95%CI 10.0, 40.7). The total revision rate was 13.6% (two cases of dislocation and one for loosening of the trapezium cup). There were no infections. The survival rate of the implant was 86.4% (95%CI 78.3, 93.3) after a five-year follow-up.There is still limited information regarding the long-term results of TMA using the Maïa prosthesis. TMA is a technically demanding procedure with a significant learning curve. With this study, we report satisfactory medium-term results in terms of motion, strength, and patient satisfaction.

Bone-Patellar Tendon-Bone Versus Quadriceps Tendon-Bone Autografts in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction.

Anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART-ACLR) can mimic the fiber arrangement of the native ACL and restore normal knee biomechanics, compared with the conventional round tunnel ACLR. ART-ACLR using a bone-patellar tendon-bone (BPTB) graft can provide satisfactory clinical outcomes; however, some issues such as secondary ACL injury and donor-site morbidity, including postoperative anterior knee pain (AKP), remain to be solved. Due to these issues, quadriceps tendon-bone (QTB) grafts have recently become more popular. To compare the 2-year clinical outcomes of ART-ACLR with BPTB and QTB autografts. Cohort study; Level of evidence, 3. A total of 134 patients underwent primary ART-ACLR with BPTB (n = 70) or QTB (n = 64). All patients had a minimum follow-up period of 2 years postoperatively. Outcome evaluations included the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), side-to-side differences (SSDs) with the KT-1000 knee arthrometer, rate of secondary ACL injury, and incidence of AKP. Regarding age, sex, height, weight,and concomitant procedures, there were no significant differences between the 2 groups. All clinical scores significantly improved from preoperatively to 6 months postoperatively and further increased throughout the 2-year postoperative period in both groups. The IKDC and all subscales of the KOOS, except Sport and Recreation, were equivalent between the BPTB and QTB groups at each postoperative time point. There were no significant differences in the SSD value of KT-1000 arthrometer between the 2 groups. The rates of secondary ACL injury were 10.0% on the ipsilateral side and 2.9% on the contralateral side in the BPTB group and 3.1% on the ipsilateral side and 4.7% on the contralateral side in the QTB group, with no significant difference between both groups. The incidence of AKP was 17.1% and 4.9% in the BPTB group and QTB group, respectively, with significance of P = .02). The clinical scores, SSD value of the KT-1000 arthrometer, and secondary ACL injury rates were equivalent between the BPTB and QTB groups. However, the incidence of AKP was significantly lower in the QTB group, suggesting that QTB could be a favorable graft for ACLR.

The Effect of C-Arm Position on Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction.

Medial patellofemoral ligament (MPFL) reconstruction is a common treatment for patellar instability. Yet nearly 40% of revisions result from femoral tunnel misplacement. One reason may be the positioning of the C-arm relative to the knee. To assess how the C-arm's position affects femoral MPFL placement when the image receptor is positioned either contralateral or ipsilateral to the operated knee. Controlled laboratory study. Ten human cadaveric knee specimens were dissected, and the femoral MPFL insertion site was identified and marked using a 10-mm eyelet. According to the possible clinical scenarios, true lateral radiographs in 2 different C-arm positions were taken. In the first scenario, the image receptor was on the ipsilateral side, being 5 cm away from the knee with the x-ray beam directed from medial to lateral (ML5). In the second scenario, the image receptor was on the contralateral side, being 25 cm away from the knee with the x-ray beam directed from lateral to medial (LM25). In each radiograph, the eyelet position was recorded and the distance (proximal-distal and anterior-posterior) from the optimal radiographic insertion point according to the literature was determined. Differences between the groups were calculated using the Wilcoxon signed-rank test, and a P value of <.05 was considered significant. The anatomic femoral MPFL insertion in the ML5-position was located a mean of 2.7 ± 2.4 mm proximal and 4.5 ± 5.5 mm anterior to the Schöttle point. This resulted in an absolute distance of 7.2 ± 3.0 mm. In the LM25-position, it was located a mean of -0.7 ± 1.8 mm distal and 3.0 ± 5.3 mm anterior, which resulted in an absolute distance of 5.4 ± 3.2 mm. The ML5 was located more anterior (1.5 ± 2.1 mm) and proximal (3.4 ± 2.4 mm) compared with the LM25 position. Measurements following methods described in the literature significantly differed in both axes in the LM25 view when compared with the ML5 view measurements (P = .005). Compared with the ipsilateral C-arm position (ML5), the contralateral C-arm position (LM25) showed a smaller range with a lower standard deviation in identifying the femoral MPFL approach across all measurement methods. When applying the method according to Schöttle et al to locate the femoral MPFL insertion point, it should be noted that in the proximal-distal orientation, the femoral MPFL insertion point is situated proximal to the Blumensaat line in the contralateral view (LM25). In contrast, when using the ipsilateral view (ML5), the femoral MPFL footprint is positioned just distal to the proximal edge of the medial condyle.

Quantifying Muscle Co-activation for Impaired Finger Independence in Stroke Survivors.

Hand impairment frequently occurs in individuals following a stroke. There is evidence of abnormal muscle co-activation that contributes to impaired control of finger independence. This study quantitatively analyzed hand muscle co-activation patterns of chronic stroke survivors. Systematically quantifying the degree of muscle co-activation patterns in stroke survivors can help us to better understand the mechanisms behind compromised finger independence and enables a more accurate assessment of hand impairment. We analyzed muscle co-activation patterns both macroscopically and microscopically using high-density surface electromyographic (HD-sEMG) signals and decomposed motor unit signals from extrinsic and intrinsic flexor/extensor muscles. The muscle co-activation patterns between both sides of stroke survivors and neurologically intact controls were compared. We observed increased levels of co-activation in the affected sides of stroke survivors compared with their contralateral sides and the control groups, with a higher degree in the extrinsic muscles than the intrinsic muscles. The asymmetry in muscle co-activation between hands correlated with impaired finger force independence and clinical assessment scales. In the micro-level analysis of motor unit action potentials (MUAPs) distributions, we observed a notable increase in action potential spread of MUAPs in the individual affected extrinsic muscles, but the altered MUAP distribution did not correlate with clinical assessment scales. We systematically quantified abnormal muscle co-activation patterns in impaired finger independence after stroke. With further development, the outcomes provide a comprehensive understanding of hand dexterity deficits in stroke survivors, which may provide guidance for targeted rehabilitation strategies and offer a potential for automated impairment evaluations.

New prospects for 89Zr-immuno-PET in brain applications – Alpha-synucleinopathies

BackgroundRecently, 89Zr-immuno-PET imaging of therapeutic antibodies, actively transported over the blood-brain-barrier via transferrin-mediated transcytosis, was demonstrated using the chelator DFO*. In these studies, aducanumab targeting amyloid-beta was fused with a transferrin binding unit: a single-chain Fab fragment derived from 8D3 (scFab8D3). Alpha-synuclein is a hallmark protein of several neurodegenerative diseases such as Parkinson's Disease, Lewy-Body-Dementia, and Multiple System Atrophy. 89Zr-immuno-PET imaging of alpha-synuclein can be a valuable tool for image-guided drug development and assessment of target engagement. The goal of this study was to compare two currently used constructs of 8D3 for targeting potential, namely a single moiety of scFab8D3 fused to the alpha-synuclein antibody HLu-3 (HLu-3-scFab8D3) versus HLu-3 fused with two 8D3 single-chain variable fragments (HLu-3-(scFv8D3)2), by 89Zr-immuno-PET in an alpha-synuclein pre-formed fibril (PFF) deposition model. HLu-3 and the HIV-targeting B12-scFab8D3 were used as controls. The best-performing compound was further investigated in an animal model with predominantly intraneural target aggregation. MethodsAntibodies were conjugated with DFO* using DFO*-NCS and subsequently radiolabeled with 89Zr. Assessment of binding affinity was done by alpha-synuclein ELISA and with FACS analysis using mTfR1 expressing CHO-S cells. Radioimmunoconjugates were first evaluated in an extracellular alpha-synuclein deposition model established by intracranial injection of non-sonicated PFFs into the left striatum of C57Bl/6 WT mice, whereas saline was injected into the contralateral side as control. PET imaging was performed 1, 3, and 7 days post-injection, followed by ex vivo biodistribution, autoradiography and immunofluorescence analysis. Based on the results from these studies, the better-performing antibody candidate was tested similarly in an alpha-synuclein seeding model. The seeding model has intraneural alpha-synuclein aggregation and was established by intracranial injection of sonicated PFFs into both striata of F28tg mice, which overexpress human wild-type alpha-synuclein. Untreated F28tg and C57Bl/6 WT mice served as controls. ResultsThe radioconjugate was produced in sufficient radiochemical yields and purity. There was no impairment of binding affinity towards alpha-synuclein, and acceptable binding with negligible losses to mTfR1. PET imaging with [89Zr]Zr-HLu-3-scFab8D3 and [89Zr]Zr-HLu-3-(scFv8D3)2 in the deposition model showed uptake at the site of alpha-synuclein deposits. However, uptake was variable between mice. Reliable PET quantification was hampered due to the small deposition volume (~2 μL). Immunofluorescence revealed specific alpha-synuclein target engagement of both constructs with PFF deposits in the striatum, in contrast to the [89Zr]Zr-B12-scFab8D3 control. Unexpectedly, ex vivo autoradiography showed uptake in some controls ([89Zr]Zr-B12-scFab8D3 in the contralateral striatum without PFFs), potentially related to astrocyte activation at the injection sides. Ex vivo and PET brain uptake was higher for [89Zr]Zr-HLu-3-scFab8D3 when compared to [89Zr]Zr-HLu-3-(scFv8D3)2 and was therefore selected for further testing in the alpha-synuclein seeding model. No significant difference in in vivo and ex vivo brain uptake of [89Zr]Zr-HLu-3-scFab8D3 between PFF-injected F28tg, F28tg and C57Bl/6 mice was observed. Furthermore, ex vivo immunofluorescence and autoradiography showed no specific alpha-synuclein target engagement. ConclusionsSuccessful target engagement of [89Zr]Zr-HLu-3-scFab8D3 and [89Zr]Zr-HLu-3-(scFv8D3)2 with alpha-synuclein was shown in a PFF deposition model. PET imaging showed variable results, and in vivo detection of the depositions was possible in some cases. Due to the better performance in the deposition model, [89Zr]Zr-HLu-3-scFab8D3 was further investigated in an alpha-synuclein seeding model with intraneural Lewy-body pathology, showing no difference between the control groups and PFF-seeded mice. Furthermore, immunostaining of seeded F28tg mice manifested sufficient intraneural alpha-synuclein pathology but no corresponding antibody accumulation. These results underscore the ongoing challenge of imaging intraneural inclusions via immuno-PET.

Vertical Alveolar Ridge Regeneration by Means of Periosteal Activation-A Proof-of-Principle Study.

To assess the possibility of vertical alveolar ridge augmentation by means of activation of the periosteum. Six adult male Beagle dogs were used for the study. All premolars and first molars were extracted, and one vertical saucer-shaped bony defect was created on each side of the mandible. After 3 months of healing, full-thickness muco-periosteal flaps were elevated, and one distraction device was placed on each side of the mandible. The distraction plate was left submerged, and the activation mechanism connected to the distraction rod was exposed intra-orally. The protocol of periosteal activation (PP: periosteal 'pumping') was initiated after a latency of 7 days. The alternation of activation and relaxation at the rate of 0.35 mm/12 h during 5 days was followed by the sole activation of 0.35 mm/12 h for 5 days (PP group). Devices were left inactivated on the contralateral control side of the mandible (C group). All animals were euthanized after 8 weeks of consolidation. Samples were analysed histologically and by means of micro-CT. New mature lamellar bone was formed over the pristine bone in all groups. More intensive signs of bone modelling and remodelling were observed in the PP group compared to the C group. Mean new bone, bone marrow, connective tissue and total volumetric densities were greater in the PP group (p < 0.001, p = 0.001, p = 0.003 and p < 0.001, respectively). No differences were observed in the relative area parameters. Total tissue volume and bone volume were higher in the PP group (p = 0.031 and p = 0.076, respectively), while the bone mineral densities were higher in the C group (p = 0.041 and p = 0.003, respectively). Trabecular number, trabecular thickness and trabecular separation values were similar between the two groups. Regeneration of vertical alveolar bone ridge defects may be enhanced by activation of the periosteum, without the application of bone grafting materials.

Decreased Choriocapillaris Vessel Density in the Ipsilateral Eye after Carotid Artery Revascularization Detected by Widefield Swept-Source OCT Angiography

ObjectiveTo investigate the short-term blood flow changes and image features of the retina and choroid in patients undergo carotid artery revascularization (CAR) for severe carotid artery stenosis (SCAS) using widefield swept-source optical coherence tomography angiography (SS-OCTA). DesignProspective study. ParticipantsThis prospective study included 112 eyes (56 eyes of the ipsilateral side and 56 eyes of the contralateral side) of 56 participants with severe carotid artery stenosis. MethodsParticipants were examined using widefield SS-OCTA covering an area of 16*16mm centered on the fovea before and after carotid artery revascularization. Retinal parameters including central macular thickness (CMT), vessel density of the retinal superficial vascular complex (VDRSVC), vessel density of the retinal deep vascular complex (VDRDVC), and vessel density of the retina (VDR) and choroidal parameters including central choroidal thickness (CCT), vessel density of the choriocapillaris (VDCC), vessel density of the medium and large choroidal vessels (VDMLC), choroidal vessel volume ratio (CVV/a), and three-dimensional choroidal vascularity index (3D-CVI) were measured. Besides, preoperative and postoperative OCTA images were screened and compared. Main Outcome MeasuresRetinal and choroidal parameters obtained from SS-OCTA. ResultsIn the ipsilateral eye (56 eyes), increase of VDRSVC, VDR, CVV/a, CCT, and 3D-CVI and decrease of VDCC was found after CAR. 13 patients were identified with postoperative ipsilateral choriocapillaris flow voids (PICCFVs) with OCTA images, and presence of PICCFVs was associated with greater postoperative VDCC decrease. In the contralateral eye (56 eyes), we found increase of VDRSVC, VDRDVC, VDR, while no difference of choroidal parameters after CAR and no findings of PICCFVs. ConclusionsFindings of this study suggest that ocular microvascular perfusion is improved after CAR in the ipsilateral eye and the contralateral eye within a wide field of the fundus. The VDCC is decreased in the ipsilateral eye, which may indicate infarctions of choriocapillaris or ischemia-reperfusion injury of the choriocapillaris after CAR.

Evaluation of Rate of Space Closure Between Platelet Rich Plasma (Prp) Injection and Piezocision in Bimaxillary Protrusion Cases

Aim: Reducing orthodontic treatment duration is a significant concern for both patients and clinicians, as prolonged treatments can lead to complications like dental caries, root resorption, and decreased patient compliance. This study aims to compare the effectiveness of two minimally invasive techniques—Piezocision and platelet-rich plasma (PRP) injection—in accelerating orthodontic tooth movement during space closure in patients with bimaxillary protrusion. Methods: Sixteen patients diagnosed with Angle's Class I bimaxillary protrusion requiring extraction of first premolars were randomly assigned to two groups. Group A (n = 8) underwent Piezocision-assisted orthodontic treatment, while Group B (n = 8) received submucosal PRP injections. In both groups, one side of the maxillary arch served as the experimental side, and the contralateral side served as the control. Measurements of space closure were taken at the initiation of retraction (T₀) and after 90 days (T₁). Results: Both Piezocision and PRP significantly enhanced the rate of space closure compared to their control sides. However, Piezocision demonstrated a statistically faster rate of tooth movement than PRP injection. The mean difference in space closure between the Piezocision and PRP groups at T₁ was significant (p &lt; 0.001). Conclusion: While both Piezocision and PRP injections effectively accelerated orthodontic tooth movement, Piezocision proved to be more efficient in reducing treatment time. Clinicians may consider Piezocision as a preferred method for patients seeking expedited orthodontic treatment.

DTI Analysis of the Peritumoral Zone of Diffuse Low-grade Gliomas in Progressing Patients

DLGGs are rare brain tumors transforming to higher grade even with surgery, chemotherapy and radiotherapy. Their preferential infiltration of WM tracts, beyond tumor boundaries on FLAIR, make difficult to plan focal treatment such as surgery, radiotherapy and monitor response to chemotherapy. DTI might reflect this infiltration of WM tracts. The aim of our study is to assess how DTI signal in the peritumoral zone might be modified before FLAIR tumor progression appears at one-year follow-up. The study retrospectively enrolled five patients who met inclusion criteria: DTI with 25 directions, T1 and FLAIR at initial imaging; FLAIR at one-year follow-up. Patients with surgery, radiotherapy and chemotherapy completed less than 2 years before initial imaging were excluded. FLAIR tumor progression, named progression mask, was assessed by subtracting tumor masks between initial imaging and one-year follow-up. Initial DTI signal was analyzed within this progression mask and compared with the healthy contralateral side. Tumor progression was confirmed for the five patients at one year. All patients showed pre-existing DTI signal abnormalities within the progression mask. Mean FA (p = 0.03) was lower in the progression mask, whereas MD, AD and RD mean (p = 0.03) was higher in the progression mask, compared to healthy side. This study shows pre-existing DTI signal abnormalities in regions with tumor progression at one year. Such abnormalities could correspond to a tumor infiltration not yet visible on FLAIR. This might be helpful to predict tumor progression and allow to adapt the therapeutic strategy.

Computed Tomography Measures of Perinephric Adipose Tissue and C-Reactive Protein-to-Albumin Ratio are Associated with Common Prognostic Models for Nonmetastatic Clear Cell Renal Cell Carcinoma Patients.

Renal cell carcinoma (RCC) is a reclusive tumor, usually discovered incidentally on imaging examinations of other abdominal diseases. Although prognosis models based on pathology are more accurate, it is crucial to evaluate tumor prognosis before invasive operations to support the choice of active surveillance and ablation therapy. Thus, non-invasive methods are essential for determining appropriate treatment strategies in patients. Data from 106 patients under non-metastatic clear cell RCC (ccRCC) who went through partial/radical nephrectomy from January 2016 to October 2023 were retrospectively evaluated. Basic demographic information, preoperative hematological indicators, pathological data, and computed tomography (CT) measurements of perinephric adipose tissue (PAT) were collected for each patient. The CT assessments of PAT, including thickness, radiodensity, and Mayo adhesive probability (MAP) score, were performed by a radiologist. Univariate and multivariate logistic regression analysis was applied to clarify risk factors of Fuhrman grade, tumor size, and the Stage Size Grade Necrosis (SSIGN) score. The receiver operating characteristic (ROC) curve of SSIGN was then constructed in order to determine discriminatory ability and optimal cut-off values of these risk factors. The radiodensity of PAT on the tumor side was significantly higher (p < 0.001) compared to the contralateral side. RCCs with higher maximum radiodensity of PAT and elevated C-reactive protein-to-albumin ratio (CAR) were related to a higher Fuhrman grade, larger tumor size, and increased Stage Size Grade Necrosis (SSIGN) scores (all p < 0.05). The area under curve (AUC) of maximum radiodensity of PAT and CAR for higher SSIGN scores was 0.816 (p = 0.003) and 0.811 (p = 0.004) each. The optimal cut-off values of PAT and CAR for higher SSIGN scores were -69.685 and 0.0452, respectively. The study corroborates that PAT and CAR's maximum radiodensity are independent markers for predicting Fuhrman grade, tumor size and SSIGN. These non-invasive methods are likely to improve traditional prognostic prediction and possibly effect new therapeutic strategies for patients with non-metastatic ccRCC.

025. Brain Corpal Evacuation Caused by Air Gun: Management and Surgical Approach Evacuation with Neuronavigation Guiding

Background: In Indonesia, cases of injury from airgun are relatively common and do not immediately result in death because the projectile velocity of airgun is slower compared to the gunshot. Consequently, if the pellet hits the brain (brain injury), it may cause the patient to live with disabilities or infection problems due to the non-sterile of the airgun pellet. Surgical procedures often difficulties in determining the location of the pellet or foreign body, especially if the pellet of air gun penetrates to the contralateral side of the entry point. Neuronavigation is a modern system in neurosurgery that helps surgeons precisely locate targets with minimal disruption to critical brain and spinal structures. This allows for more precise and easier pellet evacuation. Report a patient who had a gunshot wound with the bullet entering from the left parietal region and penetrating through to the right parietal surface of the head, managed comprehensively with neuronavigation guidance. Case: A 5-year-old female patient presented to the emergency department with an open wound on the left parietal region of the head. Her Glasgow Coma Scale score was 8 (GCS: Eye: 2, Verbal: 2, Motor: 4), indicating a sedated state. Initial and specific treatments were administered to prevent deterioration and improve the patient’s prognosis. Surgical management, using neuronavigation guidance, was employed to determine the exact location of the foreign body. The procedure included debridement of the entry point in the parietal region and evacuation of the foreign body using neuronavigation guidance. Conclusion: Early management of gunshot injuries is crucial for improving prognosis. Neuronavigation guidance proved effective, and minimally invasive neurosurgical techniques may be a safe option for treating traumatic brain injuries caused by gunshots. This approach facilitates easier, faster, and more precise incision and evacuation of foreign bodies.

Clinical significance of MRI-measured olfactory bulb height as an imaging biomarker of idiopathic Parkinson's disease.

This study aimed to determine whether the olfactory bulb height (OBH) measured using magnetic resonance imaging (MRI) has clinical utility as an imaging biomarker in the evaluation of patients with idiopathic Parkinson's disease (iPD) through its correlation with movement impairment. This retrospective study included cognitively intact patients with suspected parkinsonism. All participants underwent T2-weighted imaging to measure OBH. Logistic regression was used to determine whether OBH was an independent risk factor for distinguishing iPD patients from disease controls, and its relation with clinical parameters related to motor impairment, including clinical laterality, modified Hoehn and Yahr (HY) stage, and Unified Parkinson's Disease Rating Scale (UPDRS) III score, was investigated. Based on the final clinical diagnosis, 79 patients with iPD and 16 disease controls were included. The mean OBH was significantly smaller in iPD than in disease controls (p < 0.0001). OBH was a significant independent predictor of iPD, with a cutoff of 1.52 mm. In the comparison among the ipsilateral, contralateral side of iPD with clinical laterality, and disease control group, the OBH of the disease control group was significantly larger than both the ipsilateral and contralateral sides (P < 0.05). However, there was no significant difference in OBH between the ipsilateral and contralateral sides (p > 0.05). OBH according to HY stage was significantly smaller in HY stage 2-3 groups than in the disease control group (p < 0.001). The correlation analysis between UPDRS III and OBH showed a mild negative correlation (r = -0.32, p = 0.013). MRI-measured OBH is decreased in iPD regardless of age and sex and may be correlated with the progression of motor symptoms in the iPD.