Distal Research Articles

Reliable and streamlined model setup for digital twin assessment of fracture healing.

In large animal models of bone fracture repair, postmortem torsional testing is commonly used to assess healing biomechanics. Bending and axial tests are physiologically relevant, but much less commonly performed. Virtual torsional testing using image-based finite element models has been validated to postmortem bench tests, but its predictive value for capturing whole-bone mechanics and fracture healing quality under other physiologically relevant loading modes has not yet been established. Accordingly, the purpose of this study was to evaluate the association between mechanical biomarkers derived from virtual torsion, axial, and bending tests under strict alignment and malalignment conditions. Computed tomography (CT) scans from 24 intact and operated sheep tibiae and 29 human tibial fractures were used to create digital twins that were subjected to torsion, axial, and bending tests. The results indicated that torsional rigidity is a strong surrogate for bending flexural rigidity in both ovine and human bones. Torsional rigidity and axial stiffness were strongly correlated in the ovine data, but only moderately in human fractures due to the complex fracture patterns. Axial testing was highly prone to stiffness estimation errors as high as 50% if the applied load and anatomic axis were not perfectly aligned. In contrast, torsional rigidity had errors <1.3% for all malalignment scenarios. Based on this study, virtual torsional rigidity is the recommended summary mechanical biomarker of bone healing because it captures variations in healing biomechanics that are present in other loading modes with a simple setup that is insensitive to alignment error.

Synthesis of spherical and rods-like titanium oxide nanoparticles (TiO2 NPs) and evaluation of their cytotoxicity towards colon cells in vitro.

Titanium oxide nanoparticles (TiO2 NPs) are currently used as ingredients in medicines and sunscreens. Unfortunately, recent information about TiO2 NPs indicates their undesirable biological effect on colon cells. Therefore, the aim of this work was to synthesize and evaluate the physicochemical characterization of spherical (TiO2 NSs) and rods-like (TiO2 NRs) NPs, followed by assessment their cytotoxicity. For this purpose, both normal colon epithelial cells (CRL-1790) and cancerous colon cells (SW480) were used. Scanning transmission electron microscopy (STEM) showed that TiO2 NSs with a diameter of ≈10nm and TiO2 NRs with the size of the longer axis ≈25nm and shorter axis ≈3nm were obtained. Based on the selected area electron diffraction (SAED) patterns, it was found that crystalline phases were obtained for both TiO2 NPs. The UV-Vis spectra showed no contamination of TiO2 NPs. Zeta potential values were 9.7mV and 3.1mV for NSs and NRs, respectively. Cytotoxicity of TiO2 NPs was assessed using the MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfophenyl)-2H-tetrazolium) test for various concentration of NPs. The cytotoxic effect for both TiO2 NPs was visible for concentration of 75μg/ml (for CRL-1790) and 50μg/ml (for SW480) and higher, and it did not depend on the shape. Moreover, both types of TiO2 NPs (in higher concentration) induce the generation of reactive oxygen species (ROS) in cells cultured with these NPs. Holotomographic microscopy studies showed increased cellular uptake of TiO2 NPs by SW480. The obtained results for the synthesized TiO2 NPs are a promising prospect for their use in biomedical application.

Automated Web Tool Measurement of Total Hip Arthroplasty Acetabular Component Inclination and Anteversion Angles.

Periprosthetic hip dislocation after total hip arthroplasty is a devastating postoperative complication. It is often associated with suboptimal orientation of the acetabular component, characterized by the acetabular abduction and anteversion angles obtained from anteroposterior pelvic radiographs. We introduce a novel automated web tool to streamline the subjective and lengthy process of this manual measurement and compare it to manual human measurements. One board-certified orthopaedic surgeon used the web tool to make automatic measurements of anteroposterior radiographs of 97 patients who underwent unilateral hip arthroplasty. Manual and web tool measurements included abduction angle and calculated anteversion angle by Liaw's method. Differences between manual and web tool measurements were compared with a paired t-test and Bland-Altman analysis. There were no statistically significant differences between the average of manual measurements as compared to the web tool measurement in abduction angle (43.29 ± 7.05 vs 43.00+ 6.22, P= .85), anteversion angle (20.43 ± 7.62 vs 20.82 ± 7.37, P= .52), and ratio of the minor axis of the acetabular cup circumference in the AP radiograph to the total length of the acetabular head (0.42 ± 0.15 vs 0.44 ± 0.15, P= .18). The mean difference of average for abduction angle, anteversion angle, and ratio between the short axis of the transverse ellipse to the total length of the acetabular cup were-0.28, 0.39, and 0.02, respectively. Bland-Altman analysis for all 3 measurements displayed negligible systemic bias with random scattering. Automated measurements obtained with a novel web tool are in strong agreement with the manually obtained ground truth measurements. The web tool helps to eliminate interobserver differences that arise with manual annotation. The web tool has the potential to streamline acetabular measurements with enhanced accuracy.

Cripto-1 acts as a molecular bridge linking nodal to ALK4 via distinct structural domains.

The TGF-β family ligand Nodal is an essential regulator of embryonic development, orchestrating key processes such as germ layer specification and body axis formation through activation of SMAD2/3-mediated signaling. Significantly, this activation requires the co-receptor Cripto-1. However, despite their essential roles in embryogenesis, the molecular mechanism through which Cripto-1 enables Nodal to activate the SMAD2/3 pathway has remained elusive. Intriguingly, Cripto-1 also has been shown to antagonize other TGF-β family ligands, raising questions about its diverse functions. To clarify how Cripto-1 modulates TGF-β signaling, we integrated AlphaFold3 modeling, surface plasmon resonance (SPR)-based protein-protein interaction analysis, domain-specific anti-Cripto-1 antibodies, and functional studies in NTERA-2 cells. In contrast to canonical TGF-β signaling, where ligands bridge type I and type II receptors for activation, Nodal, bound to the type II receptor, utilizes Cripto-1 to recruit the type I receptor ALK4, forming a unique ternary complex for SMAD2/3 activation. Our molecular characterization of Cripto-1-mediated Nodal signaling clarifies the unique role of this enigmatic co-receptor and advances our understanding of signaling regulation within the TGF-β family. These insights have potential implications for both developmental biology and cancer research.

Changes in the shape of the lumbar curve during growth : a geometric morphometric approach.

The development of lumbar lordosis has been traditionally examined using angular measurements of the spine to reflect its shape. While studies agree regarding the increase in the angles during growth, the growth rate is understudied, and sexual dimorphism is debated. In this study, we used a novel method to estimate the shape of the lumbar curve (LC) using the landmark-based geometric morphometric method to explore changes in LC during growth, examine the effect of size and sex on LC shape, and examine the associations between angular measurements and shape. The study population included 258 children aged between 0 and 20 years (divided into five age groups) who underwent a CT scan between the years 2009 and 2019. The landmark-based geometric morphometric method was used to capture the LC shape in a sagittal view. Additionally, the lordosis was measured via Cobb and sacral slope angles. Multivariate and univariate statistical analyses were carried out to examine differences in shape between males and females and between the age groups. The overall shape of the LC overlapped between males and females in most age groups, except for the nine- to 12-year age group. However, size did not affect LC shape. LC shape changed significantly during growth from straight to curved, reaching its mature shape earlier in females. This corresponded with the results obtained by the lordosis and sacral slope angles. A significant positive correlation was found between the LC shape and angles, although the angles demonstrated poor distinction between age groups, as opposed to the LC shape. New insights into LC shape development were achieved using the geometrical morphometric method. The LC shape was sex-independent in most age groups. However, the LC reached its mature shape earlier in females than males. The method and data of this study are beneficial for future studies examining aetiological factors for spinal pathologies and maldevelopment.

Involvement of aSPOC in the online updating of reach-to-grasp to mechanical perturbations of hand transport.

Humans adjust their movement to changing environments effortlessly via multisensory integration of the effector's state, motor commands, and sensory feedback. It is postulated that frontoparietal (FP) networks are involved in the control of prehension, with dorsomedial (DM) and dorsolateral (DL) regions processing the reach and the grasp, respectively. This study tested (5F, 5M participants) the differential involvement of FP nodes (ventral premotor cortex - PMv, dorsal premotor cortex - PMd, anterior intraparietal sulcus - aIPS, and anterior superior parietal-occipital cortex - aSPOC) in online adjustments of reach-to-grasp coordination to mechanical perturbations that disrupted arm transport. We used event-related transcranial magnetic stimulation (TMS) to test whether the nodes of these pathways causally contribute to the processing of proprioceptive information when reaching for a virtual visual target at two different perturbation latencies. TMS over aSPOC selectively altered correction magnitude of arm transport during late perturbations, demonstrating that aSPOC processes proprioceptive inputs related to mechanical perturbations in a movement phase-dependent manner.Significance Statement Detailed knowledge regarding specific brain regions, the timing of their involvement, and roles in the online updating of sensory input during the control of the reach-to-grasp movement is critical for understanding the deficits resulting from various diseases, such as stroke, as well as for the development of effective intervention strategies. Our results provide evidence for the involvement of aSPOC in the modulation of the response to a mechanical perturbation of arm transport during the later stage of the movement, suggesting that this area participates in estimating the effector state based on proprioceptive input. Our results can provide key information for identifying brain targets of engagement in therapeutic applications of noninvasive brain stimulation to ameliorate motor deficits stemming from parietal damage.

Can Foot Orthoses Prevent Falls? A Proposal for a New Evaluation Protocol

Foot pain represents one of the most common symptoms in lower limb issues, especially in elderly individuals. This condition, often associated with other pathologies, increases the risk of falling. To better understand the risk of falls, it is essential to assess patients’ postural stability. In this pilot study, we aimed to set a protocol to prevent the falling risk. We propose the use of inertial sensors (IMUs) to detect even minimal body oscillations in a non-invasive, rapid, and cost-effective way. We have analyzed a sample of 35 patients (age = 58 ± 14 years, female = 20/male = 15) to investigate the total range of body sway in the anteroposterior (AP) and mediolateral (ML) directions during static balance in relation to their age and BMI. The analysis of the collected parameters (sway area, sway pathAP, and sway pathML) has showed a lower stability at t1, at the time of orthosis application, with respect to the previous condition, implied by the necessary period of adaptation to the new plantar device. In fact, the postural parameters have visibly improved at 30 days (t2). Comparing the results obtained in the different postural exercises, we have obtained significant differences between the natural standing position with eyes open and the others. According to these results, we can suppose that using inertial sensors associated to postural exercise is the best way to assess a patient’s postural stability and that the progressive improvements may be more marked over a longer period, such as six months (t3).

Peculiarities of morphological changes in the lamina cribrosa in patients with myopia and options of drug influence on its state

The literature review substantiates the need to study the morphological changes in the lamina cribrosa in patients with myopia. The authors discuss the pathogenesis of axial myopia, namely, changes in the lamina cribrosa in pathological elongation of the anteroposterior axis of the eye. It is interesting to review the methods for the treatment and diagnosis of myopia, which remain extremely difficult tasks due to the lack of knowledge about most pathogenetic mechanisms of its development. The authors mention the commonly available and well-known spectra of treatment measures: conservative, surgical, laser methods of treatment and diagnosis of myopia, as well as modern drug regimens to control the progression of myopic changes. To date, there are quite a few studies on changes in the lamina cribrosa in glaucoma. However, research on the parameters of lamina cribrosa changes in myopia is rare in scientific literature. A modern approach to the diagnosis of changes in the lamina cribrosa will help clarify the mechanisms of visual impairment in these patients and will serve as the basis for the development of methods for the prevention and treatment of blindness in people suffering from myopia.

Computed tomographic analysis of the frontal sinus morphology and structures that affect the size of the frontal sinus outflow tract in Vietnamese people

The frontal recess is a relatively small and narrow area with many neighboring structures and is very diverse in each body. Surgical intervention in this area is still challenging for surgeons. The International Frontal Sinus Anatomy Classification (IFAC) helps classify frontal cells on computed tomography (CT) scans for surgical purposes and anatomical accuracy. This study aims to investigate the morphology of the frontal sinus, the anteroposterior (A-P) diameter of the frontal sinus ostium and the A-P diameter of the frontal recess, the frontal cells classified by IFAC and the relationships between frontal sinus characteristics and A-P diameter of frontal sinus ostium and frontal recess on CT scans. Descriptive cross-sectional study on all CT scans of nasal cavities and paranasal sinuses of patients ≥ 20 years old at the Examination Department of Minh Duc Hospital — Ben Tre and Can Tho University of Medicine and Pharmacy Hospital. In terms of morphology, we found that the most common type was large-sized frontal sinus (40.7%), followed by medium (35.4%) and small (23.9%), respectively. The three dimensions of the frontal sinus in men were larger than in women (p&lt;0.05). The mean A-P diameter of frontal sinus ostium was 6.41±2.66 mm. The mean A-P diameter of frontal sinus recess was 3.23 ± 2.59 mm. The agger nasi cells accounted for the highest proportion (93.6%) and supraorbital ethmoid cells accounted for the lowest proportion (2.9%). There was a statistically significant relationship between ostium diameter and frontal sinus morphology with p&lt;0.001. The A-P diameter of the frontal sinus ostium and frontal recess became narrower with the appearance of the frontal cells. From the study’s results about the frontal sinus morphology, the relationship between the frontal recess cells and the structures affecting the anteroposterior diameter of the frontal sinus drainage pathway can assist surgeons in planning effective and safe surgical interventions in the frontal sinus area.

Self-organization from organs to embryoids by activin in early amphibian development.

Embryonic development is a complex self-organizing process orchestrated by a series of regulatory events at the molecular and cellular levels, resulting in the formation of a fully functional organism. This review focuses on activin protein as a mesoderm-inducing factor and the self-organizing properties it confers. Activin has been detected in both unfertilized eggs and embryos, suggesting its involvement in early developmental processes. To explore its effects, animal cap cells-pluripotent cells from the animal pole of amphibian blastula-stage embryos-were treated with varying concentrations of activin. The results showed that activin induced mesodermal tissues, including blood, muscle, and notochord, in a dose-dependent manner. Co-treatment with activin and retinoic acid further promoted the development of kidney and pancreatic tissues, while activin alone stimulated the formation of beating cardiac tissue. In subsequent experiments, high concentrations of activin conferred an organizer-like activity on animal cap cells. The pretreatment duration affected outcomes: longer exposure induced anterior structures, such as eyes, while shorter exposure resulted in posterior structures, like tails. These findings reflect moderate self-assembly, where cells become increasingly organized. In another experiment, activin was used to create an artificial gradient. Explants cultured on this gradient developed into embryoids with well-defined anteroposterior, dorsoventral, and left-right axes, exemplifying higher-order self-organization. These results demonstrate that controlled activin gradients can drive the formation of nearly complete tadpole-like larvae, effectively recapitulating the processes of early embryogenesis. This system offers valuable insights into the mechanisms underlying axis formation and organogenesis, providing a promising platform for future research in developmental biology.

Three-dimensional complementary breast ultrasound (3D CBUS): Improving 3D spatial resolution uniformity with orthogonal images.

With increasing evidence supporting three-dimensional (3D) automated breast (AB) ultrasound (US) for supplemental screening of breast cancer in increased-risk populations, including those with dense breasts and in limited-resource settings, there is an interest in developing more robust, cost-effective, and high-resolution 3DUS imaging techniques. Compared with specialized ABUS systems, our previously developed point-of-care 3D ABUS system addresses these needs and is compatible with any conventional US transducer, which offers a cost-effective solution and improved availability in clinical practice. While conventional US transducers have high in-plane resolution (axial and lateral), their out-of-plane resolution is constrained by the poor intrinsic elevational US resolution. Consequently, any oblique view plane in an acquired 3DUS image will contain high in-plane and poor out-of-plane resolution components, diminishing spatial resolution uniformity and overall diagnostic utility. To develop and validate a novel 3D complementary breast ultrasound (CBUS) approach to improve 3DUS spatial resolution uniformity using a conventional US transducer by acquiring and generating orthogonal 3DUS images. We previously developed a cost-effective, portable, dedicated 3D ABUS system consisting of a wearable base, a compression assembly, and a mechanically driven scanner for automated 3DUS image acquisition, compatible with any commercial linear US transducer. For this system, we have proposed 3D CBUS approach which involves acquiring and registering orthogonal 3DUS images ( and ) with an aim of overcoming the poor resolution uniformity in the scanning direction in 3D US images. The voxel intensity values in the 3D CBUS image are computed with a spherical-weighted algorithm from the original orthogonal 3DUS images. Experimental validation was performed with 2DUS frame densities of 2, 4, 6 frames mm-1 using an agar-based phantom with a speed of sound of 1540 ms-1 and an embedded nylon bead. Lateral and axial full-width at half-maximum (FWHMLAT and FWHMAX) values were calculated from cross-sections taken at polar view planes ranging from 0° to 90° for 3DUS and 3D CBUS images of a bead phantom in focal zone and far field regions. Kendall's Tau-b correlation coefficients were calculated between FWHM measurements and cross-section angle for all frame density settings at a significance level of . Volumetric 3D segmentations were performed for 3DUS and 3D CBUS images of an inclusion phantom to confirm volumetric reconstruction accuracy. For statistical analysis, a repeated measures ANOVA with the Greenhouse-Geisser correction was performed at a significance level of . Experimental validation of the orthogonal 3DUS images show complementary trends of increasing and decreasing FWHMLAT from in-plane to out-of-plane (0° and 90° and vice versa) views. This is exemplified with the scan taken at 4 frames mm-1 in the focal zone, where FWHMLAT ranges from 3.51 to 1.10 mm for and 1.02-3.02 mm for , spanning 0°-90°, respectively. When combined in the 3D CBUS image, the FWHMLAT exhibits greater uniformity across view angles by mitigating poor out-of-plane resolution using its complementary in-plane component, with corresponding FWHMLAT values of 1.27 and 1.46 mm. While visual enhancements were seen in the 3D CBUS image, no statistically significant differences were found in volumetric measurements of the spherical inclusions in the 3DUS and 3D CBUS images. The out-of-plane resolution in the orthogonal 3DUS images is improved upon their combination into a single 3D CBUS image. These results demonstrate that the proposed 3D CBUS generation approach can improve 3D spatial resolution uniformity, while employing a commercial US transducer. The proposed 3D CBUS method shows potential utility for improving image resolution uniformity in 3D ABUS images, with the goal of improving point-of-care breast cancer supplemental screening and diagnostic applications, particularly in women with dense breasts and limited resource settings.

P0548 Comparison of C-reactive protein level and intestinal ultrasonography in Crohn’s Disease activation

Abstract Background Noninvasive diagnostic methods and laboratory parameters play an important role in the activation of Crohn’s Disease (CD). C-reactive protein (CRP) is one of the best laboratory measurements used to evaluate the activity of CD. Ultrasonography is a non-invasive, easily accessible, inexpensive, ionizing radiation-free imaging method that can be performed at the bedside. In this study, we aimed to compare CRP level and intestinal ultrasonography (IUS) findings in CD. Methods 79 Crohn’s patients who applied due to activation or for routine control were included in the study. Patients with other causes of colitis, malignancy, chronic and rheumatological diseases that may cause elevated CRP were excluded from the study. CRP values of the patients were measured on the day of IUS. IUS examination was performed using the Toshiba aplio HDI-300 ultrasound system. The examination started from the right inguinal region using a convex probe (3.5-5.5 MHz). Wall thickness, wall echogenicity, mural stratification, involved segment, inflammation in mesenteric fat planes, lymphadenopathy, and intestinal complications such as stricture, abscess formation, and fistulas were examined using a linear probe (7-12 MHz). A wall thickness greater than 3 mm was considered pathologic. The short axis of mesenteric lymph nodes greater than 5 mm was considered pathologic. The Superior mesenteric artery (SMA) was examined by duplex color Doppler. In the spectral Doppler examination, the peak systolic velocity (PSV) and resistive index (RI) were assessed. The Limberg score was used to assess bowel wall vascularization. According to Limberg, intestinal wall vascularity is classified in 5 grades. Results In this study, increased intestinal wall thickness in IUS, inflammation findings in the mesenteric fatty planes and CRP values were highly significant (p&amp;lt;0.001). CRP values were significantly higher in the group with decreased peristalsis and loss of wall layer delineation (p ˂ 0.01) and in complicated Crohn’s patients (p ˂ 0.05). CRP value did not differ significantly (p = 0.076) in the groups with and without lymphadenopathy detected on IUS. The CRP value in the group with a Limberg score of 1 and above was significantly higher (p &amp;lt; 0.001) compared to the group with a Limberg score of 0. A significant (p &amp;lt;0.05) positive correlation was observed between SMA flow velocity and CRP on Doppler USG. No correlation (p ˃0.05) was observed between RI, PSV and CRP on Doppler USG. Conclusion In this study, CRP elevation was found to be associated with many parameters of IUS in evaluating CD activity. In clinical use, CRP and IUS are simple, noninvasive, bedside diagnostic tools. References 1)Haber HP, Busch A, Ziebach R, Stern M. Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. The Lancet. 2000;355(9211):1239-40. 2)Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, et al. Use of intestinal ultrasound to monitor Crohn’s disease activity. Clinical Gastroenterology and Hepatology. 2017;15(4):535-42. e2. 3)Filik L, Dagli U, Ulker A. C-reactive protein and monitoring the activity of Crohn’s disease. Advances in therapy. 2006;23(4):655-62.

Tissue-resident memory CD8 T cell diversity is spatiotemporally imprinted.

Tissue-resident memory CD8 T (TRM) cells provide protection from infection at barrier sites. In the small intestine, TRM cells are found in at least two distinct subpopulations: one with higher expression of effector molecules and another with greater memory potential1. However, the origins of this diversity remain unknown. Here we proposed that distinct tissue niches drive thephenotypic heterogeneityof TRM cells. To test this, we leveraged spatial transcriptomics of human samples, a mouse model of acute systemic viral infection and a newly established strategy for pooled optically encoded gene perturbations to profile the locations, interactions and transcriptomes of pathogen-specific TRM cell differentiation at single-transcript resolution. We developed computational approaches to capture cellular locations along three anatomical axes of the small intestine and to visualize the spatiotemporal distribution of cell types and gene expression. Our study reveals that the regionalized signalling of the intestinal architecture supports two distinct TRM cell states: differentiated TRM cells and progenitor-like TRM cells, located in the upper villus and lower villus, respectively. This diversity is mediated by distinct ligand-receptor activities, cytokine gradients and specialized cellular contacts. Blocking TGFβ or CXCL9 and CXCL10 sensing by antigen-specific CD8 T cells revealed a model consistent with anatomicallydelineated, early fate specification. Ultimately, our framework for the study of tissue immune networks reveals that T cell location and functional state are fundamentally intertwined.

Hyoid bone-based sex discrimination among Egyptians using a multidetector computed tomography: discriminant function analysis, meta-analysis, and artificial intelligence-assisted study

The hyoid bone has been identified as sexually dimorphic in various populations. The current study is a forerunner analysis that used three-dimensional multidetector computed tomography (3D MDCT) images of the hyoid bone to examine sexual dimorphism in the Egyptian population. A total of 300 subjects underwent neck CT imaging, with an additional 60 subjects randomly selected for model validation. Ten hyoid variables were measured. Initially, the dataset was subjected to discriminant analysis to predict sex and the critical variables associated with sexual dimorphism. Subsequently, machine learning approaches were employed to enhance the accuracy of sex determination. The results indicated that all measured dimensions of the hyoid bone were substantially larger in males confront to females. Discriminant functions combining four measurements (major and minor axes of the hyoid body, the distance between the lesser horns, and hyoid bone length) achieved a higher accuracy of sex prediction compared to univariate functions. The accuracies of machine learning models ranged from 0.8667 to 0.933 with precision, recall, and F1-scores also showing improvements. These findings underscore the robustness and reliability of hyoid bone in sex discrimination among Egyptians, supported by both traditional statistical methods and machine learning approaches, and could prove invaluable in forensic cases.

Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial.

Laparoscopic sleeve gastrectomy (LSG) causes significant postoperative pain, necessitating effective multimodal analgesia strategies. This study evaluated the efficacy of the external oblique intercostal block (EOIB) in this context. This prospective, randomized, controlled, single-blind study conducted between April and December 2023 included 60 patients who underwent LSG. Patients were divided into the EOIB (30 ml 0.25% bupivacaine/side) and control (no block) groups. The primary outcome was the cumulative intravenous (IV) morphine milligram equivalent (MME) consumption in the first 24 h postoperatively. Secondary outcomes included 12-h MME consumption, pain scores, intraoperative remifentanil use, rescue analgesia requirements, time to first analgesic request, nausea/vomiting scores, antiemetic use, and American Pain Society Patient Outcome Questionnaire-Revised Turkish Version (APS-POQ-R-TR) scores. The control group had significantly higher median opioid consumption than the EOIB group at 12 (14.4 vs. 5.8 mg; P < 0.001) and 24 h (25.9 vs. 10.6 mg; P < 0.001) postoperatively. The need for rescue analgesics did not differ significantly (43.3 vs. 23.3%: P = 0.1). The EOIB group exhibited significantly higher patient satisfaction (APS-POQ-R-TR score 2.91 vs. 4.42; P < 0.001) and consistently lower pain scores across all time points (P < 0.001) The EOIB group had lower nausea/vomiting scores (P < 0.001), fewer patients requiring antiemetics (16.7% vs. 40%; P = 0.045), longer time to first morphine request (57.5 vs. 25 min; P < 0.001), and lower remifentanil use (850 vs. 1050 μg; P < 0.001). The preoperative EOIB, as a part of multimodal analgesia, provides effective analgesia for acute pain in patients undergoing LSG.

The addition of vitamin E could reduce femoral head penetration of the polyethylene liners

BackgroundVitamin E-diffused highly cross-linked polyethylene (HXLPE/Vit E) is a relatively advanced material used in total hip arthroplasty (THA) but whether it shows superiority is unclear.ObjectiveThis meta-analysis was performed to investigate the effect of HXLPE/Vit E liners in THA.MethodsMedline/PubMed, Embase and Cochrane Library databases were searched to retrieve studies assessing the efficacy of HXLPE/Vit E liners in THA with the design of a randomized, controlled trial. Meta-analyses were conducted to merge the outcome estimates of interest, such as the femoral head penetration (FHP), FHP rate, FHP in x- (medial/lateral), y- (vertical) and z- (anteroposterior) axes, cup inclination angle, Harris hip score (HHS), numeric rating scale (NRS) and complications. Then pooled outcomes at different time points during the follow-up period were calculated.ResultsFollow an elaborate search of related databases, 23 studies involving a total of 54,920 participants were deemed eligible for this meta-analysis. The pooled results revealed significant decreased FHP at the last follow-up (pooled Mean Difference [MD] = -0.10, 95% confidence intervals [CIs]: -0.14 to -0.06). The subgroup analysis revealed a consistent trend at different time points during the follow-up. Significant decrease in the FHP rate were identified at the postoperative 1–2 years (pooled MD = -0.01, 95% CIs: -0.02 to -0.00) rather than at 2–5, 5–7, and 7–10 years. The combined results of clinical scores demonstrated no significant changes in the HHS, NRS, and EQ-5D variables. Additionally, no significant differences in the revision and cup inclination angle were identified during the follow-up period.ConclusionsThis study indicated that HXLPE/Vit E liner in total hip arthroplasty may decrease the femoral head penetration, mainly due to the decreased wear in proximal directions. However, no improvement on the clinical functions and complications were identified, and whether HXLPE/Vit E has the potential to prevent implant loosening or revision surgery could not be identified, which requires to be elaborated by high-quality randomized controlled trials.

Elaborating the connections of a closed-loop forebrain circuit in the rat: Circumscribed evidence for novel topography within a cortico-striato-pallidal triple descending projection, with thalamic feedback, to the anterior lateral hypothalamic area.

We used a bottom-up approach to identify a distinct longitudinal column of dorsomedial nucleus accumbens (ACBdm) that spans its anteroposterior axis. This region projects to medial substantia innominata (SIm) and lateral hypothalamic area (LHA), resembling the "direct" and "indirect" pathways of the classical basal ganglia circuit. We also identified topographically distinct regions in medial prefrontal cortex (strictly delineated here as the cingulate region, CNG), ventral subiculum (SUBv), and basolateral amygdala (BLA) that project to both ACBdm and LHA, further defining the circuit. Finally, we identified an LHA-to-anterior paraventricular thalamic nucleus (PVTa) feedback projection that selectively targets cortical and striatal nodes within the circuit. Our work provides novel detailed maps that bolster the proposal that this "triple descending projection" (cortico-striato-pallidal) and associated thalamic feedback loop play a role in affective and motivational processes.

Promoting longus colli muscle activation: Force direction in sitting matters.

There is limited evidence to inform exercise prescription for deep neck flexor activation out of supine. To compare activation of longus colli (LC) and sternocleidomastoid (SCM) from supine to sitting, and to compare the effect of craniocervical flexion (CCF) exercises in sitting on activation. Twenty-four individuals without neck pain (mean age 28.8 years, 12 females) completed 7 isometric CCF exercises (1 supine CCF, 6 sitting with applied head resistance through an elastic band in straight or oblique planes from the contra- or ipsilateral sides) while muscle activation was captured using ultrasound imaging. A 2-way analysis of variance examined the effects of exercise and muscle on percent change activation using planned post-hoc comparisons and Cohen's D to establish effect sizes. Supine CCF was equivocal to sitting CCF with resistance for LC activation (p=0.758). The LC muscle was most robustly activated by applying an ipsilateral oblique resistance force compared to a straight lateral force (p=0.002, Cohen's d=-0.82). LC activation was higher when oblique resistance was applied from the ipsilateral than contralateral side (p=0.002, Cohen's d=-0.84). SCM activation was higher resisting an ipsilateral lateral force compared to a contralateral force (p=0.0006, Cohen's d=1.06). Craniocervical flexion in supine and sitting activate LC equally but in sitting, applying oblique resistance during lateral flexion with extension enhances LC activation most effectively. Care should be taken with straight laterally applied forces since this can promote unwanted SCM activation.

Topology changes of Hydra define actin orientation defects as organizers of morphogenesis.

Hydra regenerates one head when cut, but how forces shaping the head are coordinated remains unclear. Soft compression of Hydra's head-regenerating tissues induces the formation of viable, two-headed animals. Compression creates new topological defects in the supracellular orientational order of muscular actin fibers, associated with additional heads. Theory supports that these defects organize muscle stresses required to shape the head. By compressing head-regenerating tissues along their body axis, we formed toroidal tissues, whose unique topology allows for the absence of defects. Toroids with no actin defects did not regenerate. Toroids with actin defects regenerated into viable toroidal animals with a bifurcated body. Topological defects in the actin orientational order are thus necessary for complete regeneration of Hydra, defining actin topological defects as mechanical organizers of morphogenesis.

A comparative developmental study of the avian syrinx: Insights into the homology of the sound-producing muscles in birds.

The anatomical innovation of sound-producing organs, which gives rise to a wide variety of sound signals, is one of the most fundamental factors leading to the explosive speciation of modern birds. Despite being a key clue to resolving the homology of sound-controlling muscles among birds, only few studies have explored the embryonic development of syringeal muscles. Using serial histological sections and immunohistochemistry, we described the three-dimensional anatomy and development of the cartilage, muscle, and innervation pattern of the tracheobronchi in three avian species: domestic fowls, cockatiels, and zebra finches. Crucially, the muscle primordia of the syringeal and tracheobronchial muscles develop from the caudal end of the lateral tracheal muscle in cockatiels and zebra finches. Furthermore, the tracheobronchial and syringeal muscle primordia of the zebra finches are subsequently split during embryonic development. Based on our findings on the identity of muscle primordia development and innervation pattern of the hypoglossal nerve between the cockatiels and zebra finches, we suggest that the muscle component traditionally documented as the superficial syringeal muscle in parrots is homologous to the tracheobronchial and ventral syringeal muscles of the zebra finches. These facts not only orchestrate the terminological discrepancies among previous studies, but also suggest that the syringeal muscles were acquired by the anatomical innovation of the lateral tracheal muscles in the common ancestor of the parrots and passerines, and further compartmentalized in the passerines, perhaps leading to a wide song repertoire for acoustic communication.