Ipsilateral Side Research Articles

Bilateral TMJ Changes Secondary to Unilateral Condylar Hyperplasia

Background: Patients with unilateral condylar hyperplasia (UCH) may present with TMJ symptoms, rather than concerns or recognition of asymmetry. Localization of TMJ pain may be on the affected (long) side, unaffected side, or both. Flattening, severe erosion and internal derangement on the opposite side can be appreciated radiologically. This can be a red herring, shielding the true diagnosis of UCH from the contralateral side. We hypothesize that excessive growth of the ipsilateral condylar neck and head on the side of UCH results in an upward and backward force on the opposite side TMJ, with resultant symptoms and findings (condylar flattening, anterior disk displacement, eminence changes). The purpose of this paper is to highlight the bilateral TMJ findings in UCH, and address potential treatment strategies. Methods: This is a retrospective study involving radiologic and biographical data from subjects with TMJ UCH, as well as controls. Patient details and high quality Cone beam CT (CBCT) scans (1 mm slices or less) were analyzed. CT scans were digitized and morphometric points were placed using Planmeca software (Hoffman Estates, Illinois). Linear and volumetric measures were taken in reference to the eminence, TMJ space, condylar position, and neck lengths. Volumetric analysis of the condylar head and neck was done using Analyze 14.0 software (Overland Park, KS, USA). Results were assessed using univariate analysis (T-Wilcoxon test). Results: Forty patients were included (29 with UCH, 11 controls). The condylar head was flatter and erosive appearing on the contralateral UCH side compared to both ipsilateral side in the same subject, and compared to controls. Analysis between the affected and unaffected sides in patients with UCH showed a significant difference in condylar head and neck length ( P = .0019) and volume ( P = .0030); anterior glenoid space ( P = .035) and vertical height of condylar eminence ( P = .00044). The difference in ramus length was not significant ( P = .6533). Between the controls and the UCH patients, there was a significant difference in the variance in condylar head and neck length ( P = 1.98e-07) and volume between the 2 sides ( P = 1.94e-08) but not ramus length ( P = 1). The vertical height of the condylar eminence was smaller on the affected side than in the controls ( P = .0018) and the anterior glenoid space was significantly smaller on the unaffected side compared to the controls ( P = .0053). Conclusion: This study highlights TMJ morphological differences in patients with UCH. These differences in condylar and glenoid morphology are consistent and should be used to aid and underpin the diagnosis and direct treatment. Importantly, patients who present with TMJ pain and erosion on one side, should be assessed for opposite side UCH, as the underlying culprit.

Role of Mast Cell in Hyperalgesic Priming and the Preventive Effect of Electroacupuncture on the Transition from Acute to Chronic Pain

Objective: Injury can lead to long-term changes that increase the sensitivity of afferent nerve endings to subsequent stimulation and pain can transition from acute to chronic. This phenomenon is known as hyperalgesic priming (HP). This study aimed to understand the mechanisms underlying the effect of Electroacupuncture (EA) on HP and optimize acupoint selection for EA to prevent pain transition. Methods: A rat HP model was established using sequential intraplantar injections of carrageenan (Cg) and prostaglandin E2 (PGE2). The pain thresholds were measured using von Frey filaments. EA on bilateral Zusanli(ST36) and Kunlun(BL60) was used to prevent pain transition. The number of mast cells in the ipsilateral hindpaw skin was determined using toluidine blue or fluorescence-labeled avidin staining. The protein expression levels of protein kinase C (PKCε) in the lumbar dorsal root ganglions (DRGs) were detected by western blotting 24 h after PGE2 injection. Serial pharmacological experiments were conducted to evaluate the relationship between mast cells and pain transition. Finally, EA on the bilateral ST36 and Chongyang(ST42) or a novel combination (ST36 and ST42 on the ipsilateral side, and ST36 and BL60 on the contralateral side) was used to prevent pain transition. Results: Although EA applied to ST36 and BL60 alleviated acute pain induced by Cg injection, it failed to prevent the pain transition caused by PGE2 injection. Mast cell accumulation in the ipsilateral hind paw was observed 7 days after Cg injection. Furthermore, mast cell degranulation may be responsible for PKCε activation in the DRG, a marker of pain transition. EA significantly decreased the number of mast cells in the skin of the ipsilateral hind paw when applied at ST36 and ST42, but not when applied at ST36 and BL60. Furthermore, EA employed to ST36 and ST42 significantly reversed long-term hyperalgesia induced by PGE2 injection, even when administered before injection. However, EA did not alleviate acute pain caused by Cg injection. By using a novel acupoint combination, EA simultaneously alleviated acute pain and prevented pain transition. Conclusions: Our study suggests that mast cells play a critical role in both HP and the transition from acute to chronic pain, whereas EA can prevent pain transition by decreasing the number of mast cells in the local tissue. Graphical abstract: http://links.lww.com/AHM/A144.

Multiparametric MRI targeted prostate biopsy: When omit systematic biopsy?

Introduction: To evaluate the detection rate for prostate cancer (PCa) performing multiparametric magnetic resonance imaging (mpMRI) fusion targeted biopsy (TPBx) combined only with ipsilateral systematic prostate biopsy (SPBx). Materials and Methods: From January 2023 to December 2023, 495 men with clinical suspicion of PCa underwent transperineal SPBx plus TPBx in the presence of PI-RADS score lesions ≥ 3. Results: In 250/495 men (50.5%) a PCa was found, while 36/250 (14.4%) men had negative mpMRI. In comparison to TPBx, SPBx diagnosed a higher number of indolent PCa, 38.5 vs. 5.8%, respectively; conversely, SPBx demonstrated a higher detection rate for clinically significant PCa (97.3 vs. 85.4%) in the presence of ISUP Grade Group 2 (GG2). In details, rates were higher in the presence of GG2 (100 vs. 76%), GG3 (85.7 vs. 75.8%) and GG4 (100 vs. 86.4%) tumors. However, in GG5, both SPBx and TPBx diagnosed 100% of csPCa. Furthermore, 89.4% of the cases showed csPCa on the negative mpMRI side. Conclusions: SPBx combined with TPBx maximized csPCa diagnosis; the use of reduced biopsy scheme limited to ipsilateral side of mpMRI lesion plus TPBx missed 11.6% csPCa. Only in the presence of PI-RADS score 5 SPBx and TPBx diagnosed both 100% of csPCa.

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

Background: 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. Purpose: 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. Study Design: Controlled laboratory study. Methods: 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. Results: 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). Conclusion: 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. Clinical Relevance: 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.

Decreased choriocapillaris vessel density in the ipsilateral eye after carotid artery revascularization detected by widefield SS-OCTA.

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.

Oncological and Surgical Outcomes of Oncoplastic Reduction Mammoplasty: A Single-centre Retrospective Study.

Breast-conserving surgery is the preferred treatment for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to improve both oncologic and aesthetic outcomes by combining local excision with plastic surgery techniques. Using breast reduction techniques in breast cancer treatment has been shown to allow for wider margins of excision, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This study aimed to analyze the surgical and oncological outcomes of a large cohort of patients undergoing oncoplastic reduction mammoplasty (ORM). A retrospective analysis of postoperative surgical and oncological outcomes of all patients who underwent ORM at a single center between January 2018 and December 2023 was performed. Preoperative patient characteristics, operative and post-operative outcomes were recorded and analyzed. A total of 67 patients that underwent oncologic breast reduction were included in the final analysis - representing a total of 71 ORM, with a mean (SD) age of 53.1 (10.5) years and a mean (SD) BMI of 28.8 (5.9) kg/m2 A superomedial pedicle-based technique was the most frequently used (36.6%), followed by inferior pedicle-based technique (28.1%). A complication rate of 18.3% on the ipsilateral side was observed. Salvage surgery was necessary in five cases (7.0%) due to positive margins - with one patient (1.4%) requiring margin expansion surgery and four (5.6%) a completion mastectomy. This monocentric retrospective study shows that ORM is safe, with a complication rate on par with conventional breast reduction and offers satisfactory oncological outcomes.

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.

Prognostic factors and outcomes of chronic limb threatening ischaemia in patients post kidney transplant: a systematic review

BackgroundKidney Transplantation (KT) is widely recognized as the optimal treatment for patients with End Stage Renal Disease (ESRD), improving not only life expectancy but also quality of life. Undetected peripheral arterial disease (PAD) in patients undergoing KT may lead to lower limb ischaemic ulceration and gangrene which is associated with an increased mortality rate. If undiagnosed and untreated this may lead to limb loss and graft failure. This review aims to evaluate the current evidence related to the prognosis of chronic limb-threatening ischemia (CLTI) in patients with a KT.MethodsWe conducted a systematic review of the literature in PubMed and MEDLINE, the Cochrane database of systematic reviews, Elsevier, Web of Science, and CINAHL using relevant search keywords to identify the prognosis and progression of CLTI in patients with a KT. Outcomes of interest were CLTI and progression rate in terms of haemodynamic measurement. This systematic review adhered to the guidelines set forth by the Cochrane Collaboration. The study design, population selection, and follow-up time frame were outlined in accordance with the PRISMA guidelines.ResultsStudies have shown a decline in the ankle-brachial index (ABI) post-KT, indicating vascular deterioration. Surgical interventions and amputations are more likely, particularly on the ipsilateral side of KT. The infrapopliteal artery is the most compromised in this cohort. A low ABI was found to be an independent predictor of graft failure, doubling the risk of mortality post-KT. Quality of evidence was observed to be low primarily due to confounding and selection bias.ConclusionsThe available evidence regarding the prognosis of CLTI in individuals with KT is limited to a small number of studies offering predominantly low-quality evidence and conflicting results pertaining to PAD and its progression into CLTI. Further research is required on CLTI prognosis and progression among KT recipients.

Impact of Significant Sac Shrinkage on Endograft Tortuosity at 5 Years Postendovascular Aortic Aneurysm Repair: A Retrospective Analysis

Significant sac shrinkage after endovascular aortic aneurysm repair (EVAR) is generally considered a positive outcome indicative of durable clinical success. However, its impact on endograft configuration is rarely addressed. Sac remodeling and volume loss due to shrinkage can potentially cause deformation of endograft components, resulting in limb angulation and compression. We investigated the hypothesis that significant sac shrinkage could affect endograft tortuosity at 5 years post-EVAR. We retrospectively reviewed patients who underwent elective EVAR for infrarenal abdominal aortic aneurysm between June 2007 and December 2018. Patients with early postoperative and 5-year follow-up CT images were included. Patients treated with modular bifurcated endografts (Zenith, Endurant, Excluder, and Incraft) were analyzed. The "shrinkage" group comprised patients with >10mm diameter reduction, while the "stable" group had ±5mm diameter change at 5 years. Tortuosity index (TI) was calculated as the ratio of centerline distance to straight-line distance between proximal and distal endograft edges. The association between sac shrinkage and ≥5% increase of TI (≥5%ΔTI) was analyzed for both ipsilateral and contralateral sides. Of 136 patients enrolled, 80 were in the shrinkage group and 56 in the stable group. On the ipsilateral side, ≥5%ΔTI was observed in 24 cases (17.6%). Patients with ipsilateral ≥5%ΔTI had significantly shorter median neck lengths (22mm vs 30mm, p = 0.030). Sac shrinkage ≥15mm was negatively associated with ≥5%ΔTI compared to stable sac (p = 0.027). Logistic regression showed sac shrinkage ≥15mm had a significant negative correlation with ≥5%ΔTI (p = 0.025, HR [95% CI] 0.218 [0.057-0.824]). On the contralateral side, ≥5%ΔTI (19 cases, 14.0%) was associated with shorter neck length but not with sac shrinkage. In the shrinkage group, cross-leg positioning resulted in a significant increase in ipsilateral TI at 5 years compared to straight positioning (median ΔTI: 1.8% vs 0.0%, p = 0.013). No reinterventions for leg-related events were necessary during the 5-year follow-up period. Contrary to our initial hypothesis, significant sac shrinkage does not adversely affect endograft configuration and may help stabilize tortuosity on the ipsilateral side. However, in patients with crossed-leg configuration, continued vigilant observation may be warranted even after achieving sac shrinkage, as it could exacerbate tortuosity. Shorter neck length was associated with increased tortuosity on both sides. Further research is needed to confirm these findings and consider potential confounding factors, including the impact of different endograft designs.

Appearance time of blood in the brain as a possible indicator of oxygen extraction fraction: a feasibility study

BackgroundImaging examination of cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen is crucial for understanding the normal functioning and pathophysiology of the brain. A recently developed method estimates the appearance time of cerebral blood (ATB) pixel-wise from the imaging examination of CBF alone. In this study, we aimed to test the potential of ATB as an indicator of OEF.ResultsWe retrospectively reviewed patients (n = 62) with suspected cerebrovascular disorders including steno-occlusive disease who underwent positron emission tomography (PET) with 15O-labelled tracers. Regarding the generated OEF and ATB images, a visual assessment was performed to test the consistency of the elevated OEF and delayed ATB. The OEF and ATB values and the absolute differences between their ipsilateral and contralateral sides were extracted and obtained for the entire hemisphere and the middle, anterior, and posterior cerebral arterial regions. Consistency was observed in 52 PET scans (83.9%) in visual assessment. The OEF and ATB values were moderately correlated (r = 0.553, p < 0.001), and the differences between their ipsilateral and contralateral sides were weakly correlated (r = 0.276, p < 0.001).ConclusionOur results indicate the potential of ATB as an indicator of OEF.

Artefacts on magnetic resonance imaging with Osia®2 bone conduction hearing aid: A cadaver study

Objectives: Hearing implants often limit the assessment of magnetic resonance examinations due to susceptibility artefacts. Our aim was to evaluate the impact of artefacts attributed to the Osia®2 implant system in terms of utility in visualizing selected cranial structures. Methods: A BI300 implant and an OSI200 actuator were implanted into a human cadaver head in the audiologically most favourable position according to the manufacturer’s guidelines. Scanning was accomplished using the institutional head and inner ear protocol with a General Electric 1.5 Tesla scanner with retained and removed implant magnet, extended with T1 and T2 weighted sequences with metal-artefact reduction (MAVRIC SL). Image quality was evaluated by three radiologists. Results: The Osia®2 produced significant artefacts in most of the series of standard imaging sequences predominantly on the ipsilateral side of the head. The majority of the artefacts were caused by the implant magnet. Even without removing the magnet, MAVRIC SL improved image quality to such an extent that it became comparable with that after magnet removal. Conclusions: The standard sequences suffer considerable quality loss due to the artefacts, attributed predominantly to the magnetic component. Metal-artefact reduction sequences are effective in obtaining sufficient-to-good quality images without surgical magnet removal.

Effects of end-effector robotic arm reach training with functional electrical stimulation for chronic stroke survivors

ABSTRACT Background Upper-extremity dysfunction significantly affects dependence in the daily lives of stroke survivors, limiting their participation in the social environment and reducing their quality of life. Objectives This study aimed to investigate the effect of end-effector robotic arm reach training (RAT) with functional electrical stimulation (FES) on upper-limb motor recovery in chronic stroke survivors. Methods In this single-blinded randomized controlled trial, 28 chronic stroke survivors were randomized to receive RAT-with-FES and RAT-without-FES for 40 min/day, three times per week over a 4-week period, and the data of 26 participants were used in the final analysis. Upper-limb motor recovery was measured using the Fugl-Meyer assessment (FMA), and kinematics (movement time, speed, and distance) during reaching movements toward targets placed in three directions (ipsilateral, median, and contralateral sides) were measured using a robotic arm. Results The upper-limb motor recovery (FMA and kinematics) improvement for the within-group comparisons tended to be greater in the RAT-with-FES group than in the RAT-without-FES group. However, in the between-group comparison, no significant differences were found in FMA, and significant differences were observed only for 2 distance parameters of kinematic factors: total (23.0% vs. 1.7%) and straight total (25.5% vs. 2.6%) distance on the ipsilateral side (p < 0.05). Conclusions This study was unable to clearly reveal the positive effects of electrical stimulation combined with robotic arm training. However, we believe that it provides basic data that furthers our understanding of the role of hybrid neuroprostheses in stroke rehabilitation and the factors determining successful treatment.

Should individuals with unilateral transtibial amputation carry a load on their intact or prosthetic side?

Carrying side loads often occurs during activities of daily living. As walking is most unstable mediolaterally, side load carriage may further compromise gait biomechanics, especially for transtibial amputees (TTAs). This study investigated the effects of side load carriage on gait kinetics during steady-state walking to determine which side, intact or prosthetic, TTAs should carry a load. Twelve unilateral TTAs wore a passive-elastic foot and carried a side load of 13.6 kg while walking at their self-selected speed. Kinetic metrics, including ground reaction force peaks and impulses, loading and unloading rates, and joint moments and powers, were analyzed. TTAs had smaller propulsive forces on their intact limb during the prosthetic side load condition. During the intact side load condition, they exhibited smaller hip flexor moment in late stance and smaller knee flexor moment at the end of swing on their intact limb. They had higher hip and knee abductor moments on their intact limb and prosthetic limb in early and late stance during the contralateral side load condition. TTAs generated higher hip extensor power at weight acceptance during the ipsilateral side load. Significant interactions were observed in hip extensor power and abductor moment, suggesting strong associations between hip extensor power generation and the ipsilateral side load and between hip abductor moment and the contralateral side load. These mixed results demonstrate some kinetic changes due to side load carriage and suggest that the side TTAs should carry a load depends on the desired effects, primarily on their intact limb.

Paresis of the Oculomotor nerve due to neurovascular conflict with Superior Cerebellar Artery

Background: Neurovascular conflict between the Oculomotor nerve (CN III) and any of the posterior circulation cerebral arteries is a relatively frequent radiological finding, however, it does not manifest clinically or manifests itself only minimally (slowly reacts to light on the ipsilateral side). Sustained paresis of CN III arose directly due to neurovascular conflict between the Superior Cerebral Artery (SCA) and CN III, resolved after microvascular decompression, is extremely rare and has not yet been published. Aim: This case report aims to present a case of a scarce clinical condition caused by a generally common anatomical variation. This variation was proved to be the only cause of the clinical status and the symptoms did resolve after microsurgical restoration of the neuroanatomy. Case description: A 34-year-old female patient presented with an advancing ptosis and a downward gaze on one side. Differential diagnostics ruled out all other causes of the Oculomotor paresis, MRI showed significant oppression of the Oculomotor nerve by an aberrant SCA on the ipsilateral side. Neurovascular decompression performed microsurgically has resulted in near complete resolution of the symptoms. Conclusions: Oculomotor nerve paresis caused directly by neurovascular conflict is an extremely rare diagnosis, but microvascular decompression should be considered in these cases, especially if other reasons have been excluded.

The Cytidine N-Acetyltransferase NAT10 Promotes Thalamus Hemorrhage-Induced Central Poststroke Pain by Stabilizing Fn14 Expression in Thalamic Neurons.

The recognition of RNA N4-acetylcytidine (ac4C) modification as a significant type of gene regulation is growing; nevertheless, whether ac4C modification or the N-acetyltransferase 10 protein (NAT10, the only ac4C "writer" that is presently known) participates in thalamus hemorrhage (TH)-induced central poststroke pain (CPSP) is unknown. Here, we observed NAT10 was primarily located in the neuronal nuclei of the thalamus of mice, with Fn14 and p65. An increase of NAT10 mRNA and protein expression levels in the ipsilateral thalamus was observed from days 1 to 14 after TH. Inhibition of NAT10 by several different approaches attenuated Fn14 and p65 upregulation of TH mice, as well as tissue injury in the thalamus on the ipsilateral side, and the development and maintenance of contralateral nociceptive hypersensitivities. NAT10 overexpression increased Fn14 and p65 expression and elicited nociceptive hypersensitivities in naïve mice. Our findings suggest that ac4C modification and NAT10 participate in TH-induced CPSP by activating the NF-κB pathway through upregulating Fn14 in thalamic neurons. NAT10 could serve as a promising new target for CPSP treatment.

Asymmetry and rehabilitation of the subjective visual vertical in unilateral vestibular hypofunction patients.

Patients with acute unilateral peripheral vestibular hypofunction (AUVP) show postural, ocular motor, and perceptive signs on the diseased side. The subjective visual vertical (SVV) test measures the perceived bias in earth-vertical orientation with a laser line in darkness. This study was aimed at (1) examining whether SVV bias could depend on preset line orientation and angles, and (2) investigating whether vestibular rehabilitation (VR) can improve SVV normalization. To our knowledge, SVV symmetry/asymmetry and impact of VR on SVV normalization have never been documented in the literature. We investigated the SVV bias in a retrospective study (Study 1: n = 42 AUVP patients) comparing the data recorded for line orientation to the ipsilateral and contralateral sides at preset angles of 15° and 30°. We investigated the effects of VR on SVV normalization in a prospective study (Study 2: n = 20 AUPV patients) in which patients were tilted in the roll plane using a support tilted to the hypofunction side with the same amplitude as the SVV bias. This VR protocol was performed twice a week for 4 weeks. Supplementary data on body weight distribution and medio-lateral position of the center of foot pressure (CoP) were obtained using posturography recordings. Study 1 showed asymmetrical values of the SVV bias. On average, the SVV errors were significantly higher for ipsilateral compared to contralateral line orientation (6.98° ± 3.7° vs. 4.95° ± 3.6°; p < 0.0001), and for 30° compared to 15° preset angle (6.76° ± 4.2° vs. 5.66° ± 3.3°; p < 0.0001). Study 2 showed a fast SVV normalization with VR. Non-pathological SVV bias (below ±2°) was found after only 3 to 5 VR sessions while pathological SVV values were still observed at the same time after symptoms onset in patients without VR (1.25° ± 1.46° vs. 4.32° ± 2.81°, respectively; p < 0.0001). A close temporal correlation was observed in the time course of body weight distribution, mediolateral CoP position, and SVV bias over time, suggesting beneficial effects of the VR protocol at both the perceptive and postural levels. We recommend routine assessment of the ipsilateral and contralateral SVV bias separately for a better evaluation of otolith organs imbalance that can trigger chronic instability and dizziness. The SVV bias and the postural impairment caused by the imbalanced otolith inputs after unilateral vestibular loss can be rapidly normalized by tilting the patients in the roll plane, an additional means in the physiotherapist's toolbox. The protocol likely reweights the visual and somatosensory cues involved in the perception of verticality.

Postoperative Orbital Morphology Observations Following Fronto-Orbital Advancement and Cranial Vault Remodeling in Patients With Unilateral Coronal Synostosis.

Observations of preoperative and postoperative orbital morphology following fronto-orbital advancement and cranial vault remodeling (FOA and CVR) in patients with unilateral coronal synostosis (UCS). This retrospective cohort included patients diagnosed with unilateral coronal synostosis and treated with fronto-orbital advancement and cranial vault remodeling at the Children's Hospital of Fudan University. The orbital height, orbital width, and orbital volume were obtained from head 3-dimensional computed tomography of preoperation and postoperation. The DICOM data of CT were then imported into mimics research version 21.0. The authors measured OH and OW according to the bony landmarks, then reset the parameters of the soft tissue window, and conducted a 3-dimensional reconstruction of the orbital soft tissue to get OV. The preoperative and postoperative measurements of the intact side were compared with the affected side, respectively. Statistical analysis was performed using SPSS version 25.0 (Ρ=0.05). Twelve patients with UCS (5 male, 7 female) meeting criteria were included in the study. There were 4 patients with UCS on the left and 8 on the right. The average age at initial surgery was 19.50 months. Before the operation, the data of the intact side and the affected side were compared, respectively, and the difference was found to be significant in OH (Ρ=0.005) and OW (Ρ=0.005), while the OV (Ρ=0.106) was not statistically significant. After procedures of FOA and CVR, the data of the intact side and the affected side were compared, respectively, the significant difference was found in OV (Ρ=0.002), while not in OH (Ρ=0.060) or OW (Ρ=0.066). After undergoing the operation of FOA and CVR, the OH and OW of the ipsilateral and contralateral sides of patients with UCS were basically symmetrical, while the volume of the affected orbit was still relatively smaller.

Choke Anastomosis: A Key Element Acting as a Shunt Converter Between Adjacent Angiosomes.

Choke anastomosis is commonly recognized as a resistance factor that detrimentally affects the hemodynamics of the skin flap; however, its additional potential physiological roles in normal skin function are currently not fully understood. Ten cadaveric forehead flap specimens pedicled with unilateral STAs were perfused with lead oxide-gelatin mixture, and then dissected into 3 layers, including the super temporal fascia-frontalis-galea aponeurotica layer, the subcutaneous adipose tissue layer, and the "super-thin flap" layer. The forehead flap and stratified specimens underwent molybdenum target x-ray and subsequent transparent processing to effectively visualize the microscopic spatial architecture of arterial vessels across all levels. Based on the different anastomoses near the midline area of the flap, 2 types of arterial perfusion were identified: choke anastomosis type (8/10) and true anastomosis type (2/10). The former formed multiple choke anastomoses near the midline. In the "super-thin flap" layer, arterial perfusion density on the ipsilateral side was significantly higher compared to that on the contralateral side. The arterioles on the ipsilateral side exhibited a dense and uninterrupted distribution, whereas those on the contralateral side appeared sparse and dispersed. The latter exhibited an alternative perfusion pattern; the bilateral arterial vessels were connected with 3 to 5 true anastomoses near the midline. Furthermore, the microscopic architecture confirmed a uniform distribution of arterioles that remained continuous from ipsilateral to contralateral sides in the "super-thin flap" layer. This study demonstrated that choke anastomosis not only impairs blood perfusion in the adjacent angiosomes but also acts as a shunt converter to impact the blood supply of distal skin flaps at different levels through the "trans-territory diversion phenomenon." This results in necrosis of the superficial dermis while preserving survival of the deep subcutaneous adipose tissue.

Relationship between onset of trunk muscle activities and pelvic kinematics in individuals with and without chronic low back pain.

Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the pelvic tilt, oblique and rotation. The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P< 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P= 0.019, r= 0.597), whereas no significant correlation was observed in the CLBP group (P= 0.810, r=-0.068). The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP.

Trans Oblique Ileal Conduit Technique Has a Low Risk of Parastomal Hernias

ObjectivesTo outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. MethodsWe identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate two years after surgery. Additionally, we present the 30-day postoperative complication rate. Results50 underwent transoblique conduits and we matched them to 190 transrectus patients. 67% were men with a median age of 62. 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The two-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least one postoperative complication. ConclusionsA transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates.