Medial Segment Research Articles

Primary pulmonary alveolar soft part sarcoma with ASPSCR1-TFE3 gene fusion: Case report and literature review.

Primary pulmonary alveolar soft part sarcoma (ASPS) is an extremely rare disease characterized by a specific genetic abnormality - the ASPSCR1-TFE3 gene fusion. This study presented a 27-year-old male patient who experienced persistent chest tightness for over 6 months. The computed tomography (CT) scan and enhanced CT scan revealed a mass in the medial segment of the right middle lobe of his lung. The patients then underwent further diagnosis. Pathological examination showed the tumor to be consisting of polygonal cells with abundant eosinophilic or transparent cytoplasm arranged in nests. Next-generation sequencing reported ASPSCR1-TFE3 gene fusion, confirming the final diagnosis of primary pulmonary ASPS. Regular follow-ups of 12 months showed no signs of tumor recurrence. The patients underwent the medial segment resection of the right middle lobe for treatment. A CT examination 3 months after the operation showed that the patient had improved. The last review showed no recurrence or metastasis. This case report highlights the importance of detailed diagnosis, prompt treatment, and close monitoring of patients with ASPS.

027. Successful Management of Penetrating Thoracic Injury With Impaled Object: A Case Report

Background: Penetrating thoracic injuries with impaled objects are rare but potentially life-threatening emergencies that require immediate medical intervention. These injuries pose significant challenges due to the risk of pneumothorax, hemothorax, and lung laceration. Prompt diagnosis and surgical management are essential to prevent severe complications. Case: A 28-year-old male was admitted to Adam Malik Hospital with a chief complaint of shortness of breath following an accident where a foreign object impaled his right chest. The injury occurred while he was repairing his motorcycle, and an explosion caused the object to penetrate his chest. The patient reported continuous right chest pain, worsened by breathing. On examination, he was alert with stable hemodynamics (BP: 130/70 mmHg, HR: 98 bpm, SpO2: 99% on 10L NRM), and a penetrating wound of 5x2x3 cm was observed in the right chest. Chest X-ray and clinical assessment confirmed a diagnosis of hemopneumothorax with an impaled object. Emergency thoracotomy revealed 800cc of hemorrhagic fluid, lung laceration, and a foreign body penetrating the right lung's superior and medial segments. The foreign body was removed, the lung was sutured, and a thoracic drain was placed. Conclusion: This case highlights the importance of timely surgical intervention in penetrating thoracic injuries. Hemodynamic stability and appropriate surgical techniques led to a successful outcome in this patient, demonstrating the effectiveness of rapid, multidisciplinary management in emergency thoracotomy.

The influence of сestodes parasitizing in the small intestine of herring gull chicks on the activity of the host proteases

The activity of proteases and subclasses of proteases in small intestines of the herring gull (Larus argentatus (Pontoppidan, 1763)) chicks were determined. Changes of the protease activity in chicks infested by cestodes Tetrabothrius erostris (Loennberg, 1889) (Cestoda: Tetrabothriidae), Microsomacanthus ductilus (Linton, 1927) (Cestoda: Hymenolepididae), Wardium cirrosa (Krabbe, 1869) (Cestoda: Aploparaksidae), Arctotaenia tetrabothrioides (Loennberg, 1890) and Alcataenia larina (Krabbe, 1869) (Cestoda: Dilepididae) were studied. The activity of serine proteases decreased in the small intestine of gulls at the sites of cestode parasitism with high infestation values (M. ductilus in the proximal segment, W. cirrosa in the distal segment, A. tetrabothrioides, T. erostris and A. larina in the medial segment). The activity of cysteine proteases increased in the sites of localization of cestodes M. ductilus, W. cirrosa and A. larina. All the studied cestodes adsorbed proteases on the surface of the tegument, most of those were represented by serine proteases. Cestode homogenates of W. cirrosa, M. ductilus, A. tetrabothrioides, T. erostris and A. larina inhibited the activity of host proteases and the activity of commercial trypsin.

Suitability of Hair Testing in Medical Dispensing Errors: A Fatal Case of Gliclazide Poisoning

ABSTRACTA patient was prescribed a new treatment, 40 mg furosemide. Her pharmacist mistakenly dispensed 40 mg gliclazide instead. After 3 weeks of treatment, the patient was found in a coma, was hospitalised and died after a week. Hair sample was collected during post‐mortem examination and tested for gliclazide on three 2 cm sections, starting at the root end. Hair strands were decontaminated, segmented and incubated in the presence of diazepam‐d5, and a solid–liquid extraction has been performed. Finally, toxicological analyses were performed by UFLC Shimadzu Prominence ‐ MS/MS Sciex 6500 QTRAP. Gliclazide was found on the proximal (238 pg/mg), median (77 pg/mg) and distal (69 pg/mg) segments. The concentration in the proximal segment was largely higher than in the other two, which demonstrates repeated intake of gliclazide by the patient during at least the last 2 months before death. The lower concentrations in the medial and distal segments, as well as a part of the concentration in the proximal segment, may be linked to external hair contamination. These could be due to either radial sweat diffusion, possibly occurring in the last week hospitalisation of the patient, or to biological fluids contamination during post‐mortem examination. This case illustrates the opportunity to confirm slow and fatal chronic poisoning by gliclazide using hair analysis and shows the benefit of hair testing for the investigation of medical or dispensing errors.

Linking NAFLD and Nephrolithiasis: A CT-Based Investigation

Objective: To evaluate the association between NAFLD and renal stone detected on computed tomography. Method: This study encompassed 240 patients who underwent noncontrast CT abdomen-pelvis computed tomography between November 2023 and April 2024. The nonalcoholic fatty liver disease group included those who had a reduced mean Hounsfield unit (HU) of the right lobe, lateral and left medial segment of the liver as compared to that of the spleen. The control group included patients who had liver parenchyma HU larger than spleen HU. All patients were examined for the presence or absence of radiopaque kidney, ureter, or urinary bladder stones, whether symptomatic or not. Results: From 240 patients, 122 were healthy (50.8%) without NAFLD or renal stone disease. NAFLD was found in 88 individuals with a mean age of 46.8±17.7 years, 42 (47.7%) males and 46 (52.3%) women. Renal stone disease was detected in 70 patients, accounting for 29.1% of the total. The average age of these patients was 43.7± 19.3 years, with 32 males and 38 females. Forty individuals with NAFLD had renal stones (45.5%) which was significantly more than the prevalence in those who are NAFLD negative 13 (19.7%), p <0.001. Females with NAFLD had a considerably greater renal stone rate (52.2%) compared to those without NAFLD (16.3%), P < 0.001. Conclusion: Patients with non-alcoholic fatty liver disease (NAFLD) had a significantly higher incidence of renal stone disease compared to persons with a healthy liver, especially among women.

Fungal Pneumonia in a Diabetic Female Masquerading as Primary Lung Cancer

Abstract Aspergillus is a ubiquitous saprophytic mold that humans and animals constantly inhale. In health, the conidia are eliminated by the innate immune system. However, a subset of individuals with risk factors such as neutropenia, receiving high doses of glucocorticoids or certain biologicals, and recipients of hematopoietic or solid-organ transplants develop invasive aspergillosis. The mortality associated with invasive aspergillosis is 42%–64%. The early diagnosis of invasive pulmonary aspergillosis in patients without classical risk factors remains challenging. We present a case of an elderly female with uncontrolled diabetes mellitus who presented with acute-onset chest pain, breathlessness, and cough without expectoration. On evaluation, her chest radiograph showed a mass lesion in the right upper zone. 18Fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography showed two FDG-avid lesions in the apical and medial segment of the right upper lobe. The lung biopsy was negative for malignancy; however, she was diagnosed with invasive pulmonary aspergillosis based on serum and bronchoalveolar fluid galactomannan positivity. She was managed with voriconazole with complete resolution of the lesion.

Additional suture augmentation to anterior cruciate ligament reconstruction with hamstring autografts bring no benefits to clinical results, graft maturation and graft-bone interface healing

BackgroundFrom the perspective of graft protection and early rehabilitation during the maturation and remodeling phases of graft healing, suture augmentation (SA) for anterior cruciate ligament reconstruction (ACLR) has attracted more and more attention.Study DesignRetrospective study.PurposeTo determine whether the additional SA affects clinical results, graft maturation and graft-bone interface healing during two years follow-up after ACLR.Methods20 ACLRs with additional SA (ACLR-SA group) and 20 ACLRs without additional SA (ACLR group) were performed between January 2020 and December 2021 by the same surgeon and were retrospectively analyzed. Pre- and postoperative International Knee Documentation Committee (IKDC) scores, Lysholm scores, graft failure and reoperation were evaluated. The signal/noise quotient (SNQ) of autografts and the signal intensity of graft-bone interface were analyzed. All 40 patients in ACLR-SA group and ACLR group completed 2-years follow-up.ResultsThere was no patient in the two cohorts experienced graft failure and reoperation. The postoperative IKDC and Lysholm scores have been significantly improved compared with preoperative scored in both ACLR-SA group and ACLR group, however, there was no significant difference between two groups. The SNQ of proximal graft of ACLR-SA group (14.78 ± 8.62 vs. 8.1 ± 5.5, p = 0.041) was significantly greater while the grades of graft-bone interface healing of posterior tibial was significantly lower than that of ACLR group at 1-year postoperatively (p = 0.03), respectively. There were no significant differences between the two groups of the SNQ of proximal, distal medial graft segments, and the graft-bone interface healing grades of anterior femoral, posterior femoral, anterior tibial and posterior tibial at other time points (p>0.05).ConclusionsThe additional SA in ACLR had no effect on IKDC scores, Lysholm scores, graft maturation and graft-bone interface healing at 2-year postoperatively. Our research does not support the routine use of SA in ACLR.

Decreased Cerebral Perfusion in Chronic Migraine: A Voxel-based Cerebral Blood Flow Analysis Using 3D Pseudo-continuous Arterial Spin Labeling.

A contrast agent-free approach would be preferable to the frequently used invasive approaches for evaluating cerebral perfusion in chronic migraineurs (CM). In this work, non-invasive quantitative volumetric perfusion imaging was used to evaluate alterations in cerebral perfusion in CM. We used conventional brain structural imaging sequences and 3D pseudo-continuous arterial spin labeling (3D PCASL) to examine thirteen CM patients and fifteen normal controls (NCs). The entire brain gray matter underwent voxel-based analysis, and the cerebral blood flow (CBF) values of the altered positive areas were retrieved to look into the clinical variables' significant correlation. Brain regions with the decreased perfusion were located in the left postcentral gyrus, bilateral middle frontal gyrus, left middle occipital gyrus, left superior parietal lobule, left medial segment of superior frontal gyrus, and right orbital part of the inferior frontal gyrus. White matter fibers with decreased perfusion were located in bilateral superior longitudinal tracts, superior corona radiata, external capsules, anterior and posterior limbs of the internal capsule, anterior corona radiata, inferior longitudinal fasciculus, and right corticospinal tract. However, the correlation analysis showed no significant correlation between the CBF value of the above positive brain regions with clinical variables (p > 0.05). The current study provided more useful information to comprehend the pathophysiology of CM and revealed a new insight into the neural mechanism of CM from the pattern of cerebral hypoperfusion.

Default mode network perturbations in Alzheimer's disease: an fMRI study in Klang Valley, Malaysia

The default mode network (DMN) is a large neural network that has a significant correlation with Alzheimer's disease (AD). Grey matter volume (GMV) and functional connectivity (FC) involving the regions of the DMN have been noted to differ significantly between AD and healthy older adults. Nevertheless, there is a paucity of data on the structural and functional changes in the DMN of AD patients in Malaysia. We conducted a cross-sectional study in Klang Valley, Malaysia, to evaluate AD subjects compared to healthy controls (HC) using a resting-state functional MRI (rs-fMRI) experiment. We recruited 22 subjects (AD=11, HC=11) and conducted neuropsychological tests such as the Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). The subjects then underwent rs-fMRI scans, and subsequently, we quantitatively analysed the GMV by Voxel based Morphometry (VBM) using the structural data. We also utilised the CONN toolbox on Statistical Parametric Mapping (SPM) software to evaluate the FC and activation of the nodes of the DMN. In comparison with the HC group, the AD group demonstrated a reduction in GMV in the right and left inferior temporal gyrus, left superior frontal gyrus, right superior frontal gyrus medial segment, right gyrus rectus, right temporal lobe, left putamen, and right precuneus. Moreover, there was a significant decrease in the FC of the nodes of the DMN noted on rs-fMRI (cluster-size corrected p<0.05). In particular, the precuneus and anterior cingulate cortex had decreased FC in AD compared to HC. Hence, structural and resting-state fMRI can detect distinct imaging biomarkers of AD based on GMV and DMN functional connectivity profiles. This tool can be used as a non-invasive tool for improving the feature detection and diagnosis of AD in the Malaysian population.

A case of laparoscopic hepatic S4 partial resection after coronary artery bypass grafting using the right gastroepiploic artery

AbstractLaparoscopic liver resection has become safer over time, making it a viable option for patients previously considered high‐risk. We discuss a case in which a 73‐year‐old man underwent laparoscopic liver resection after coronary artery bypass grafting using the right gastroepiploic artery (RGEA). The patient was noted to have liver metastases of rectal cancer in the medial segment. Laparoscopic hepatic S4 partial resection was done after preoperative assessment of the RGEA graft pathway by computed tomography. During the operation, the RGEA graft was adherent to the dorsal surface of the liver, but the laparoscopic approach allowed fine dissection. The tumor was then safely removed, and the patient was discharged without complications. Preoperative assessment of the graft pathway is necessary because of the lack of tactile sensation during laparoscopic surgery. However, a magnified view of the laparoscope enabled us to perform fine dissection to avoid injury to the graft vessels.

Systematic reduction of gray matter volume in anorexia nervosa, but relative enlargement with clinical symptoms in the prefrontal and posterior insular cortices: a multicenter neuroimaging study

Although brain morphological abnormalities have been reported in anorexia nervosa (AN), the reliability and reproducibility of previous studies were limited due to insufficient sample sizes, which prevented exploratory analysis of the whole brain as opposed to regions of interest (ROIs). Objective was to identify brain morphological abnormalities in AN and the association with severity of AN by brain structural magnetic resonance imaging (MRI) in a multicenter study, and to conduct exploratory analysis of the whole brain. Here, we conducted a cross-sectional multicenter study using T1-weighted imaging (T1WI) data collected between May 2014 and February 2019 in Japan. We analyzed MRI data from 103 female AN patients (58 anorexia nervosa restricting type [ANR] and 45 anorexia nervosa binge-purging type [ANBP]) and 102 age-matched female healthy controls (HC). MRI data from five centers were preprocessed using the latest harmonization method to correct for intercenter differences. Gray matter volume (GMV) was calculated from T1WI data of all participants. Of the 205 participants, we obtained severity of eating disorder symptom scores from 179 participants, including 87 in the AN group (51 ANR, 36 ANBP) and 92 HC using the Eating Disorder Examination Questionnaire (EDE-Q) 6.0. GMV reduction were observed in the AN brain, including the bilateral cerebellum, middle and posterior cingulate gyrus, supplementary motor cortex, precentral gyrus medial segment, and thalamus. In addition, the orbitofrontal cortex (OFC), ventromedial prefrontal cortex (vmPFC), rostral anterior cingulate cortex (ACC), and posterior insula volumes showed positive correlations with severity of symptoms. This multicenter study was conducted with a large sample size to identify brain morphological abnormalities in AN. The findings provide a better understanding of the pathogenesis of AN and have potential for the development of brain imaging biomarkers of AN. Trial Registration: UMIN000017456. https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000019303.

The Difference of Mean WSS Value on The Carotid Bifurcation and The Medial Segment of Common Carotid Artery Using Vector Flow Ultrasonography in Hypertensive Patients at Prof Dr. I.G.N.G Ngoerah General Hospital February-April 2022

Background : Hypertension is a risk factor for atherosclerosis which increases the risk of stroke. Transitions in blood vessels such as bifurcations are associated with changes in the velocity and pattern of blood flow that decrease wall shear stress (WSS) and is believed to be a risk factor for atherosclerosis. Shear stress on the common carotid artery also decreased with increasing blood pressure. This study aims to determine the difference of mean WSS value on the carotid bifurcation and the medial segment of common carotid artery using vector flow ultrasonography in hypertensive patients. Methods: This study used a cross-sectional design with the research location at the Radiology Installation of Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar in February-April 2022. The sample of this study was hypertensive patients who came to the Radiology Installation of Prof. Dr. I.G.N.G Ngoerah Hospital and met the inclusion criteria as many as 32 people. The examination was carried out by a consultant of head and neck radiology, using an ultrasound device with a linear transducer probe that has a probe frequency range of 3-9 Mhz. Results: The average age of the sample in this study was 50 years, with 9 males (28.1%), 23 females (71.9%). The results showed that the average maximum WSS value on the carotid bifurcation (3.37±0.96) Pa, the mean value (1.15±0.45) Pa, while the average maximum WSS value on the medial segment of the common carotid artery (4 ,41±1.45)Pa, the mean value (1.78±0.54)Pa. The average maximal and mean WSS value on carotid bifurcation were lower than the medial segment of the common carotid artery in hypertensive patients (p<0,05). The results of multivariate analysis on WSS values after controlling for confounding variables, obtained the average maximal and mean WSS value on carotid bifurcation, remained lower than the medial segment of the common carotid artery (p<0,05). Conclusion: there were significant differences in the mean wall shear stress (WSS) of the carotid bifurcation and the medial segment of the common carotid artery in hypertensive patients. Suggestions that can be done next are in facilities that have vector flow ultrasonography facilities, it is recommended to measure the WSS value in hypertensive patients as additional information as a predictor of atherosclerosis

Abstract 12579: Intracoronary Thrombolysis, an Option in Coronary Arteries With Unique Characteristics: A Case Series Report

Cases Description: Case 1: A 47-year-old male with inferior ST-segment Elevation Myocardial Infarction (STEMI). Percutaneous Coronary Intervention (PCI), showed an ectasic Right Coronary Artery (RCA) with an occlusive thrombus in mid-distal segment, TIMI 0. Thromboaspiration was not successful, proceeding to use intracoronary (IC) Alteplase 15mg. 72 hours later, PCI showed a RCA without stenosis, TIMI 2. Intravascular Ultrasound (IVUS) was used, showing no plaques or dissection. Discharged with Rivaroxaban 20mg QD and Acetilsalicylic acid (ASA) 100mg QD. Case 2: A 38-year-old male, with previous PCI and 1 stent in Anterior Descending Artery (ADA); arrives with STEMI. PCI showed a ADA non-occlusive intrastent thrombus, TIMI 2. IC Alteplase 15mg was used. After 72 hours, PCI identified the ADA with TIMI 3 flow. IVUS and Optical Coherence Tomography (OCT) showed a mild intrastent thrombus and proximal infraexpansion of previous stent. Proximal and medial segments were dilated, and 1 stent was placed distal. IVUS showed adequate expansion. Discharged with Apixaban 5mg BID and Clopidogrel 75mg QD. Case 3: A 64-year-old male, with inferior STEMI. PCI shows an ectasic ADA with a proximal and medial segment thrombus, TIMI 2. Tromboaspiration and posterior IC Alteplase 15mg were used, with TIMI 3 result. PCI 24 hours later, shows the ADA with TIMI 3 flow. IVUS identifies that no angioplasty was needed. Discharged with Ticagrelor 90mg BID and ASA QD. Discussion: IC thrombolysis is a useful method in primary PCI, where there is no favorable anatomy or massive IC thrombus. These cases show the utility of using IC imaging to evaluate the anatomy and thrombotic content of angiographic lesions. There is no consensus in the chronic anticoagulation/antithrombotic management after IC thrombolysis.

The tendency of segmental distribution of hepatic metastasis according to couinaud classification: a comparison of portal versus systemic route of metastatis due to primary colorectal and breast tumors.

The liver is the commonest site of metastatic disease for patients with colorectal cancer (CRC), with at least 25% of patients developing liver metastasis (LM) during their illness. About 50% of patients diagnosed with metastatic breast cancer develop LM, and 5-12% of these patients develop LM as the main site of breast cancer recurrence. This study aims to determine the frequency of segmental distribution of LM seeding from portal versus systemic routes of dissemination due to primary CRC and breast carcinoma, respectively. This retrospective study was conducted in a tertiary care teaching hospital in Pakistan. Ethical approval was taken from the institutional review board. A total of 587 patients were included in the study with 297 CRC patients with LM and 300 breast carcinoma patients with LM. Segment I involvement was excluded from the calculation because of the dual blood supply. Patients' detailed demographics and other information were collected on a predesigned proforma. The authors evaluated axial and multiplanar reformatted computed tomography images for LM and CRC metastasis. Data analysis was done using SPSS version 25. P value less than or equal to 0.05 was considered statistically significant. A study population of 587 patients was employed that comprised 287 CRC and 300 breast carcinoma patients. There were 179 (30.5%) male and 408 (69.5%) female patients. The mean age of patients was 54.9±13.3. The study revealed that 204 (34.8%) CRC patients showed right lobe (V, VI, VII, VIII) and 83 (14.1%) CRC patients showed left lobe involvement of metastasis while 192 (32.7%) breast carcinoma patients showed right lobe involvement and 108 (18.4%) breast carcinoma patients showed left lobe involvement in metastasis (P=0.02). We also found 40 (6.8%) colorectal and 55 (9.4%) breast carcinoma patients showed left lateral segment (II, III) involvement. Medial segment involvement (IV) was seen in 43 (7.3%) CRC patients and 53 (9%) breast carcinoma patients (P=0.03). The right hepatic lobe is the predominant site of metastasis independent of the portal or systemic route of dissemination in primary carcinoma. Moreover, in left lobe metastasis medial segment (IV) is more affected in CRC while the lateral segment (II, III) is more affected in breast carcinoma.

Exploring somatosensory innervation of the human lip: A focus on the vermilion

BackgroundThe lips are a vital component of the face and are densely innervated to perform various functions. The lip edges are covered with mucocutaneous tissue called vermilion which is particularly receptive to touch and temperature. The aim of this study was to investigate the somatosensory innervation of human lips, focusing on sensory corpuscles and the presence of mechano-gated (ASIC2, PIEZO2, and TRPV4) and thermosensing (TRPV1, TRPM2, and RPM8) ion channels within them. MethodsTwelve intact lips (6 upper and 6 lower) were obtained from non-embalmed frozen cadavers (five females and seven males) with an age range of 60–80 years. The specimens were divided into three zones (medial, lateral, and median). The morphotypes of sensory corpuscles and their immunohistochemical profile was analysed. The occurrence of ion channels involved in mechanosensation and temperature detection was examined using various antibodies. Sensory corpuscle density was quantified in vermilion sections, and statistical analyses were conducted to assess differences between the upper and lower lips, as well as between females and males (p < 0.05). ResultsDifferent morphotypes of sensory corpuscles were identified: Ruffini-like associated with hair follicles, Meissner and glomerular corpuscles in the vermilion, and less classifiable sensory corpuscles within the mucosa. The density of sensory corpuscles in the vermilion was higher in the upper lip than in the lower lip; glomerular corpuscles predominated in the medial and median segments, whereas Meissner corpuscles were more abundant in the lateral segment. No sex-related differences were observed in the density or distribution of the two main corpuscular morphotypes. In contrast, the axons of both the glomeruli and Meissner corpuscles regularly displayed ASIC2 and PIEZO2 immunoreactivity, whereas immunoreactivity for TRPV1, TRPV4, TRPM2, and TRPV8 was absent. ConclusionsThese results demonstrate that the sensory corpuscles of the vermilion are a mixture of those typical of glabrous skin mucocutaneous tissues. The presence of PIEZO2 and ASIC2 in their axons suggests that these sensory corpuscles function as mechanosensors.

Cortical Response Variation with Social and Non-Social Affective Touch Processing in the Glabrous and Hairy Skin of the Leg: A Pilot fMRI Study.

Despite the crucial role of touch in social development and its importance for social interactions, there has been very little functional magnetic resonance imaging (fMRI) research on brain mechanisms underlying social touch processing. Moreover, there has been very little research on the perception of social touch in the lower extremities in humans, even though this information could expand our understanding of the mechanisms of the c-tactile system. Here, variations in the neural response to stimulation by social and non-social affective leg touch were investigated using fMRI. Participants were subjected to slow a (at 3-5 cm/s) stroking social touch (hand, skin-to-skin) and a non-social touch (peacock feather) to the hairy skin of the shin and to the glabrous skin of the foot sole. Stimulation of the glabrous skin of the foot sole, regardless of the type of stimulus, elicited a much more widespread cortical response, including structures such as the medial segment of precentral gyri, left precentral gyrus, bilateral putamen, anterior insula, left postcentral gyrus, right thalamus, and pallidum. Stimulation of the hairy skin of the shin elicited a relatively greater response in the left middle cingulate gyrus, left angular gyrus, left frontal eye field, bilateral anterior prefrontal cortex, and left frontal pole. Activation of brain structures, some of which belong to the "social brain"-the pre- and postcentral gyri bilaterally, superior and middle occipital gyri bilaterally, left middle and superior temporal gyri, right anterior cingulate gyrus and caudate, left middle and inferior frontal gyri, and left lateral ventricle area, was associated with the perception of non-social stimuli in the leg. The left medial segment of pre- and postcentral gyri, left postcentral gyrus and precuneus, bilateral parietal operculum, right planum temporale, left central operculum, and left thalamus proper showed greater activation for social tactile touch. There are regions in the cerebral cortex that responded specifically to hand and feather touch in the foot sole region. These areas included the posterior insula, precentral gyrus; putamen, pallidum and anterior insula; superior parietal cortex; transverse temporal gyrus and parietal operculum, supramarginal gyrus and planum temporale. Subjective assessment of stimulus ticklishness was related to activation of the left cuneal region. Our results make some contribution to understanding the physiology of the perception of social and non-social tactile stimuli and the CT system, including its evolution, and they have clinical impact in terms of environmental enrichment.

Effective Correction of Columellar Base Deviation in Primary Unilateral Cleft Lip Repair: A Muscle-Driven Method.

Columellar base deviation is a common and challenging deformity in patients with unilateral cleft lip. Debate continues on its surgical correction without sufficient studies to establish effective management. This article presents the authors' experience in correcting the columellar base deviation with the muscle-driven method in primary lip repair. The key is to perform extensive muscle dissection and reconstruction. In the medial lip segment, muscle dissection is performed subcutaneously up to the contralateral nostril floor for effective lengthening and rotation. In the lateral lip segment, muscle dissection is executed in both submucosal and subcutaneous planes, and muscle component is extensively separated from the lip skin and buccal mucosa. The lateral muscle flap is advanced and reattached to the contralateral nostril floor and columellar base using a subcutaneous sustaining suture. Cinching suture between columellar base and alar base is performed. These 2 sutures help centralize and overcorrect the columellar base. Bilateral muscle components are reoriented and approximated in a Z-plasty format for lengthening of the lip. The patients were followed up for at least 3 years. Quantitative measurements of deviation in columellar base angulation were taken and revealed 55.8 ± 2.6 degrees (before nasoalveolar molding), 29.6 ± 1.7 degrees (after nasoalveolar molding), and 2.8 ± 0.4 degrees (postoperative follow-up), respectively. The muscle-driven method represents a safe and effective technique to correct columellar base deviation in patients with unilateral cleft lip.

Accumulation of 18F-FDG at Anomalous Systemic Arterial Supply to Normal Lung on 18F-FDG PET/CT.

Anomalous systemic arterial supply to normal lung is an anatomical variant in which a portion of the lung is supplied by a systemic vessel without a distinct pulmonary sequestration. We report a case of mild to moderate accumulation of 18F-FDG in the medial basal segment of left lung; corresponding CT images localize this uptake in the tortuous artery arising from the descending aorta with similar uptake to that of descending aorta. Findings are suggestive of anomalous systemic arterial supply to normal segments of the lung. Hybrid PET/CT allows precise anatomical localization and helps in differentiate benign mimics of disease, which can alter patient management.

Falciform ligament hernia: combination of key CT findings

A male patient in his early 90s with no history of abdominal surgery was referred to us for abdominal pain and vomiting. An abdominal computed tomography (CT) demonstrated dilated small bowel with a double beak sign and poorly enhanced wall, which indicated a closed-loop obstruction that leads to strangulation. A closed-loop bowel was located in front of the anterior and medial segments of the liver and to the right of the round ligament of the liver on axial images. Sagittal images revealed that the round ligament has deviated downward and 2 adjacent narrowed intestines were located at its cranial side. These CT findings suggested the hernia orifice was in the falciform ligament. Emergency surgery for highly suspected bowel ischemia revealed the falciform ligament hernia. A combination of the CT findings played a key role, including the double beak sign, the location of the closed-loop small bowel, and the downward deviation of the round ligament, although preoperative CT diagnosis of falciform ligament hernia is a diagnostic challenge.

Disrupted structural brain networks across psychiatric disorders determined using multivariate graph analyses

IntroductionIdentifying the specific brain pattern characterizing psychiatric disorders could lead us to precise diagnostic process, better treatment plan and outcome prediction. Structural covariance is a graph-analysis method with which disruptions in large scale brain network organization can be observed. More studies, employing this method in psychiatry, are still needed.ObjectivesThe current study aims to investigate how the main psychiatric disorders – schizophrenia, major depressive disorder, bipolar disorder, affect brain circuitry by means of multivariate graph theory, more specifically – structural covariance. We hypothesized that specific abnormalities in the brain circuits would be found in separate diagnostic entities.Methods164 subjects were included with schizophrenia-SCH (n=17), bipolar disorder-BD(n=25), major depressive disorder–MDD(n=68) and a healthy control group-HC(n=54). Each participant provided a written informed consent and the study protocol was approved by the University’s Ethics Committee. High resolution structural MRI was acquired, and preprocessing was performed using SPM 12 toolbox. The structural covariance method was applied consisting of calculation of the correlation across subjects between the different pairs of regions by using the gray matter average volume. We used the threshold statistic to binarize the covariance matrix and transform it into an adjacency matrix. This allows us to compare psychiatric disorders at a network level by calculating measures such as authorities, hubs and outdegree.Results61 statistically significant regions were found for the whole sample. The matrices of the four groups were compared according to their ‘authorities’ ,‘hubs’ and ‘outdegree’ as first, second and third ranking variables, respectively. In the group comparison between HC and BD patients the top five significant regions were Planum temporale (PT), Putamen, Precuneus (PreCu), Calcarine cortex (Calc_cor) and Postcentral gyrus medial segment (PostCGms). The MDD group demonstrated the following regions with most significant difference including Precentral gyrus (PreCG), Entorhinal area (EntA), Amygdala (Amy), Anterior cingulate gyrus (ACC), Anterior insula (AI). While SCH grop was charachterized by ACC, PreCG – medial segment, PostCGms, anterior orbital gyrus, and frontal pole.ConclusionsThe results of our study demonstrated that schizophrenia and mood disorders have specific disturbances in brain network structural organization, affecting hubs of default mode network, salience network, motor, sensory and visual cortex, as well as limbic system. These alterations might elucidate the pathophysiological mechanisms of common symptoms of the disorders under investigation including perceptual, affective and cognitive disturbances.Disclosure of InterestNone Declared