Medial Segment Research Articles

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery.

To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC). We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects. At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes. The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

Abstract 386: Sonic Hedgehog Promotes Stem Cell Differentiation to Vascular Smooth Muscle in vitro

Background: The morphogen Sonic Hedgehog (SHh) and its signaling pathway components are significantly up-regulated within adventitial and medial segments from arteriosclerotic vessels in mice concomitant with enhanced accumulation of SMCs. This vessel remodelling is attenuated in vivo following Hh receptor, Patched 1, depletion. There is evidence supporting a role for stem cell-derived vascular smooth muscle (vSMCs) in contributing to arteriosclerotic vascular disease. In this context, SHh signaling may be an important regulator of stem cell self-renewal and differentiation to SMC in vitro. Aim: Determine the effects of SHh on bone-marrow derived mesenchymal stem cell (MSC) differentiation to SMC in vitro. Methods: Murine CD44+ bone-marrow derived MSCs and Sca1+ rat adventitial progenitor stem cells (APCs) were examined for SHh components and their capacity to differentiate to SMCs before and after treatment with sonic hedgehog (rSHh, 0.5 μg/ml) for 7 d, in the absence or presence of Hh inhibitors cyclopamine (10μM) or HPI-4 (50μM). The transition to SMC was determined be examining intermediate (calponin1, CNN1) and late (myosin heavy chain, Myh11) SMC differentiation marker expression by western blot analysis and immunocytochemistry, respectively. Results: Hh signaling components were present on MSCs and APCs. Stem cell growth was unaffected by treatment with Hh inhibitors cyclopamine or HPI-4 at concentrations that inhibited Gli signalling in vitro. Recombinant SHh increased SMC differentiation marker protein protein expression after 7 days, an effect that was inhibited following SHh inhibition with smoothened inhibitors cyclopamine and HPI-4. Conclusion: in the absence of any effect on cell growth, Sonic Hedgehog controls mesenchymal stem-like cell differentiation to SMC.

Hypertriglyceridemia: An Open Door for Cancer Treatment?

Does lipid management have a significant role in cancer treatment? Could hypertriglyceridemia be an accelerating factor in certain tumors? These questions have grown from the long-standing recognition of the relationship of lipids to certain cancers. Cancers express high levels of lipid synthase, the enzyme responsible for the production of fatty acids. Lymphoma and other cancers have been found to have the ability to generate the lipids via de novo lipogenesis at a rate faster than other lipogenetic tissues [1]. Continuous de novo lipogenesis provides cancer cells with membrane building blocks, signaling lipid molecules, posttranslational modifications of proteins as well as energy supply to support rapid cell proliferation [2]. Protection of cancer cells by apoptosis by overexpression of fatty acid synthase (FASN) also helps the progression of the cancer [2]. Recent studies have documented the changes in lipid levels in the etiology and most importantly prognosis of cancer [3, 4]. There are many studies that have shown that the degree of lipid abnormality was directly related to the underlying tumor burden in addition to the abnormality in triglyceride clearance [5]. In one study, 25 patients with acute leukemia and nonHodgkin’s lymphoma (NHL) were studied; all patients demonstrated an abnormality in at least one plasma lipid fraction that consisted of extremely low levels of high density lipoprotein (HDL), elevated triglycerides (TG) and elevated very low density lipoprotein (VLDL). The levels were found to be normalized after recovery [5]. Another study was performed to investigate serum lipid alterations in patients with acute lymphoblastic leukemia (ALL) at diagnosis and during remission of the disease. Plasma lipids and lipoproteins were measured at diagnosis, prior to the administration of induction treatment, and every 2 months for the first 12 months of the maintenance phase of chemotherapy in 64 patients with ALL. Nearly all patients demonstrated serum lipid alterations which included elevated TG, LDL and cholesterol and values were returned back to normal during remission [6]. This points out the direct link between cancer progression and lipid levels. Metastasis is another interesting area in which the lipid level can correlate with disease burden. In one study, 205 Iranian patients from Semnan Oncology Clinic were studied and there was a significant association between higher levels of serum LDL and metastasis [7]. Aggressiveness of the tumor including metastasis can be highlighted by the levels of lipids. This brings up to the point of our case. We present a patient with stage IV diffuse large B-cell NHL with diffuse involvement of the bone and liver whose course was complicated with an incidental finding of hypertriglyceridemia. A 67-year-old Caucasian male with a past medical history of chronic obstructive pulmonary disease, diabetes mellitus, hypertension, coronary artery disease, and pulmonary embolism was admitted to the hospital for severe lower back pain and significant weight loss for 1 month. He denied any familial or personal history of hypertriglyceridemia. Physical examination was remarkable for pale conjunctivae, positive straight leg test on the left lower extremity, and a limited range of motion in his right upper extremity. There was no point tenderness noted in his back but there was mild tenderness to palpation of the right chest wall. CT abdomen imaging revealed several masses in the liver which involved the lateral segment of the left lobe, the medial segment, and an illdefined mass in the right lobe posteriorly. Biopsy of the liver demonstrated evidence for diffuse large B-cell NHL and bone marrow involvement was also seen in bone marrow biopsy. Lipid profile drawn 2 years ago were found to be TG 195 mg/ dL, cholesterol 146 mg/dL, LDL 74 mg/dL, VLDL 39 mg/dL and HDL 33 mg/dL. The lipid panel had changed dramatically during this admission demonstrating TG 1,154 mg/dL, cholesterol 204 mg/dL, and HDL 4 mg/dL, and LDL and VLDL were unable to be calculated. This unusual level of TG highlighted the aggressiveness of the tumor and more importantly the prognosis of the cancer. The patient was treated with gemfibrozil and insulin. TG levels were markedly improved from 1,154 to 690 mg/dL. The patient deteriorated before initiation of chemotherapy and expired. The issue of interest in this case is not the specific attributes of the cancer discussed but of the rise and fall of TG associated with it. The possible implications of this event may correlate with the aggressiveness of the tumor or the type of cancer and presents an intriguing possibility of manipulating this process as a means of treatment. The current standards for Manuscript accepted for publication March 24, 2016

A differential distribution of auxin and flavonols in radiata pine stem seedlings exposed to inclination

Stem reorientation in response to inclination in trees has commanded the attention of the research community widely, but the molecular mechanisms of the response are still unknown. The most accepted theory is auxin redistribution in affected tissues. Flavonols have been reported as potent inhibitors of polar auxin transport; however, no reports have shown differential modulation by flavonols within the trunk. Here, transcriptional, microscopic, and chemical approaches were used to analyze the contents of flavonoids in 45° inclined radiata pine seedlings. A time course was established and samples obtained by cutting stems into apical, medial, and basal segments or by longitudinal dissection into upper and lower halves to determine polar distribution of flavonoids. The expression analysis of PrCHS, PrF3H, and PrFLS indicated induction in response to inclination; higher transcript levels were recorded at the basal zone and in the upper half of the stem. A reduction in abundance of PrARP transcripts in addition to immunospecific auxin detection at the lower half of inclined stem was found. Concomitantly, quercetin and kaempferol accumulated in the upper stem half. Our results suggest that stem reorientation is a response to a concerted and differential mechanism that modulates imbalance of auxin distribution in one side of the stem.

Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver.

To analyze the vascular structure of the liver in patients with a right-sided round ligament. We reviewed 16 patients with a right-sided round ligament and 3 polysplenia and situs inversus patients with a left-sided round ligament who underwent multidetector row CT with contrast media. The patient population consisted of 13 men and 6 women (mean 62years). We analyzed the axial and volume-rendered images for the location of the round ligament, gallbladder, portal veins, hepatic veins, and hepatic artery. The following imaging findings for the patients with polysplenia and situs inversus were horizontally reversed. The prevalence of a right-sided round ligament with and without polysplenia was 75 and 0.11%, respectively. The gallbladder was located to the right, below, and left of the round ligament in 27.7, 38.8 and 33.3%, respectively. Independent branching of the right posterior portal vein was noted in 57.8%. PV4 was difficult to identify in 36.8%. The middle hepatic vein was located to the left of the round ligament. Two branching patterns for the lateral and medial branches of the right anterior hepatic artery were noted: the common (44.4%) and separated types (55.5%). Both of the right anterior hepatic artery and portal vein ramified into two segments; the lateral segment with many branches and the medial segment with a few branches. The right-sided round ligament divided the right anterior section into the lateral and medial segments based on the portal vein and hepatic artery anatomy.

Contractile Properties of the Rat Extensor Digitorum Longus Muscle in Relation to Regional Variation in Fibre Type Composition

Muscle contractile characteristics are commonly investigated in relation to global phenotype. The extensor digitorum longus (EDL) muscle has frequently been used in physiological studies as an example of a typical fast muscle. However, the fibre type composition is not homogeneous. In the rat, the EDL contains a mixture of oxidative and glycolytic fibres, heterogeneously distributed across the muscle cross section to produce a gradient of aerobic capacity. The aim of this study was to characterize the contractile characteristics of this mixed muscle in relation to the regional variation in fibre type composition. It was hypothesized that isometric twitch characteristics and optimal frequency for power generation would not differ regionally, while the fatigability will correlate with aerobic capacity.The EDL muscle from male Wistar rats comprises four segments which insert on to phalanges 2–5; we used the medial and lateral segments, which insert on to phalanges 2 and 5, respectively. The contractile characteristics of each segment were determined under isometric conditions, in order to quantify twitch kinetics and tetanic stress. Power output of the muscle was measured at a range of cycle frequencies during cyclical contractions, using the work loop technique. The ability to sustain power was quantified using a series of repeated cyclical contractions. A range of monoclonal antibodies was used to determine fibre type composition.The two muscle segments had significantly different fibre type composition; the medial segment containing 41% Type IIb, 49% Type IIa and 10% Type I while the lateral segment contained 95% Type IIb and 5% Type IIa. The medial segment had slower twitch kinetics than the lateral segment, consistent with the presence of Type 1 fibres and lower proportion of Type 2 fibres. Isometric stress was lower in the medial segment producing 155.3 kN m−2 compared to 194.6 kN m−2 in the lateral segment; this may be related to the higher proportion of non‐contractile elements such as mitochondria in the medial segment, i.e. a lower proportion of myofibrils, compared with the lateral segment. Peak net power output and the frequency at which this was attained were similar between both muscle segments.Variation in the physiological properties of the lateral and medial segments of the rat EDL are consistent with the decrease in oxidative capacity and a decrease in the proportion of fast‐twitch fibres from medial to lateral sides. This suggests that there may be regional variation in mechanical function, with a shift from the medial segment providing work for ankle flexion at relatively low speeds, to the lateral segment increasingly fulfilling the role at higher speeds.

The Clinical Features of Tracheobronchial Living Foreign Body: Leech

SESSION TITLE: Procedures: Bronchoscopy SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: To investigate the clinical features of tracheobronchial foreign body: leeches. METHODS: This is a retrospective study of medical records in three tertiary hospital of Yunnan Province from August 2013 to February 2015. Data was collected from patients who were diagnosed as had tracheobronchial leeches via bronchoscopy. The associated medical information, bronchoscopic features and removal method were reviewed and analyzed. RESULTS: Four patients with tracheobronchial leeches were enrolled. Among whom one-half were male and the mean age was 51.0 ± 3.5 years old (range, 48 years to 58 years). All the patients came from rural areas and had a history of drinking field unboiled water from streams, pools and springs. 3 patients had dyspnea, 1 case had cough and bloody sputum and 1 patient had mild anemia. The peripheral blood eosinophile granulocytes of 3 patients were increased. The coagulation function of all the patients was normal and all patients had no hemorrhagic tendency. Chest computed tomography showed tracheal foreign bodies of 2 cases, the basal segment of the lower lobe of the right lung had a lesion with high density in 1 case, and some exudation in the medial segment of the right middle lobe in the other case. Bronchoscopy revealed a leech in trachea of 3 cases and one leech in the right medial basal segmental bronchus of 1 case. 3 leeches were removed via cryotherapy by flexible bronchoscope and 1 leech was taken out through foreign body forceps by flexible bronchoscope. The symptoms of all the cases were improved obviously after removed the leeches. CONCLUSIONS: The physician should be aware of the possibility of the tracheobronchial leeches if the patients who come from rural areas have a history of drinking field unboiled water and have the following symptom, such as dyspnea, cough, bloody sputum and increased peripheral blood eosinophilic eosinophiles. The tracheobronchial leeches can be removed via cryotherapy or foreign body forceps by bronchoscope. CLINICAL IMPLICATIONS: The tracheobronchial leech infestation should be kept in mind especially in patients presenting with unexplained dyspnea, bloody sputum and increased peripheral blood eosinophilic eosinophiles and a history of drinking infested water from streams, pools and springs. DISCLOSURE: The following authors have nothing to disclose: Xi-Qian Xing, Zhong-Chuan Yang, Yan-Ping Li, Xu-Wei Wu, Hong-Yan Liu, Li-Qiong Liu, Li-Hui Zhang No Product/Research Disclosure Information

Особенности течения первичной закрытоугольной глаукомы, осложненной псевдоэксфолиативным синдромом

Purpose. To investigate the prevalence of pseudoexfoliation syndrome (PES) in primary angle-closure glaucoma (PACG) and the nature of changes in ocular structures in process of PES progression to determine the choice of pathogenically oriented treatment. Material and methods. For this investigation 220 Uzbek patients (358 eyes) with hyperopic type of eyes (axial length was 22.8 mm and less) have been selected. The main group included 176 patients (286 eyes) with PACG and different degrees of lens opacity. The comparative group consisted of 44 patients (72 eyes) without PACG and clinical PES symptoms, and with analogous lens opacity. The average age was not statistically significant in both groups and was 58.6±1.2 and 56.4±1.4 years, respectively. All patients underwent complete ophthalmologic examinations. Ultrasound biomicroscopy (UBM) was the basic method of investigation using the model 840 (Zeiss-Humphrey Instruments). The measurements were performed in the superior, lateral, inferior, and medial segments of iridocilliary zone. Results. The UBM method allowed to detect PES symptoms in 64.5% of PACG cases even in absence of clinical PES symptoms. The presence of flakes of pseudoexfoliative material of different echo-density was found on structures of iridocilliary zone with its insufficiency. The pseudoexfoliative flakes were associated with a ciliary zonule fiber weakness. Difference of cilliary zonule fibers length differed by 0.2-0.7mm in various segments of measurement. In these cases an alteration of space correlation between iridocilliary structures took place. The asymmetry of iridocilliary structure parameters and disturbance of their topographic relationships detected by the UBM in PES cases with zonules damage lead to a combination of intraocular blocks in one eye in PACG cases. In segments of cilliary zonule fibers stretching (0.68±0.02mm) the UBM reflected a pattern of segmental relative pupillary block. In opposite segment a sharp reduction of visualized cilliary zonule fibers (0.27±0.02mm) was revealed. The UBM reflected a pattern of plateau iris syndrome. In other situations there was observed a combination the pupillary block and the block induced by the crystalline lens. Conclusion. The results of investigations using the UBM method in Uzbek patients showed that the PES was accompanied with PACG in the absence of clinical signs of disease. The PES was accompanied by alterations of topographic relationships of iridocilliary zonule structures in PACG eyes and promoted in these situations an appearance of intraocular blocks combination: relative pupillary block, block of plateau iris syndrome and crystalline lens block that requires a differentiated approach to the choice of pathogenetic treatment tactics of PACG.

Automated daily breath hold stability measurements by real-time imaging in radiotherapy of breast cancer

Background and purposeBreath hold is increasingly used for cardiac sparing in left-sided breast cancer irradiation. We have developed a fast automated method to verify breath hold stability in each treatment fraction. Material and methodsWe evaluated 504 patients treated with breath hold. Moderate deep inspiration breath hold was audio-guided. Medial and lateral large tangential field segments were delivered in a single breath hold and movieloops of these fields were acquired with an EPID. The thoracic wall position was automatically detected in each frame and the full range of thoracic wall motion (RTWM) was determined. If the RTWM >4mm more than 3 times, the patient was excluded from breath hold treatment if further coaching did not yield improvement. ResultsUnstable breath hold was observed in 2.8% of the patients. However, this frequency dropped from 9.5% in the first 6months to 1.6% in the subsequent 16months. The 97% of patients with proper breath hold showed excellent stability: the average RTWM was 0.9±0.5mm. The reproducibility of the breath hold depth was confirmed by (1) the small difference between the thoracic wall positions in the medial and lateral fields within one fraction and (2) the setup errors of breath hold patients showed no significant differences with those of right-sided breast patients. ConclusionsWe have developed and clinically applied an imaging tool to automatically determine stability of breath holds in each treatment fraction during beam delivery.

Symmetry detection based on multiscale pairwise texture boundary segment interactions

In this paper, we propose a new unsupervised and simple approach to local symmetry detection of ribbon-like structure in natural images. The proposed model consists in quantifying the presence of a partial medial axis segment, existing between each pair of (preliminary detected) line segments delineating the boundary of two textured regions, by a set of heuristics related both to the geometrical structure of each pair of line segments and its ability to locally delimit a homogeneous texture region in the image. This semi-local approach is finally embedded in a two-step algorithm with an amplification step, via a Hough-style voting approach achieved at different scales and coordinate spaces which aims at determining the dominant local symmetries present in the image and a final denoising step, via an averaging procedure, which aims at removing noise and spurious local symmetries. The experiments, reported in this paper and conducted on the recent extension of the Berkeley Segmentation Dataset for the local symmetry detection task, demonstrate that the proposed symmetry detector performs well compared to the best existing state-of-the-art algorithms recently proposed in the literature.

Computed Tomographic Evaluation of Joint Geometry in Patients With End-Stage Ankle Osteoarthritis.

Deformation of the talus and the distal tibia can be frequently observed during ankle joint osteoarthritis (OA). The aim of this study was to objectify these morphologic changes. We hypothesized that a flattening of the talus and a broadening of the distal tibia surface occurs in end-stage OA of the ankle joint. Twenty-seven computed tomography (CT) ankle joint examinations of unilateral ankle OA were matched by sex and age with 27 CT examinations of healthy ankle joints. Three-dimensional reformatting and measurements were performed with geometry analysis software. The following parameters were assessed: sagittal radius of the talus, talus height, and mediolateral and anteroposterior width of the distal tibial joint surface. Medial, midsagittal, and lateral sagittal arc radii of osteoarthritic tali were significantly larger compared to tali of controls. There was a statistically significant difference in the height of the osteoarthritic talar dome in the medial and in the lateral frontal segment and in the medial central segment compared to tali of controls. The anteroposterior width and the sagittal curvature of the distal tibia was significantly larger in OA ankles than in the control group. The mediolateral measurements were comparable across both groups. Flattening of the talus appears to be more pronounced in the frontal aspect of the talus. The distal tibia broadens anteroposteriorly. These findings may contribute to better understanding of ankle OA development. Level III, retrospective comparative cohort study.

Morphological characteristics and clinical manifestations of orbital emphysema caused by isolated medial orbital wall fractures.

To investigate the morphological characteristics and clinical manifestations of orbital emphysema in patients with isolated medial orbital wall fractures. This was a retrospective observational case series of 348 orbits of 348 patients with isolated medial orbital wall fractures. Medical charts were reviewed, and computed tomographic (CT) images were examined to determine the morphological characteristics of orbital emphysema. Orbital emphysema was detected in 70 orbits (20.1%). Large and communited type fracture was related with the presence of orbital emphysema (P<0.05). Orbital air pockets were detected in medial or superior extraconal orbital segment in all cases with orbital emphysema. Swollen eyelid with crepitus (90.0%) and supraduction limitation (31.4%) were developed with orbital emphysema. All cases with supraduction limitation accompanied with superior extraconal orbital emphysema and superior rectus muscle deviation, and these eyes were fully recovered with conservative management without surgery. Orbital emphysema can be a cause of ocular motility restriction following orbital wall fracture. If supraduction limitation is noted with isolated medial wall fracture and superior orbital emphysema with superior rectus muscle deviation is detected by CT scan, conservative management can be a good choice for spontaneous recovery delaying the surgery.

Morphometric changes in liver cirrhosis: aetiological differences correlated with progression.

To evaluate the morphometric changes in liver cirrhosis using multidetector CT volumetry and to analyse the differences in morphometric changes among different aetiologies and stages of cirrhosis. Each portal segment with the respective proportion relative to total liver volume was measured in 54 patients without cirrhosis as a control (male/female, 29/25; 62.4 ± 7.6 years) and 250 patients with cirrhosis (male/female, 172/78; 64.6 ± 9.2 years) related to hepatitis virus infection (n = 96), alcoholism (n = 88) and non-alcoholic steatohepatitis (NASH) (n = 66). 149 patients were classified as patients with Child-Pugh Class A, 57 patients as patients with Class B and 44 patients as patients with Class C. The Kruskal-Wallis test was used for statistical analysis (p < 0.05). Cirrhosis associated with all aetiologies commonly showed atrophy of the medial and anterior segments and right lobe and hypertrophy of the lateral segment and caudate lobe compared with the control (p < 0.05). In Child-Pugh Class A, hypertrophy of the caudate lobe progressed more in alcoholism and NASH than in virus-related aetiologies (p < 0.001). Hypertrophy of the lateral segment and atrophy of the medial and anterior segments and right lobe progressed less in NASH than in cases with virus related and alcoholic cirrhosis (p < 0.001). In patients with Class B, these differences were less prominent than in those with Class A (p < 0.001). In Class C, no significant differences were noted in any segment, regardless of aetiology (p > 0.05). Morphometric changes of cirrhosis display different patterns according to aetiology. Differences between aetiologies would decrease with progression of cirrhosis. Morphometric changes of cirrhosis display different patterns according to aetiology. Differences between aetiologies would decrease with progression of cirrhosis.

Association of non-alcoholic fatty liver disease with renal stone disease detected on computed tomography

ObjectiveTo evaluate the association between Non-alcoholic fatty liver disease (NAFLD) with renal stone disease detected on computed tomography (CT). MethodA total 1812 patients who underwent abdomen-pelvis CT in July 2015 were included in this study. The inclusion criteria for NAFLD were as follows: (i) lower average Hounsfield unit (HU) of hepatic right lobe, left medial and lateral segment when compared with that of spleen, (ii) patients who having urolithiasis in kidneys, ureters and urinary bladder, and (iii) patients underwent abdomen-pelvis CT including noncontrast image. The statistical significance of the association between NAFLD and renal stone disease was assessed using Chi Square Test. The Odds ratios and 95% CI were calculated to assess the propensity of renal stones disease for NAFLD by using Logistic Regression analysis. ResultsThe frequency of renal stone disease in patients with NAFLD was higher approximately 19% than those who having renal stone disease without NAFLD. In addition, the presence of NAFLD was linked with renal stone disease showing that detection rate of renal stone disease in patients with NAFLD was markedly high (odds ratio: 5, 95% CI, 3–8.2) (p<0.05) in multivariate analysis. ConclusionThe presence of significant association between NAFLD with renal stone disease and NAFLD may be considered to be an independent variable as a risk factor for renal stone disease.

Morphological patterns of lip prints in Mangaloreans based on Suzuki and Tsuchihashi classification.

Introduction:Cheiloscopy is the study of the furrows or grooves present on the red part or vermilion border of the human lips. The present study aims to classify the characteristics of lip prints and to know the most common morphological pattern specific to Mangalorean people of Southern India. For the first time, this study also assesses the association between gender and different lip segments within a population.Materials and Methods:A total of 200 residents of Mangalore (100 males and 100 females) were included of age ranging from 18 years to 60 years. Materials used to take the impression of lips included red lipstick, A4 size white bond paper and cellophane tape. The prints obtained were scanned using a Canon Image Scanner and stored in a folder on a personal computer. The images were cropped and inverted in gray scale using Adobe Photoshop software. Each lip print was divided into eight segments and was examined. Suzuki and Tsuchihashi's classification (1970) was used to classify the types of grooves, and the results were statistically analyzed. Six types of grooves were recorded in the Mangalorean's lips.Statistical Analysis:Association between gender and different lip segments was tested using Chi-square analysis in the given population.Results:In males, the groove Type I' was the highest recorded followed by Type III, Type II, Type I, Type IV and Type V in descending order. In females, Type I' was the highest recorded followed by Type II, Type III, Type IV, Type I and Type V in descending order.Conclusion:Males and females displayed statistically significant differences in lip print patterns for different lip sites: lower medial lip, as well as upper and lower lateral segments. Only the upper medial lip segment displayed no statistically significant difference in lip print pattern between males and females. This shows that the distribution of lip prints is generally dissimilar for males and females, with varying predominance according to lip segment.

Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry.

AIMTo evaluate the diagnostic performance of computed tomography (CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD).METHODSA total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment (LLS), left medial segment, caudate lobe, and right lobe (RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman’s rank correlation coefficient. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage.RESULTSThe volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage (r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage (r = -0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis (F3-F4) was 4.789%, 85.7% sensitivity and 94.1% specificity.CONCLUSIONThe volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.

Endobronchial metastasised endometrial stromal sarcoma

A 43-year-old woman presented with cough and gradually aggravating exertional dyspnoea of 5 months’ duration. She had undergone a hysteromyomectomy for myoma uteri 3 years previously. Chest CT revealed a...

Inhalation of Pin - A Rare Case Report

A boy aged 1year presented with persistent cough, sputum and fever for last two months which is did not subside in spite of empirical mediacal therapy. For last 15 days symptoms started to aggravate and not responding to medical management. Chest X-ray showed a pin in the right main bronchus with more radiolucency of right lung. CT scan of chest revealed radiodense linear opacity in the right lower lobe primary and secondary bronchus with partial collapse consolidation of right lower lobe medial basal and lateral basal segment. Rigid bronchoscopic removal was tried but failed. Ultimately thoracotomy was done to remove the foreign body.

Magnetic resonance correlation of iron content with neuromelanin in the substantia nigra of early-stage Parkinson's disease.

Magnetic resonance (MR) studies have demonstrated a significant reduction of neuromelanin in the substantia nigra (SN) of Parkinson's disease (PD) patients with high accuracy for differential diagnosis compared to non-PD controls and essential tremor. However, studies state that not knowing how paramagnetic effects of iron influence neuromelanin signal is a limitation. In this study a neuromelanin-sensitive MR sequence was combined with T2* relaxometry iron quantification analysis to study the SN of early-stage PD patients to investigate the correlation between these parameters. The inclusion criteria were untreated de novo PD patients and a 2-5 year disease duration (early PD); in addition, age-matched controls were enrolled. These were studied at 3.0 T with a high-resolution T1-weighted MR sequence to visualize neuromelanin and a relaxometry sequence for iron quantification. The primary outcome was the correlation of the width of the neuromelanin high signal region and the T2* values in the lateral, central and medial segments of the SN. Very weak correlations of T2* values with neuromelanin width, positive for global and negative for the medial and lateral SN segments, were found in both PD groups and control subjects. The SN neuromelanin width was markedly reduced in the de novo and early PD groups compared with controls in all SN segments, but no significant difference in T2* values was found between the groups. The SN neuromelanin signal does not have a significant correlation with iron content in PD patients or controls. The neuromelanin MR signal reduction in PD does not seem to be significantly influenced by paramagnetic iron effects.

A149 - Sustained Weight Loss and Safety At Two Years With Vagal Nerve Block In The Recharge Trial

Background: Over the last two and one half years a laparoscopically placed silicone covered titanium clamp for weight loss has been placed vertically paralleling the lesser curvature of the stomach. The clamp compartmentalizes the stomach into a medial segment where food would pass and an excluded lateral gastric segment. The clamp at its inferior aspect has an aperture by which gastric juices created by the fundus and the body can empty into the distal antrum. The aperture also allows endoscopic examination of the excluded segment. The device facilitates weight loss while avoiding altering of the anatomy of the stomach or intestines, avoiding stapling, and avoiding device adjustment. Placement of the clamp can be reversed. Methods: Under IRB protocol, from November 2012 to February 2015, 68 patients were implanted at one site. Changes in weight loss, complications and side effects were assessed. Technique: The posterior limb of the clamp is placed retrogastrically and tunneled to and around the angle of His. The latch on anterior limb of the clamp is then lpassed through the opening on the posterior limb. A 28 F bougie is used. The clamp is sutured in place both posteriorly and anteriorly. Results: Average age 28.8 years(range 19-38), average weight at baseline was 111.2 kg (range 91-134), average BMI 43.5(range 35-56 ), average length of stay 1.4 days, 89% females, avg operating time 69 minutes. A 28 F bougie was used. %Excess Weight Loss (%EWL) at 3,6,12,18,24 months respectively were 31.45 (5-57), 44.1 (16-76), 47.7 (23-85), 53.1 (30-86), 58.2 (48-65). There were 9 (13%) pts with slippage/gastric outlet obstruction, 6 were explanted, one was revised but months later required explantation, 2 were treated conservatively. Since the clamp was modified to avoid the tearing of the silicone by the anchoring sutures, there has been no slippage (35 pts). Other adverse events have been mild, early in the post op phase, easily controlled and include: nausea and/or vomiting (13%), gastroesophageal reflux (10%), abdominal pain (5.8%). There have been no erosions, no infections, no deaths, no conversions to open surgery. Four pts have had a moderate Hiatal Hernia fixed at the same time, without any complications Conclusions: Further studies are needed to delineate the safety and efficacy of the clamp in the use against morbid obesity and co-morbidities. The vertically placed weight loss clamp is reversible, does not require cutting, stapling or removal of the stomach or intestines, and does not require adjustment