Middle Third Research Articles

Tendinopathy of the superficial flexor of the finger in horses: morphological changes in the middle third of the pastern

A feature of the training process in riding sports horses is the repeated uneven maximum weight loads on the limbs and, in particular, on their tendon-ligamentous apparatus. The study used the tendons of the superficial flexor of the pectoral and pelvic extremities of sports horses that died from causes unrelated to tendon injuries. Tendinopathy was diagnosed in all animals during their lifetime. Isolated hands of the thoracic limb and feet of the pelvic limb were selected, as well as samples of the tendon of the superficial flexor of the finger of 15 sports horses aged 6 to 15 years. Histological studies were carried out according to a generally accepted technique: the material was fixed in a 10% formalin solution, poured into paraffin, sections were prepared, which were stained with hematoxylin and eosin to identify the general morphological picture, according to Van Gieson to assess the condition of bundles of collagen fibers and alcyan blue to identify glycosaminoglycans. The micropreparations were studied using Jenamed-2 and MicroScreen microscopes. As a result of the conducted research, original data were obtained. Signs of chronic inflammation, numerous foci of tissue destruction in combination with moderate reactive changes in the tissue indicate a long, long-term course of the pathological process. Since the tendon is a moderately vascularized tissue, insufficient perfusion does not allow maintaining redox processes at the required level. Therefore, in conditions where metabolism is restored in well-vascularized skeletal muscles, this process has not yet been completed in tendons. The conditions of hypoxia themselves create a background for the development of connective tissue and sclerosis. It is possible that this is how the signs of sclerosis gradually increase in the epithenonia and perithenonia, as well as in the walls of blood vessels, which were identified in our studies.

Assessment of different irrigation techniques on the penetration depth of different sealers into dentinal tubules by confocal laser scanning microscope: An in vitro comparative study.

The effective disinfection of the entire root canal system aids in the penetration of irrigants into the dentinal tubules further improving sealer penetration and achieving a three-dimensional seal in endodontically treated teeth. Various final irrigation techniques can be employed to achieve this goal. Therefore, this study intended to assess and compare the efficacy of three final irrigation techniques on the depth of penetration of two root canal sealers into dentinal tubules using confocal laser scanning microscope (CLSM). Forty-eight single-rooted mandibular premolars were selected and decoronated to a length of 12 mm. All the samples were prepared using ProTaper Gold rotary files and divided into three groups: Group 1 - Conventional syringe irrigation (CSI), Group 2 - passive ultrasonic irrigation (PUI), and Group 3 - Pro-agitator tip system (PATS). Each group was divided into two subgroups: Subgroup A - AH Plus and Subgroup B - GuttaFlow Bioseal (GFB). Then, sealers were mixed with 0.1% rhodamine B dye and the samples were obturated. All the samples were sectioned at 2 mm and 5 mm from the apex and visualized under confocal laser scanning microscope (CLSM) (10×) for maximum mean penetration depth and percentage of sealer penetration. Statistical analysis was done using the independent t-test and one-way analysis of variance test, followed by Tukey's Post hoc analysis. PUI performed better in the apical third, whereas PUI and PATS showed comparable results in the middle third for both depth and percentage of sealer penetration. Among the two sealers, GFB performed better than AH Plus in both the apical and middle third. These values were statistically significant. (P < 0.05). Final irrigation activation with PUI or PATS can significantly improve sealer penetration. The average depth of penetration of GFB both at the middle and apical third of the root was significantly superior to AH Plus.

Comparative Evaluation of Volume and Homogeneity of Obturation with Four Different Obturation Systems Using Micro-Computed Tomography: An In vitro Study.

To evaluate and compare volume and homogeneity of the three different root canal obturation systems. Single-rooted premolar (n = 24) teeth samples were selected, and crowns were removed for standardization. Four groups are divided randomly as (n = 6), namely: For group I (single-cone gutta-percha obturation), group II (Beefill 2 in 1 obturation), group III (GuttaCore obturation), group IV (GuttaFlow bioseal obturation) and the root canal were subjected to prepare till X3 (protaper next) and subjected to micro-CT imaging. After completion of obturation, the image was taken by using micro-CT imaging. This is to evaluate the volume of filled obturation material in the canal space and the voided area sections, viz. the apical, middle, coronal, and third sections. Group III (GuttaCore obturation) showed the least significant mean of the difference in relation to the volume of the canal obturation (81.148). The least mean significant difference in area of voids in the canal region for apical (0.00133), middle (0.00233), and coronal thirds (0.00533). The most statistically significant difference is in the apical and middle thirds root canal space. All the experimental groups showed significant differences in volume and voids in the obturation at three different levels, and the GuttaCore obturation systems occupied more of the volume with less voids in the prepared root canal space.

Efficiency of Canal Brush and Ultrasonic Activated Irrigation in Smear Layer Removal Using Two Different Chelating Agents (In Vitro Study)

Objective: This study aims to evaluate the efficiency of two different activation methods after using two different chelating agents inthe removal of the smear layer.&#x0D; Methods: In this study, seventy single-rooted mandibular premolar teeth were included, and divided into six study groups and onecontrol group according to the chelating agents and activation methods used. In groups 1,3, and 5, EDTA was used as the chelatingagent, where it was activated by Canal Brush in G3 and by Ultra Smart in G5. In groups 2,4, and 6, 7% Maleic acid was used insteadand activated by Canal Brush in G4 and Ultra Smart in G6. While in G1 and G2, no activation systems were used. The 7th group wasa negative control and purposed to verify the internal microstructure, so only distal water was irrigated (no activation and no chelatingagent was used). Samples were sectioned longitudinally and prepared for Scanning Electron Microscope (SEM) analysis in the coronal,middle, and apical parts. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. The level of significancewas set to 0.05 (P &lt; 0.05).&#x0D; Results: Although the G5 (Ultra Smart +EDTA) median score showed the best smear layer removal score, it was not statisticallysignificant in comparison with the other 5 study groups. In all groups (whether Maleic acid or EDTA were used), smear layer removalwas effective in the coronal and middle thirds while less effective in the apical third, with no statistically significant difference betweenthe chelating agents.&#x0D; Conclusions: Under the limitations of this in vitro study, no activation system was able to remove the smear layer from the root canalwall completely. However, NaOCl and EDTA's irrigation sequence combined with Ultra Smart (ultrasonic activation) obtained betterresults than the other techniques.

An in vitro evaluation of Icon resin infiltrant penetration into demineralized enamel lesions using an indirect staining technique with confocal laser scanning microscope analysis in dual fluorescence mode.

White spot lesion is the first clinical sign of a caries lesion and represents mineral loss from the enamel subsurface. The aim of this study was to evaluate the penetration depth (PD) of Icon resin infiltrant into artificially demineralized enamel lesions using confocal laser scanning microscope (CLSM) analysis in dual fluorescence mode. The design of the study was an in vitro study. 22 extracted human permanent maxillary central incisor teeth were collected, and enamel sections were obtained from the coronal middle third. All enamel specimens were exposed to demineralization and remineralization solutions for 14 days. On positive confirmation of enamel demineralization by scanning electron microscope analysis, 20 specimens were then subjected to Icon resin infiltration following manufacturer instructions. Specimens were processed with indirect staining technique using rhodamine B and sodium fluorescein dyes and examined under CLSM at ×10 magnification in dual fluorescence mode using ImageJ software to evaluate PD of resin infiltrant into demineralized enamel lesions. Obtained data were analyzed using an independent t-test. P ≤0.05 was considered statistically significant. The maximum depth of demineralized enamel lesion was 590 μm, and the mean depth was 290.78 ± 14.80 μm. The maximum depth of resin infiltrant penetration was 580 μm, and the mean depth was 279.08 ± 13.88 μm; P = 0.006. The percentage penetration of resin infiltrant was 95.99%. Icon resin infiltrant was highly effective in its depth of penetration into demineralized enamel lesions. The use of indirect staining and CLSM analysis in dual fluorescence mode is more reliable and accurate technique to evaluate the PD of resin infiltrant.

‘Methodism Alive’: Mass Observation's Worktown Perspective

Abstract This paper explores the potential of the Mass Observation Archive at the University of Sussex for studying the history of Methodism in Bolton (aka ‘Worktown’) during the middle third of the twentieth century, with particular reference to the years 1937–40 and 1960, demonstrating its value for recording the lived experience of Methodism. An appendix contains three key documents, two of them relating to the work of the Victoria Hall in the Bolton Mission circuit, which was much lauded by Mass Observation.

Effect of artificial aging on the stability of color match of Omnichroma composite resin

Purpose To evaluate the effect of artificial aging on the stability of color match between the teeth and Omnichroma composite resin compared to that in the teeth restored with Tetric EvoCeram nanohybrid composite resin. Materials and methods Twenty sound, freshly extracted human maxillary premolars were mounted in acrylic blocks. The baseline shade of the selected teeth was A2 as measured from the middle third of the buccal surface by spectrophotometer (Vita Easyshade Advance). Trapezoidal Class V cavity was prepared on the buccal surface of each tooth 0.5 mm coronal to CEJ. Cavity dimensions were width of 4 mm occlusally and 3 mm gingivally, 2 mm occluso-gingival length and 1.5 mm depth. A 45-degree bevel was placed on the occlusal cavity margin. Results Specimens were randomly divided into two equal groups (n = 10) representing the materials used to restore the cavities. Group I: Tetric EvoCeram while Group II: Omnichroma. Specimens were artificially aged by storage for 6 months in artificial neutral saliva in an incubator at 37 ± 5°C during which the saliva was replaced daily. Color measurements and ΔE values were recorded before cavity preparation representing the baseline tooth color to be used for detection of the initial color match between the tooth and restoration where their color was measured after storage in saline for 24 h. Conclusion At the end of the storage period, the color of both the teeth and the restorations was remeasured to detect the stability of color match between the restoration and the tooth due to storage.

Micro-CT evaluation of the presence of voids in endodontic obturation.

To analyze by micro-CT the presence of voids in lower single-rooted premolar root canal obturations prepared using the single cone and ultrasound vibration technique. Twenty extracted single-rooted lower premolars were selected, and the root canal prepared surgically and chemically. In GROUP 1 - Without Vibration, the canal was obturated with a single cone and bioceramic, without applying vibration. In GROUP 2 - With Vibration, the gutta-percha cone inside the root canal was held with a cotton plier to which ultrasound vibration was applied for 3 periods of 3 seconds each. A micro-CT scanner was used to acquire and reconstruct images for analysis. No significant difference was found between obturation techniques, though there were differences between thirds, with the cervical third having a higher percentage of voids than the middle and apical thirds. The results suggest that the volume of closed, open and total voids does not differ between treatments with and without ultrasound vibration. In the cervical third, the highest volume of voids was related to oval geometry in the teeth evaluated.

493 Predictors of Recurrence After Surgical Resection of Parafalcine and Parasagittal Meningiomas

INTRODUCTION: Parasagittal and parafalcine meningiomas are challenging tumors to resect, owing to their proximity to the sagittal sinus and associated collateralized venous channels. More research is needed to elucidate relevant factors that affect risk of recurrence. METHODS: This is a retrospective study of all patients who underwent resection of parasagittal and parafalcine meningiomas between 2012-2018. Multivariable Cox regression and Kaplan Meier analysis was performed to assess for factors that influence progression free survival (primary endpoint). RESULTS: A total of 110 consecutive subjects (mean age: 59.4+/-15.2 years, 67.3% female) with 74 parasagittal and 36 parafalcine meningiomas (92 WHO grade 1, 18 WHO grade 2/3) are included in the study. A total of 37 patients (33.6%) exhibited recurrence with median follow-up of 42 months (IQR: 10-71). In the overall cohort, parasagittal meningiomas exhibited shorter progression free survival compared to parafalcine meningiomas (p = 0.045). On univariate analysis, predictors of recurrence include WHO grade 2/3 vs. grade 1 tumors (HR 4.27, 95%CI: 2.01-9.09; p &lt; 0.001), higher Ki-67 indices (HR, 1.11, 95% CI: 1.07-1.14; p &lt; 0.001), partial (Sindou class 2-4) (HR 2.32, 95% CI: 1.03-5.19; p = 0.04) or complete (Sindou class 5-6) sinus invasion (HR 4.65, 95% CI: 2.07-10.42; p &lt; 0.001), and subtotal resection (HR 4.13, 95% CI: 2.05-8.32; p &lt; 0.001). Location along the anterior, middle or posterior third of the sagittal sinus did not influence risk of recurrence (HR 0.82, 95%CI: 0.30-2.28; p=0.71). Multivariable Cox regression analysis revealed high grade meningiomas (HR: 3.62, 95% CI: 1.60-8.22; p = 0.002), complete sinus invasion (HR: 3.00, 95% CI: 1.16-7.79; p = 0.024), and subtotal resection (HR: 3.10, 95% CI: 1.38-6.96; p = 0.006) portend increased risk of recurrence. CONCLUSIONS: This is the largest study to date that identifies predictors that confer increased risk of recurrence after resection of parasagittal and parafalcine meningiomas, which can be used to

Osteo-Cutaneous Reconstruction of the Thumb by Radial Composite Flap

Background. One of the possible ways of the thumb reconstruction when it is lost at the level of the middle third of the ray is osteo-cutaneous reconstruction, which today is carried out by transplantation of the blood-supplied composite tissue complex, which allows for reconstruction of the lost thumb without the risk of the bone graft resorption.&#x0D; The aim — to evaluate the effectiveness of osteo-cutaneous reconstruction of the thumb using a blood-supplied tissue complex based on the radial artery. The study is based on the results of the treatment of 27 patients who underwent the thumb reconstruction with a radial osteo-cutaneous tissue complex performed according to the G. Foucher’ technique. The average age of the operated patients was 44±12.7 years. The island tissue complex was used in 22 patients; in 5 cases, a free flap from another forearm was transplanted.&#x0D; Results. Long-term results were evaluated one year after reconstruction. In all cases, good functional results were achieved with an average DASH score of 44.4±10.6 points. The best results were obtained in patients with a stump at the base of the thumb proximal phalanx due to the preservation of the metacarpophalangeal joint mobility, the average volume of movements of which was 45°. When using Littler’s flap, it is possible to achieve a 2PD of the working surface of the restored thumb within 7.5±0.9 mm. Otherwise, only the protective sensitivity is restored.&#x0D; Conclusions. The osteo-cutaneous reconstruction of the thumb when it is absent at the level of the middle third of the ray is an effective method of reconstruction if it is impossible to use other microsurgical methods, such as transplantation of the second toe or the fragment of the great toe.

Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection.

Perforation is one of the most important complications of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Several studies have examined risk factors for intraoperative and delayed perforations, but most were retrospective analyses with small numbers of patients. This study represents a secondary analysis of a Japanese multicenter prospective cohort study. We investigated the factors associated with each type of perforation using 9015 patients with 9975 EGCs undergoing ESD between July 2010 and June 2012. Intraoperative perforation occurred in 198 patients (2.2%) with 203 lesions (2.0%), necessitating emergency surgery for four lesions (0.04% [2.0%, 4/203]). Delayed perforation occurred in another 37 patients (0.4%) with 42 lesions (0.4%), requiring emergency surgery for 12 lesions (0.12% [28.6%, 12/42]). Factors showing significant independent correlations with intraoperative perforation were upper or middle third of the stomach; remnant stomach or gastric tube; procedure time ≥100min; tumor size >35mm; body mass index (BMI)<18.5kg/m2; and ≥72years. Factors showing significant independent correlations with delayed perforation were procedure time ≥60min; BMI<18.5kg/m2; ≥75years; ulceration; and tumor size >20mm. Intraoperative perforation occurred most frequently at the greater curvature in the upper third of the stomach (7.9%), whereas delayed perforation occurred most frequently at the greater curvature in the middle third (1.2%). This multicenter prospective cohort study clarified the risk and risk factors of intraoperative and delayed perforation related to ESD for EGCs, providing information to help endoscopists reduce perforation.

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Biomechanics of Central Incisor Endocrowns with Different Lengths and Milled Materials after Static and Vertical Loading: A Finite Element Study.

The aim of this study was to compare and assess the stress distribution and failure possibility of endodontically treated central incisor protected with endocrowns with different heights, with various CAD-CAM blocks such as IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia. A root canal-treated central incisor (plastic model) restored with an endocrown was scanned with a laser scanner to prepare a control model with a CAD software and then transferred to an FEA software. Proposed crown heights were 2, 4, and 6 mm. The model that was duplicated and restored with CAD-CAM blocks, IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia were tested as endocrown materials. Bone geometry was simplified to be two coaxial cylinders in all models. Stress distributions under 50 N axial and oblique (with 135° angle from the vertical plane) loading were analyzed. Each model was then subjected to two occlusal loading conditions-the lingual slope of the incisal edge and the junction between incisal and middle thirds. Eighteen runs and calculations were performed to determine the endocrown height and material effect. The results showed a minor or negligible effect of changing the endocrown material. Increasing endocrown height was shown to reduce stresses and deformations on most of the model components (bone, gutta-percha, periodontal ligament, and endocrown), except root and cement. Differences in deformations and stresses between the two models of 4 and 6 mm were relatively smaller (ranged between 1% and 30%) compared to those between the 2 and 4 mm models (ranged between 10% and 400%). The material used to fabricate endocrowns did not show considerable effect on the underlying structures. However, the endocrown design (2, 4, and 6 mm height) was shown to affect all components of the studied systems. Increasing endocrown height is recommended for bone, periodontal ligaments, and endocrown body, as it reduces stresses and deformations. On the other hand, it dramatically increases stresses on the root and cement layer. Smaller endocrown sizes represent an acceptable treatment option when there is a healthy periodontal state, while using larger sizes will be more suitable when there is a periodontal compromise with bone loss.

Delimitation of the risk area of the vertebral artery during the paramedian suboccipital approach

ObjectiveThe V3 segment of the vertebral artery (V3-VA) is at risk during diverse approaches to the craniovertebral junction. Our objective is to present a system of anatomic and topographic landmarks to identify the V3-VA during the paramedian suboccipital approach (PMSOA) with the help of minimal or basic tools. Material and methodsThe first was a retrospective analysis of the angiotomography (CTA) of 50 patients over 18-years old, and 9 anatomical dissections. A series of lines were defined between the different bony landmarks. Within this lines the risk area of the vertebral artery (RAsV3-VA) and the risk point of the vertebral artery (RPsV3-VA) were defined.The second stage was a prospective study, where the previously defined measurements were carried out by using neuronavigation in 10 patients (20 sides) operated with the PMSO approach in order to confirm the presence of the V3 segment in the RAsV3-VA and RPsV3-VA. ResultsIn the first stage, the V3 segment was found in the middle third of the X line in 96,6% of the cases. The distance between the inion and the UCP (percentile 5) was 20 mm and to the LCP (percentile 95) was 40 mm. In the range between the UCP and the LCP, in the middle third of the inion-mastoid line (RAsV3-VA), we found 90% of the V3-VA.The measurements taken during the second stage revealed that the artery was in the middle third of the X line in 97% of the cases. 85% of the patients presented the total of the V3s-VA on the RAsV3-VA and in 85% there was a direct relationship with the V3 segment and the RPV3s-VA. ConclusionWe propose an easy-to-implement system to delimit the risk area of the V3-VA during the PMSOA. We believe that these landmarks provide a practical, reliable, costless and useful tool that could decrease the risk of lesion of the V3-VA during this approach without the need of using.

Ileoneocystoplasty After Radical Cystectomy – Modification of the Method and Immediate Results

The objective: is to evaluate the effectiveness of the treatment of muscle-invasive bladder cancer (MIBC) by creating an artificial reservoir for the derivation of urine from segments of the small intestine of patients and to study urination and other functions of the urinary system in the postoperative period. Material and methods. During 2019-2020, the SI «Academician O.F. Vozianov Institute of Urology National Academy of Sciences of Ukraine» conducted examinations and treatments on nine patients diagnosed with MIBC at clinical stages T2aN0M0–T3bN0M0. All patients underwent laparoscopic cystectomy and lymphadenectomy, while a third of them underwent open bladder resection at other medical facilities. Among these, three patients received intracorporeal ileoneocystoplasty, whereas in six patients, the procedure involved a change in access from a median laparotomy. The implemented method of orthotopic ileoneocystoplasty during radical cystectomy involves creating an orthotopic artificial bladder from a previously resected segment of the ileum and anastomosing it with the proximal part of the urethra and the distal segments of the ureters. Notably, this method introduces several innovations: firstly, it allows for instrumental intestinal suturing in cases of endoscopic variants of radical cystoprostatectomy, and reduces the necessary length of the ileo-intestinal fragment to 50 cm. Secondly, it involves complete detubularization of the intestine fragment, asymmetrically during its middle 5 cm to form a cervical flap, and symmetrically along the contramesenteric edge for the remaining length. Thirdly, the medial edges of the right and left intestinal segments are initially fixed to the upper edge of the middle segment. Fourthly, after creating the eye of the neck of the future reservoir, the upper and middle thirds of the lateral edge of the right and left intestinal segments are fastened together. Fifthly, the original neck of the intestinal bladder is formed by performing vertical incisions of the pre-created eye of the neck of the reservoir at 12 and 6 o’clock to expand its diameter to 1.0–1.5 cm, followed by eversion and tubularization of the formed semicircles on the urethral catheters using 3–5 nodal sutures and a neck duplication maneuver with two nodal, superimposed parallel to the axis of the neck, sero-muscular sutures with a step between injection and needle puncture of 0.3–0.5 cm. Sixth, after forming the vesico-urethral anastomosis, the free edge of the cervical flap and the lower thirds of the lateral edge of the right and left intestinal segments are sutured, the adoral nd aboral intestinal openings are sealed, a cystostomy drainage is installed through the latter, and a reversible peritonization maneuver is performed. Results. According to the type of intervention, patients were divided into 2 groups: 1 group of open ileoneocystoplasty – 6 patients, 2 group of intracorporeal ileoneocystoplasty – 3 patients. According to the results of the operation, the average volume of the artificial reservoir immediately after the operation was: in group 1 – 180 ml ± 23 ml, in group 2 160 ml ± 50 ml. After 6 months, this volume increased and was 420 ± 68 ml in group 1, 380 ± 50 ml in group 2, which allowed patients to urinate 6-8 times a day and 2-3 times a night in some cases. The postoperative bed-day in group 2 was shorter on average by 7 days (7.2 ± 1.5 vs. 14.2 ± 4.2). In this study, there were no registered cases of leakage of the vesico-urethral anastomosis or its stenosis. Conclusions. Application of the proposed method of orthotopic ilioneocystoplasty during radical cystectomy will allow: – to reduce the total time of the operation in connection with the use of modern methods of intestinal suture provided for in its framework; – to compensate for the possible tension of the vesico-urethral anastomosis, which will lead to a decrease in the frequency and intensity of such postoperative complications and negative consequences as: leakage of the vesico-urethral anastomosis or its stenosis, as well as urinary incontinence at night; – thanks to the original maneuver of forming the neck of the ileal reservoir, reduce the hypermobility of the reconstructed bladder-urethral segment; – reduce the likelihood of metabolic disorders in the postoperative period due to the reduction of the length of the ileal segment removed from the patient; – to unify the technology of orthotopic ilioneocystoplasty within the framework of various approaches to performing radical cystectomy, among them: traditional «open», laparoscopic or robot-assisted.

AUTOTRANSPLANTATION WITH EXTRACORPORAL RECONSTRUCTION OF RENAL VESSELS: A CLINICAL CASE OF “THE NUTCRACKER SYNDROME” AND LEFT RENAL ARTERIES HYPOPLASIA COMBINATION

Ex vivo kidney autotransplantation with renal artery reconstruction is an effective method of surgical correction of vascular abnormalities (fibromuscular dysplasia, hypoplasia, and renal artery aneurysms) showing good long-term results. The combination of renal artery abnormalities with aorto-mesenteric compression syndrome (“the nutcracker” syndrome) is extremely rare and complicates the diagnosis making greatly. Renal artery hypoplasia is an abnormality that is rarely diagnosed and may not manifest clinically in the absence of contralateral kidney pathology as well as its vascular structures. Renal hypoplasia may be caused by mutations in the kidney development genes (HNF1B, PAX2, PBX1) and/or several environmental factors such as intrauterine growth retardation, maternal diseases (diabetes, hypertension), medication taken by the mother (renin-angiotensin system inhibitors or nonsteroidal anti-inflammatory drugs) and intoxication (smoking and alcohol). Premature delivery (before the 36th week) is also a risk factor due to incomplete nephrogenesis. Renal arteries hypoplasia is associated with fibromuscular dysplasia in most cases. The disease is characterized by non-inflammatory non-uniform focal hyperplasia of the renal artery wall with damage to small and medium arteries. Simultaneous damage to two or more vascular segments is detected in 25% of patients.&#x0D; A clinical case of successful treatment of “the nutcracker” syndrome (annular renal vein) combined with hypoplasia of the left main and accessory renal arteries associated with fibromuscular dysplasia is described. A 27-year-old female was admitted to the Department of Vascular Surgery of Municipal Noncommercial Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” on October 4, 2021, with complaints of pain in the left lumbar region and the left half of the abdomen, hematuria, proteinuria, a persistent increase in blood pressure. Ultrasound of the renal veins: the left renal vein in the aorto-mesenteric segment was not visualized, the posterior portion of the left renal vein was determined. Peak systolic velocity was up to 230 cm/s at the point of confluence with the inferior vena cava and 28 cm/s more distally. The vein was up to 12.0 mm in the renal hilum and up to 11.0 mm in the middle third. MSCT of the abdominal cavity, retroperitoneal space and pelvic organs: CT signs of pyelonephritis of the left kidney. Hypoplasia of the left kidney. Reactive para-aortic lymphadenopathy on the left. Hypoplastic left renal artery (3,8 mm) and presense of accessory ones, annular left renal vein. Angiomyolipoma of the right kidney (2,6 cm). Varicose veins of the small pelvis on the left. The patient underwent surgical treatment, namely ex vivo autovenous prosthetic repair of the left renal artery with autotransplantation of the left kidney. The course of the postoperative period was without complications, the reconstruction was functioning. Ultrasound of the renal vessels (1 week after the surgery): the blood flow was located in the renal hilum in the course of Doppler sonography of intrarenal branches. Venous outflow was unobstructed. Corticomedullary differentiation was marked satisfactorily.&#x0D; The study presented by us demonstrates the effectiveness of kidney autotransplantation for the correction of renal vascular abnormalities.&#x0D; Though of a solitary nature, the combination of renal vessels abnormalities complicates significantly the course of the disease and the possibilities of this pathology diagnostics.

Morphometric Measurements of Root Anatomic Areas of Maxillary First Premolar Teeth in a Representative Nepalese Population

Background The prognosis of furcation involved maxillary first premolar is typically guarded to poor. The presence of concavities in the root trunk and the positioning of the roots in the buccal and palatal regions of the teeth are responsible for its challenges during instrumentation and control plaque. We aimed to access the presence of concavities on the root surface as well as morphometric measurement of the root trunk dimensions in the maxillary first premolar teeth in Nepalese population.MethodsA cross-sectional quantitative study was conducted in the Department of Periodontics and Oral Implantology, College of Medical Sciences (CoMS). Extracted Maxillary first premolar teeth were evaluated for the number of roots, morphometric measurement of the root trunk, root divergence, and root length. The presence of concavities was recorded on the mesial and distal root surface at cervical, middle, and apical thirds of the root.ResultsThe overall mean root trunk length was less on the mesial aspect than on the distal aspect (6.39 ± 2.54 and 8.08 ± 3.48 respectively). The prevalence of root surface concavity on the cervical third at the mesial aspect (90 %) was found to be higher than in the distal aspect (15%) Conclusions Owing to the higher prevalence of root surface concavity on the cervical third of mesial aspect, use of mini-bladed curettes is recommended for the effective root surface debridement of the periodontally involved maxillary first premolar tooth. Patients with periodontally involved maxillary first premolar should be advised to use interdental brushes rather than dental floss.

ANATOMICAL CHARACTERISTICS OF THE THIGH PARAMETERS THE STUDENTS OF BUKOVYNA

It is known that the factor that determines success in sports is the morphological features of the structure of the human body. In order to establish the anatomical characteristics of the thigh parameters of students of Bukovyna who play football and handball, followed by modeling for sports selection, a study was conducted of students of higher educational institutions of Bukovyna (n=129), of which young boys - n=69 and young girls - n=60. The subjects were divided into a main group - 89 students who improved by playing football and handball and a control group - 40 students who did not do the sports. Students of the main group, in addition to the physical activity that was included in the program of their specialty during the year, additionally attended sports sections in football and handball during the year. Medium-intensity training took place under the control of a trainer, the frequency of training was 3.43 ± 1.26 days/week (90 minutes each). Students of the control group did not do the sports. The initial survey was conducted in 2021 year, and the same students were resurveyed in 2022 year. All subjects were subjected to an anthropometric study, according to the method of P.P. Shaparenka (thigh circumference in the upper third, in the middle third and in the lower third, body weight, height). So, it was found that when comparing the first and second measurement, the thigh circumference indicators at the second measurement (in dynamics after one year) were slightly higher in students who play football (young boys and young girls) in the upper, middle and lower thirds than in students who play handball (for students who play football ±3.43 cm, for students who play handball ±2.12 cm). The model for predicting the circumference of the thigh in the upper third on the right: Cpr=β1 + β2 + 0.493w – 0.135h, where Cpr is the circumference of the thigh in the upper third (right), w is body weight, h is height, β1= (49.735 for girls and 44.489 for young men), β2= (–1.391 for the soccer group; –2.321 for the handball group), on the left: Cpl=β1 + β2 + 0.465w, where Cpl is the circumference of the thigh in the upper third (left), w is body weight, β1= ( 25.736 for girls and 20.147 for boys), β2= (–1.333 for the football group; –0.515 for the handball group).&#x0D; The model for predicting the circumference of the thigh in the middle of the right: Cmr=β1 + β2 + 0.460w – 0.183h, where Cmr is the circumference of the thigh in the middle of the right, w is body weight, h is height; β1= (52.567 for young girls and 48.930 for young boys), β2= (–2.235 for the football group; –1.968 for the handball group); on the left: Cml=β1 + β2 + 0.449w, where Cml is the thigh circumference in the middle of the left, w is body weight; β1= (20.716 for young girls and 20.943 for young boys), β2= (– 0.254 for the football group; –1.405 for the handball group). The model for predicting the circumference of the thigh in the lower third of the right: Cdr=β1 + β2 + 0.418w, where Cdr is the circumference of the thigh in the lower third of the right, w is body weight, β1= (25.560 for young girls and 20.165 for young boys), β2= (– 0.039 for the football group; 0.061 for the handball group); on the left: Cdl=β1 + β2 + 0.387w, where Cdl is the thigh circumference in the lower third on the left, w is body weight; β1= (24.638 for young girls and 18.523 for young boys), β2= (– 0.379 for the football group; –0.261 for the handball group). So, it is established that for significant predictors for predicting thigh circumference on the right in the upper and middle third are gender, sport, height and body weight, in the lower third are gender, sport and body weight, on the left are gender, sport and body weight.

Propeller Flap: A Feasible Flap for Distal Third of Leg Defects – Two Cases Done at the Plastic Surgery Unit of the Greater Accra Regional Hospital

Introduction: The traditional way of reconstructing soft tissue defects of the lower limb utilized muscle flaps as the ‘gold standard’ for Gustillo Anderson Grade III B fractures of the upper and middle thirds of the leg. Defects of the lower third of the leg are usually reconstructed with free flaps because of paucity and decreased reach of muscles. In resource constrained environments where free flaps are not routine with high failure rates, fasciocuataneous flaps are the only option left. We present our experience with the novel pedicled propeller perforator flaps for reconstruction of soft tissue defects in the lower limb. Case Presentation: Between June and October 2020, 2 consecutive patients - a 34-year-old male and a 51-year-old female, were referred for cover for their distal leg defects from the Orthopedics and trauma Unit. All patients were operated on under spinal anaesthesia. Perforators from posterior tibial and peroneal arteries respectively, were identified pre-operatively with hand-held doppler and the propeller-pattern skin paddle was designed around the perforator closest to defect. After elevation of flaps and skeletonization of perforators, they were then rotated (180 degrees) and inset into defects. Case 1 had whole flap (104 cm2) surviving with only minor marginal epidemiolysis at tip whilst the second flap (58.5cm2) had necrosis of only the business end of the flap but subsequently healed by secondary intention after serial dressings. Both had secondary defects proximally after the rotation, which were skin grafted with 100% take. Conclusion: Propeller flap in our experience, is a feasible versatile option for reconstruction of soft tissue defects in the distal third of the leg.

Three-dimensional evaluation of interproximal contacts of permanent dentition: a cone beam computed tomography study.

To assess the various patterns of the inter-proximal contact areas of the permanent dentition using the available cone beam computed tomography (CBCT) images. A retrospective cross-sectional study was performed on existing CBCT images from a University hospital and teaching department. Three thousand two hundred and fifty inter-proximal contacts were assessed from 125 existing CBCT scans of patients (age range: 14years 3months-29years 9months) who had matched the eligibility criteria. The types of inter-proximal contacts of the permanent dentition were scored at occlusal, middle, and cervical thirds, according to the OXIS inter-proximal contacts classification. Chi-square test was used to assess the contacts and gender/arches. The most prevalent contact was type I for the posterior teeth contacts, and types S1 and S2 for the anterior teeth contacts. Statistical significance was not observed between the contacts on the left and right sides (P > 0.05), while statistical significance was observed between the inter-proximal contacts of the maxilla and mandible (P < 0.05). The CBCT-based three-dimensional assessment of the inter-proximal contact areas of the permanent dentition is representative of the OXIS classification. The occlusal level contact was predominantly representative of the overall type of the contact.