Outer Splitting Research Articles

The Utility of Bone Burring for the Clearance of Locally Advanced Scalp Malignancies: A Scoping Review.

A literature search was conducted systematically using MEDLINE, Embase, and PubMed. Articles were reviewed for inclusion, and eligible studies were analyzed for study design, patient and intervention details, and outcome measures. A formal statistical analysis was not conducted. The original search yielded 1506 unique results, and eight studies met the inclusion criteria: four case series, two retrospective analysis of records, two case reports. A number of tumor types were identified, but the burring method used was consistent in all studies. Despite reassuring primary outcome measure results, specifically in terms of local control rates, the overall evidence quality is limited by the nature of the included studies. Few adverse events were reported. Evidence for the oncological efficacy of scalp bone burring remains limited. Although the technique seems relatively safe, further investigation is required into its utility and drawbacks. Future studies should aim to report more technical details and more information about outcomes. It may also be worth comparing burring to alternatives such as outer cortical splitting, curettage, and high-dose curative radiotherapy.

Donor site morbidity in autologous bone grafting – A comparison between different techniques of anterior iliac crest bone harvesting: A prospective study

Background: The aim of this study is to compare morbidities at the donor site in autologous bone harvesting from an anterior iliac crest via the outer cortex, inner cortex and table splitting technique. Methods: The randomized, prospective and comparative study was conducted in 60 patients who were treated with bone grafting as a part of their treatment plan. Group A underwent the outer cortex technique (20 patients), Group B underwent the inner cortex technique (20 patients) and Group C underwent the table splitting technique (20 patients). The comparison of morbidities associated with various techniques of anterior iliac crest bone graft harvesting was done for a period of one year. Results: Most common morbidity observed was pain, measured by the visual analogue scale score (60/60, 100% of patients). The visual analogue scale score was significantly higher for the outer cortex group followed by the inner cortex group, and then the lowest score was for the table splitting group ( p < 0.05). Followed by numbness (40/60, 66%), least in the table splitting group and maximum in the outer cortex group ( p < 0.05). Next was abnormal gait, which was mostly seen in patients with the outer table method and least in the table split group ( p < 0.05). Other complications were infections (4), itching at the surgical site (3) and hematoma (1). There were no significant difference regarding scar satisfaction among comparison groups. Conclusion: we conclude that few differences do exist in harvest-site morbidities between different techniques used in our study. Overall, the most common morbidity observed were pain, numbness and abnormal gait. However, the table splitting group has the lowest morbidity, therefore bone harvesting by the table splitting appears to be a very good option.

A fingerprint hidden inside the eye. A unique pattern of outer retina splitting as seen on en-face OCT and OCT-angiography

A splitting of the outer plexiform retinal layer in a saw-like hyporeflective pattern in addition to partially formed concentric circles centred at the foveola were observed using en-face OCT and OCT-angiography in a 27-year-old female patient with rhegmatogenous retinal detachment and a 50-year-old female patient with Vogt-Koyanagi-Harada chorioretinopathy.

S4B-16 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS MANDIBULAR OUTER CORTEX SPLITTING OSTEOTOMY: IS IT AN EFFECTIVE FACIAL CONTOUR SURGERY?

Introduction: Background: Mandibular outer cortex splitting osteotomy(MOCSO) is widely used as a facial contour surgery to shape a narrower lower face. Mandible outer cortex regeneration occur as a natural process of bone healing. The volume of mandible regeneration largely affect the clinical result of MOCSO. However, the postoperative mandible regeneration were rarely investigated. This study aim to clarify the morphologic change of mandible after MOCSO. Methods: A retrospective study of MOCSO from 2009–2016 was conducted. 16 patients with preoperative, immediately postoperative and 12 months postoperative CT were enrolled. 3D visual reconstruction and registration of preoperative, immediately postoperative and postoperative mandible were performed. MOCSO area was segmented based on the immediately postoperative mandible bone defect. Then 3D comparison and analysis of the MOCSO area was performed. Results: The bone volume of the MOCSO area was 6921.5±878.1m3 preoperative; 4181.7±574.1m3 immediately postoperative; 6674.7±919.7m3 6 months postoperatively. The bone regeneration rate of the MOCSO area is 95.17% 12 months postoperatively. Conclusion: The bone regeneration rate of MOCSO is over 90%. Although our result needs to be further strengthened by clinical study with more cases, practitioners should be cautious about adopting MOCSO as a valid facial contour surgery.

Clinical feasibility and efficiency of a 3-dimensional printed surgical template for mandibular angle osteotomy and mandibular angle splitting osteotomy

Mandibular angle osteotomy (MAO) and mandibular angle splitting osteotomy (MASO) are the two main surgical approaches used to correct a square mandible for a desirable aesthetic appearance. However, there are concerns about the safety and accuracy of both procedures as they may lead to unsatisfactory results such as injury to the nerve. To achieve symmetry and security we designed and evaluated a 3-dimensional printed surgical template, which indicates the outer cortex splitting line of the MASO, and the curved cutting line of the MAO. We operated on 11 patients who had been diagnosed with broad mandibles using the assisted template. The mean duration of osteotomy, degree of numbness of the inferior alveolar nerve, and reduction in the width of the mandible (Go-Go) were recorded. The mandibular curve before and after operation was fitted to evaluate its accuracy. The results showed that mean duration of osteotomy and numbness of the nerve were reduced, and there was no significant difference between simulation and postoperatively. The mean (SD) reduction in the mandibular width was 15.2 (1.6)mm. The template facilitated accuracy and safety in both procedures.

Computably enumerable sets that are automorphic to low sets

We work with the structure consisting of all computably enumerable (c.e.) sets ordered by set inclusion. The question we will partially address is which c.e. sets are autormorphic to low (or low2) sets. Using work of R. Miller, we can see that every set with semilow complement is � 0 automorphic to a low set. While it remains open whether every set with semilow complement is effectively automorphic to a low set, we show that there are sets without semilow complement that are effectively automorphic to low sets. We also consider other lowness notions such as having a semilow1.5 complement, having the outer splitting property, and having a semilow2 complement. We show that in every nonlow c.e. degree, there are sets with semilow1.5 complements without semilow complements as well as sets with semilow2 complements and the outer splitting property that do not have semilow1.5 complements. We also address the question of which sets are automorphic to low2 sets.

Correction of asymmetric facial deformity by contouring: indications and outcomes.

Facial asymmetry is usually due to unbalanced development of the lower jaw and zygoma and often results in esthetically unpleasant appearance. However, reasonable and systematic treatment of such an asymmetric face is rarely reported in the literature. This article aims to evaluate the effectiveness of surgical correction of asymmetric facial deformity and discuss their indications. From July 2006 to November 2010, a total of 52 patients received contour reshaping procedures to correct their asymmetric faces. Those patients in whom the asymmetric facial deformities were initiated by hypertrophy of the mandible and zygoma without occlusion and temporomandibular joint problem were chosen for this study. The authors performed a modified reduction malarplasty to correct asymmetric middle face and mandibular outer cortex splitting ostectomy, mandibular "V-line" ostectomy, and rotation genioplasty to improve asymmetric lower face depending on individual asymmetric facial characteristics. The effectiveness was then evaluated through cephalometric radiographs, three-dimensional computed tomography, and presurgical and postsurgical standard facial photographs. The postoperative results of all 52 cases showed that the asymmetric face was effectively corrected without serious complications and the harmonious facial contour improved significantly. The final esthetic outcomes were quite satisfactory for both surgeons and patients. The results indicate that a variety of contouring techniques for facial asymmetric deformity could be carried out based on characteristics of asymmetric face, so as to acquire a symmetric and harmonious face in accordance with facial esthetics.

Comprehensive Consideration and Design for Treatment of Square Face

From an East Asian traditional esthetic viewpoint, a soft facial appearance seems to be more attractive. A prominent mandibular angle, a high zygomatic bone, and an inharmonious chin strongly lessen the attributes of femininity. Attention should be paid to the zygomatic projection and square mandible from the frontal view and the gonial angle and mental region configuration from the lateral view to obtain a slender oval face (melon seed face). From January 2005 through December 2010, 47 patients underwent a combination of 4 operative techniques to reshape a square face: L-shaped osteotomy, V-line osteotomy, mandibular outer cortex splitting ostectomy, and sliding genioplasty. Outcomes in and feedback information from patients showed that these methods made the square face look more harmonious, with significant improvement of the middle and lower facial contours. Asians with a square face have different combinations of facial features; thus, surgeries should be customized and designed comprehensively to achieve optimal results.

Adiabatic evolution of light in an array of parallel curved optical waveguides

Adiabatic evolution of light in parallel curved optical waveguide array is investigated theoretically. This problem is shown to bear a close connection with the process of coherent population transfer in a ``bow-tie'' model in quantum physics. Under certain conditions on the geometry of the waveguides and the optical properties of the system complete light transfer between the outer waveguides is achieved. Special attention is paid to the case of three waveguides, which is analyzed using the solutions of the well-known bow-tie model. The analytic solution is used to design recipes for creating arbitrary superpositions of light intensity between the waveguides, with possible applications in achromatic optical multiple-beam splitters. For more than three waveguides complete light transfer between the outer waveguides and beam splitting is demonstrated numerically.

On the Infinite Products of Matrices

In different fields in space researches, Scientists are in need to deal with the product of matrices. In this paper, we develop conditions under which a product Пi=0∞ of matrices chosen from a possibly infinite set of matrices M={Pj, j∈J} converges. There exists a vector norm such that all matrices in M are no expansive with respect to this norm and also a subsequence {ik}k=0∞ of the sequence of nonnegative integers such that the corresponding sequence of operators {Pik}k=0∞ converges to an operator which is paracontracting with respect to this norm. The continuity of the limit of the product of matrices as a function of the sequences {ik}k=0∞ is deduced. The results are applied to the convergence of inner-outer iteration schemes for solving singular consistent linear systems of equations, where the outer splitting is regular and the inner splitting is weak regular.

Clinical observations of correction of square jaw in East Asian individuals

A square face along with a variety of facial features is considered to be unappealing in the East Asian population. Thus, the objective of this study was to assess the facial features and the various operative techniques available for surgical correction of a square jaw via the intraoral approach. All surgical procedures were performed via the intraoral approach. Surgical approaches such as curved mandibular ostectomy, outer cortex splitting ostectomy, "V-Line" ostectomy, and modified genioplasty were performed according to the different types of facial characteristics. All the patients had standard frontal and lateral cephalometric radiographs and panoramic radiographs, and were photographed preoperatively and postoperatively to assess their facial contour. The width of the lower face caused by prominence of the mandibular angle was effectively corrected, resulting in improved facial contours. Limitation of mouth opening was seen immediately postsurgically but returned to normal following a period of mouth-opening exercises. Serious complications, such as facial nerve injury or fracture, were not witnessed in our study. Mandibuloplasty is an effective and a safe method for the treatment of a prominent mandibular angle. The selection of surgery should be based on the type of square jaw.

2H NMR and Simulation Studies of Chain Segment Orientation in PDMS Bimodal Networks

We present a systematic study through 2H NMR and molecular simulations of chain segment orientation in model PDMS bimodal networks. Estimates of the average segment orientation order parameter in model PDMS bimodal networks compare well to those of equivalent simulated networks. We find that line shapes of short and long chains are different due to the dissimilar degrees of motional restrictions. Short-chain conformations are perturbed from random coiled states when incorporated into bimodal networks whereas long-chain conformations are unaffected. Although experiments and simulations both indicate that the overall segment orientation normalized by the elastic modulus is fairly constant across all bimodal network compositions, short-chain normalized segment orientation displays a nonmonotonic trend with the network composition (related to changes in network microstructure and mechanical properties). Finally, we show that the unusual outer splittings observed in spectra of highly extended unimodal and bimodal samples correspond to segments in long chains able to be exceptionally stretched and oriented along the strain axis.

CONVERGENCE OF RELAXED TWO-STAGE MULTISPLITTING METHOD USING AN OUTER SPLITTING

In this paper, we study the convergence of relaxed two-stage multisplitting method using H-compatible splittings or SOR multisplitting as inner splittings and an outer splitting for solving a linear system whose coefficient matrix is an H-matrix. We also provide numerical experiments for the convergence of the relaxed two-stage multisplitting method.

Convergence of two-stage multisplitting method using AOR or SSOR multisplittings

In this paper, we study the convergence of two-stage multisplitting method using AOR or SSOR multisplittings as inner splittings and an outer splitting for solving a linear system whose coefficient matrix is an H-matrix. We also introduce an application of the two-stage multisplitting method.

Resonant zones, inner and outer splittings in generic and low order resonances of area preserving maps

We consider a one-parameter family of area preserving maps in a neighbourhood of an elliptic fixed point. As the parameter evolves hyperbolic and elliptic periodic orbits of different periods are created. The exceptional resonances of order less than 5 have to be considered separately. The invariant manifolds of the hyperbolic periodic points bound islands containing the elliptic periodic points. Generically, these manifolds split. It turns out that the inner and outer splittings are different under suitable conditions. We provide accurate formulae describing the splittings of these manifolds as a function of the parameter and the relative values of these magnitudes as a function of geometric properties. The numerical agreement is illustrated using mainly the Hénon map as an example.

Investigation of Antimicrobial and Lipid Perturbing Properties of Lactoferrin Peptides

An increase in bacterial resistance to conventional antibiotics has led to an intense search for alternative treatments. Lactoferricin B (FKCRRWQWRMKKLGAPSITCVRRAF), a peptide with potent broad-spectrum antimicrobial activity, is released by pepsin from bovine lactoferrin. A smaller amidated peptide, (LfB6; RRWQWR-NH2), has been identified as having the core antimicrobial activity (Tomita et al. (1994) Acta Paediatr Jpn. 36:585-91). The exact mechanism by which antimicrobial peptides interact with bacterial cell membranes is not well understood, but it is proposed to depend on lipid composition. In contrast to mammalian membranes which are comprised primarily of neutral lipids, bacterial membranes contain a significant (∼20-25%) fraction of negatively charged lipids. In the case of LfB6, the presence of two tryptophans (W; Trp) and three arginines (R) are thought to promote selective interaction with bacterial cell membranes. Recently, we have shown that the antimicrobial activity of LfB6 peptides is increased by N-acylation and Trp-methylation (Greathouse et al. (2008) J. Pept. Sci. 14:1103-1110).To ascertain whether LfB peptides perturb lipids with negatively charged head groups, macroscopically aligned bilayers composed of lipids to mimic bacterial cell membranes have been prepared in the absence and presence of peptide. The samples are composed of neutral (POPE) and anionic (POPG) lipids (3:1), containing either sn-1 chain perdeuterated POPE-d31 or POPG-d31. The effects of LfB6 and amino acylated LfB peptides on lipid dynamics are being investigated by solid-state deuterium NMR spectroscopy and differential scanning calorimetry. The 2H NMR spectra reveal that the addition of LfB6 results in slight but specific changes in the outer quadrupolar splittings, which result from the methylene groups closest to the lipid head groups. Antimicrobial assays against S. aureus and E. coli demonstrate that the activity of N-acylated LfB peptides increases with acyl chain length.

Domain Formation in Sphingomyelin/Cholesterol Mixed Membranes Studied by Spin-Label Electron Spin Resonance Spectroscopy

Interactions of palmitoylsphingomyelin with cholesterol in multilamellar vesicles have been studied over a wide range of compositions and temperatures in excess water by using electron spin resonance (ESR) spectroscopy. Spin labels bearing the nitroxide free radical group on the 5 or 14 C-atom in either the sn-2 stearoyl chain of phosphatidylcholine (predominantly 1-palmitoyl) or the N-stearoyl chain of sphingomyelin were used to determine the mobility and ordering of the lipids in the different phases. Two-component ESR spectra of the 14-position spin labels demonstrate the coexistence first of gel (L(beta)) and liquid-ordered (L(o)) phases and then of liquid-ordered and liquid-disordered (L(alpha)) phases, with progressively increasing temperature. These phase coexistences are detected over a limited range of cholesterol contents. ESR spectra of the 5-position spin labels register an abrupt increase in ordering at the L(alpha)-L(o) transition and a biphasic response at the L(beta)-L(o) transition. Differences in outer splitting between the C14-labeled sphingomyelin and phosphatidylcholine probes are attributed to partial interdigitation of the sphingomyelin N-acyl chains across the bilayer plane in the L(o) state. In the region where the two fluid phases, L(alpha) and L(o), coexist, the rate at which lipids exchange between phases (<<7 x 10(7) s(-)(1)) is much slower than translational rates in the L(alpha) phase, which facilitates resolution of two-component spectra.

Interaction of cholesterol with sphingomyelin in mixed membranes containing phosphatidylcholine, studied by spin-label ESR and IR spectroscopies. A possible stabilization of gel-phase sphingolipid domains by cholesterol.

The ESR spectra from different positional isomers of sphingomyelin and phosphatidylcholine spin-labeled in their acyl chain have been studied in sphingomyelin(cerebroside)-phosphatidylcholine mixed membranes that contain cholesterol. The aim was to investigate mechanisms by which cholesterol could stabilize possible domain formation in sphingolipid-glycerolipid membranes. The outer hyperfine splittings in the ESR spectra of sphingomyelin and phosphatidylcholine spin-labeled on the 5 C atom of the acyl chain were consistent with mixing of the components, but the perturbations on adding cholesterol were greater in the membranes containing sphingomyelin than in those containing phosphatidylcholine. Infrared spectra of the amide I band of egg sphingomyelin were shifted and broadened in the presence of cholesterol to a greater extent than the carbonyl band of phosphatidylcholine, which was affected very little by cholesterol. Two-component ESR spectra were observed from lipids spin-labeled on the 14 C atom of the acyl chain in cholesterol-containing membranes composed of sphingolipids, with or without glycerolipids (sphingomyelin/cerebroside and sphingomyelin/cerebroside/phosphatidylcholine mixtures). These results indicate the existence of gel-phase domains in otherwise liquid-ordered membranes that contain cholesterol. In the gel phase of egg sphingomyelin, the outer hyperfine splittings of sphingomyelin spin-labeled on the 14-C atom of the acyl chain are smaller than those for the corresponding spin-labeled phosphatidylcholine. In the presence of cholesterol, this situation is reversed; the outer splitting of 14-C spin-labeled sphingomyelin is then greater than that of 14-C spin-labeled phosphatidylcholine. This result provides some support for the suggestion that transbilayer interdigitation induced by cholesterol stabilizes the coexistence of gel-phase and "liquid-ordered" domains in membranes containing sphingolipids.

Initial acyl chain segments of gluco- and phospholipids differ in ordering in both lamellar and reversed hexagonal phases

2H-NMR studies of three synthetic phospholipids and two glucolipids from Acholeplasma laidlawii, all having C2-deuterated acyl chains, have been performed. In the lamellar liquid crystalline (Lα) phase the phospholipids generate three Pake doublets with large differences in magnitude, while only two Pake doublets of similar magnitude are recorded from the glucolipids because of overlap between the two outer splittings. In an Lα phase with one phospholipid and one glucolipid a superposition of the individual 2H-NMR spectra is obtained. These results point to a distinct difference in the conformations of the initial segments of the acyl chains in the two lipid classes, and to the fact that the two acyl chains in the glucolipids have more similar average conformations of the initial segments. Furthermore, the results imply that the two lipids retain their respective acyl chain and glycerol backbone conformations in the mixtures. We report, for the first time, that separate quadrupole splittings are obtained from the sn-1 and each of the sn-2 deuterons present in phospholipids forming a reversed hexagonal (HII) phase. In contrast, glucolipids generate just one splitting in an HII phase. These results indicate that both the phospholipids and the glucolipids essentially retain their respective conformations of the acyl chains and the glycerol backbone upon a transition from an Lα to an HII phase. It is speculated that the different appearance of the spectra obtained from the glucolipids is achieved by slightly tilting the glycerol backbone relative to the normal of the bilayer surface. The reason for the tilting may be that the non-ionic, less hydrophilic, glucolipid headgroups are somewhat more deeply positioned in the interfacial polarity gradient of the bilayer than the ionic phosphate-containing headgroups.

The two-stage iterative methods for symmetric positive definite matrices

Two-stage iterative methods for the solution of the symmetric positive definite linear system Ax= b are considered. In this paper, in particular: strong conditions and feeble conditions on splittings are given so that the two-stage methods are convergent for any number of inner iterations and for any nonnegative even number of inner iterations, respectively. Some suitable examples of strong P-regular splittings are presented and the convergence of some feasible two-stage methods is discussed, in which the outer splitting is weak P-regular and the inner splitting is strong or weak P-regular splittings.