Portion Of Fiber Research Articles

On muscle spindles, dystonia and botulinum toxin

Dystonia may produce co-contractions and constant strain in numerous muscle fibers, including those of the muscle spindles. As proprioceptors, muscle spindles detect dynamic or static changes in muscle length and their afferent projections to the spinal cord play a central role in control of antagonistic muscles. Their parallel arrangement with extrafusal muscle fibers and association with the earlier recruited oxidative motor units allow them to conveniently sample the activity of all motor units and effectively modulate movement. At the same time, fusimotor muscle spindle innervation contracts the striated polar portions of the intrafusal muscle fibers and prevents their slackening during extrafusal muscle contractions. Botulinum toxin remains the most efficient therapy of dystonia. Its muscular mechanism of action is hinged on cholinergic blockade not only of extrafusal, but also of intrafusal muscle fibers. Besides being a targeted muscular therapy, the alteration of the corresponding sensory input following an effect of botulinum toxin on the intrafusal muscle fibers is pivotal in modulating loss of pre-synaptic inhibition in dystonia, including suppression of the tonic vibration reflex. Whether or not trans-synaptic botulinum toxin migration occurs, a modification of the central motor programming is bound to happen in dystonia, with botulinum toxin acting either as another 'sensory trick' or as a form of 'short-term plasticity'. Knowledge of the muscle spindle anatomy and function is key to unify our understanding of abnormal movements and of effects of botulinum toxin therapy. Thus, in dystonia, overactivity of muscles and increased spindle sensitivity are germane to botulinum toxin targets of action.

Horizontal portion of arcuate fasciculus fibers track to pars opercularis, not pars triangularis, in right and left hemispheres: A DTI study

The arcuate fasciculus (AF) is a white matter pathway traditionally considered to connect left Broca's area with posterior language zones. We utilized diffusion tensor imaging (DTI) in eight healthy subjects (5 M) to track pathways in the horizontal mid-portion of the AF (hAF) to subregions of Broca's area — pars triangularis (PTr) and pars opercularis (POp); and to ventral premotor cortex (vPMC) in the right and left hemispheres (RH, LH). These pathways have previously been studied in the LH, but not in the RH. Only 1/8 subjects showed fiber tracts between PTr and hAF in the RH (also, only 1/8 in the LH). In contrast to PTr, 5/8 subjects showed fiber tracts between POp and hAF in the RH (8/8 in the LH). Fiber tracts for vPMC were similar to those of POp, where 7/8 subjects showed fiber tracts between vPMC and hAF in the RH (8/8 in the LH). Our designated hAF could have included some of the superior longitudinal fasciculus (SLF) III, because it is difficult to separate the two fiber bundles. The SLF III has been previously reported to connect supramarginal gyrus with POp and vPMC in the LH. Thus, although the present DTI study showed almost no pathways between PTr and hAF in the RH (and in the LH), robust pathways were observed between POp and/or vPMC with hAF in the RH (and in LH). These results replicate previous studies for the LH, but are new, for the RH. They could contribute to better understanding of recovery in aphasia.

Development of high strength flowable mortar with hybrid fiber

An experimental study was conducted on the high strength flowable mortar reinforced by the different percentages of steel fiber (0–2%), palm fiber (0–1%) and the hybridization of these two fibers with 2% volumetric fractions to determine the density, compressive strength, flexural strength and toughness. The results show that such hybridization are promising concept and the replacement of a portion of steel fiber with palm fiber can significantly reduce the density, enhance the flexural strength and toughness.

A Novel Design of Grooved Fibers for Fiber-Optic Localized Plasmon Resonance Biosensors

Bio-molecular recognition is detected by the unique optical properties of self-assembled gold nanoparticles on the unclad portions of an optical fiber whose surfaces have been modified with a receptor. To enhance the performance of the sensing platform, the sensing element is integrated with a microfluidic chip to reduce sample and reagent volume, to shorten response time and analysis time, as well as to increase sensitivity. The main purpose of the present study is to design grooves on the optical fiber for the FO-LPR microfluidic chip and investigate the effect of the groove geometry on the biochemical binding kinetics through simulations. The optical fiber is designed and termed as U-type or D-type based on the shape of the grooves. The numerical results indicate that the design of the D-type fiber exhibits efficient performance on biochemical binding. The grooves designed on the optical fiber also induce chaotic advection to enhance the mixing in the microchannel. The mixing patterns indicate that D-type grooves enhance the mixing more effectively than U-type grooves. D-type fiber with six grooves is the optimum design according to the numerical results. The experimental results show that the D-type fiber could sustain larger elongation than the U-type fiber. Furthermore, this study successfully demonstrates the feasibility of fabricating the grooved optical fibers by the femtosecond laser, and making a transmission-based FO-LPR probe for chemical sensing. The sensor resolution of the sensor implementing the D-type fiber modified by gold nanoparticles was 4.1 × 10−7 RIU, which is much more sensitive than that of U-type optical fiber (1.8 × 10−3 RIU).

Hair interior defect in AKR/J mice

All AKR/J mice have a subtle defect that involves malformation of the central portion of hair fibres that is best visualized under white and polarized light microscopy. This study sought to characterize the clinical and ultrastructural features of the hair interior defect (HID) phenotype and to determine the chromosomal localization of the hid mutant gene locus. White and polarized light microscopy combined with scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to characterize the HID phenotype. Complementation testing and gene-linkage studies were performed to map the locus. Using SEM, the hair-fibre structure on the surface was found to be similar to hairs obtained from normal BALB/cByJ+/+and C57BL/6 J+/+mice. There were also no differences in sulphur content. TEM revealed degenerative changes in the medulla similar to that seen by light microscopy. This autosomal recessive mutation is called HID (locus symbol: hid). We mapped the hid locus to the distal end of mouse chromosome 1. No genes reported to cause skin or hair abnormalities are known to be within this interval except for the lamin B receptor (Lbr), which had been excluded previously as the cause of the hid phenotype in AKR/J mice. A potentially novel gene or known gene with a novel phenotype resides within this interval, which may shed light on human diseases with defects in the inner structure of the hair fibre.

A fiber-optic evanescent wave sensor for dissolved oxygen detection based on novel hybrid fluorinated xerogels immobilized with [Ru(bpy)3]2+

We have prepared a novel fiber-optic evanescent wave sensor (FEWS) for dissolved oxygen (DO) detection. The sensor fabrication was based on coating a decladded portion of an optical fiber with a microporous coating, which was prepared from 3,3,3-trifluoropropyltrimethoxysilane and n-propyltrimethoxysilane. The fluorophores were immobilized in the porous coating and excited by the evanescent wave field produced on the core surface of the optical fiber. The sensitivity of the sensor was quantified by the ratio of the fluorescence intensities in pure deoxygenated (I (0)) and in pure oxygenated environments (I). Results show that the quenching response of DO is increased with the enhancement of the coating surface hydrophobicity using the presented hybrid fluorinated ORMOSILs. The calibration curve of I (0)/I to [O(2)] is linear from 0 to 40 ppm and the detection limit is 0.05 ppm (3sigma) with a short response time of 15 s for DO detection.

Simulation of biochemical binding kinetics on the microfluidic biochip of fiber-optic localized plasma resonance (FO-LPR)

A reflection-based localized surface plasma resonance fiber-optic probe for chemical and biochemical sensing, called fiber-optic localized plasma resonance (FO-LPR), has been proposed in the literature. Bio-molecular recognition is detected by the unique optical properties of self-assembled gold nanoparticles on the unclad portions of an optical fiber whose surfaces are modified with a receptor. To enhance the performance of the sensing platform, the sensing element is integrated with microfluidic chips to reduce sample and reagent volume, to shorten response time and analysis time, as well as to increase sensitivity. The main purpose of the present study is to simulate the biochemical assays in the FO-LPR microfluidic chip and to investigate the effects parameters, such as inlet concentrations of analyte or the flowrate on the biochemical binding kinetics. The geometry of the grooved channel is also proposed to enhance the biochemical binding on the unclad optical fiber. The results reveal that the chaotic mixing generated by the grooves enhances the biochemical binding when the injected flowrate is high and, because of that, limits the performance of the molecular mixing. The enhancement of biochemical binding performance was significant, especially at the low injected concentration of analyte.

238 とうもろこし由来グリーンコンポジットの製造プロセス技術と引張特性評価に関する研究(生体・環境適合型材料の創製と特性評価)

From the viewpoint of functional cascade utilization of agricultural waste ; namely of non-woody plants with superior sustainability, this paper describes about tensile properties of the fiber extracted from maize stem and green composites (GC) composed of long maize fibers and biodegradable PLA matrix. Three sorts of maize fibers were prepared in order to evaluate the tensile properties of maize fiber. Tensile properties variation of maize fibers were analyzed statistically in connection with the portion of fibers extracted from a maize stem. Tensile strength was found to be superior for the fiber extracted from the upper portion of maize stem as compared with the one of lower potions, which is attainable to more than 450 MPa in average. Then, the long maize fiber/PLA composites with fiber volume fraction of 25% and 34% were manufactured and evaluated by means of tensile testing. As a result, the tensile strength of GC with fiber volume fraction of 34% was increased appreciably as compared to PLA polymer.

Plasma membrane removal in rat skeletal muscle fibers reveals caveolin-3 hot-spots at the necks of transverse tubules

Caveolin-3, the muscle-specific isoform of the caveolae-associated protein caveolin, is often thought to be localized exclusively in the surface membrane in mature fibers and associated with transverse (t)-tubular system only transiently during development. Skeletal muscle fibers present a model where the surface membrane (sarcolemma) can be completely separated from the cell by mechanical dissection. Western blotting of matching portions of individual fibers from adult rat muscle in which the sarcolemma was either removed (skinned segment), or left in place (intact segment), revealed that ≥ 70% of caveolin-3 is actually located deeper in the fiber rather than in the sarcolemma itself. Triton solubility of caveolin-3 was no different between sarcolemmal and t-tubule compartments. Confocal immunofluorescence microscopy showed caveolin-3 present throughout the t-system in adult fibers, with ‘hot-spots’ at the necks of the tubules in the sub-sarcolemmal space. A similar representation was seen for the muscle specific voltage-dependent sodium channel Nav1.4 and it was found that at least some Nav1.4 co-immunoprecipitated with caveolin-3 in skinned muscle fibers. The caveolin-3 hot-spots just inside the opening of t-tubules may form regions that localize ion channels and kinases at the key place needed for efficient electrical transmission into the t-tubules as well as for other signaling processes.

Retargeting R-Type Pyocins To Generate Novel Bactericidal Protein Complexes

R-type pyocins are high-molecular-weight bacteriocins that resemble bacteriophage tail structures and are produced by some Pseudomonas aeruginosa strains. R-type pyocins kill by dissipating the bacterial membrane potential after binding. The high-potency, single-hit bactericidal kinetics of R-type pyocins suggest that they could be effective antimicrobials. However, the limited antibacterial spectra of natural R-type pyocins would ultimately compromise their clinical utility. The spectra of these protein complexes are determined in large part by their tail fibers. By replacing the pyocin tail fibers with tail fibers of Pseudomonas phage PS17, we changed the bactericidal specificity of R2 pyocin particles to a different subset of P. aeruginosa strains, including some resistant to PS17 phage. We further extended this idea by fusing parts of R2 tail fibers with parts of tail fibers from phages that infect other bacteria, including Escherichia coli and Yersinia pestis, changing the killing spectrum of pyocins from P. aeruginosa to the bacterial genus, species, or strain that serves as a host for the donor phage. The assembly of active R-type pyocins requires chaperones specific for the C-terminal portion of the tail fiber. Natural and retargeted R-type pyocins exhibit narrow bactericidal spectra and thus can be expected to cause little collateral damage to the healthy microbiotae and not to promote the horizontal spread of multidrug resistance among bacteria. Engineered R-type pyocins may offer a novel alternative to traditional antibiotics in some infections.

Chromatin insulators and cohesins

Chromatin insulators have evolved to regulate transcription by using regulatory elements that are often distant from each other on the linear genome. This feature is position‐dependent—that is, a functional insulator must be positioned between the enhancer and its target promoter (Wallace & Felsenfeld, 2007). The molecular basis of insulation seems to be tightly linked to, and might depend on, several long‐range physical interactions between different portions of the chromatin fibre (Wallace & Felsenfeld, 2007). This is exemplified by the H19 imprinting control region, which not only regulates long‐range interactions but also the epigenetic states of a crucial cis element (Kurukuti et al , 2006). Independent suggestions have promoted the idea that components of the cohesin complex might participate in the formation of such complexes and contribute to the insulator function (Hagstrom & Meyer, 2003). This proposal has been partly borne out in three seminal reports published in recent issues of Nature (Wendt et al , 2008), Cell (Parelho et al , 2008) and The EMBO Journal (Stedman et al , 2008). Although the full implications of these observations remain to be elucidated, they have shed new light on how the enigmatic chromatin insulators might operate. How do the cohesins work and how are they organized? The cohesin complex comprises four components termed Smc1, Smc3, Scc3 and Scc1 (Smc for structural maintenance of chromosomes; Scc for Subunit of the cohesin complex), also known as Rad21. It has been proposed that Smc1 and Smc3 form a heterodimer together with Scc1, and that Scc3 organizes a ring structure. In addition, Scc2 and Scc4 are required for the loading of the cohesin complex onto the chromatin fibre. Functionally, the cohesin complex holds sister chromatids together after DNA replication until their sequential separation during G2/M phases. This function is essential for genomic DNA stability and repair (for reviews, see …

Characterizing the Expansive Deformation of a Bioresorbable Polymer Fiber Stent

Polymeric vascular stents must employ other strategies than malleable deformation, as generally practiced with metal stents, to expand and withstand compressive stresses in situ. The stent expansion strategy must further consider induced flow perturbations and wall stresses that may injure the vessel wall and promote thrombogenesis. Analyzing the stresses furled stents undergo during balloon-assisted expansion is an important first step in achieving a better understanding of stent-wall mechanical interactions, thereby to improve stent function. To this end, we performed finite element (FE) analysis of the balloon-induced unfurling of an internally coiled, bioresorbable polymeric stent employing a 3D FE solid model of a 120 degrees symmetric stent segment and a large deformation finite strain formulation. Uni-axial tensile testing of stent fiber elastic to plastic yielding provided the mechanical property information, and the von Mises criterion was employed to establish the elastic-plastic transition in the FE model. The model was validated with pressure and deformation measurements obtained during stent expansion tests. The internal coils of this inner coil-outer coil design twisted as the stent expanded, leading to plastic yielding at the point of tangency of the inner and outer coils. The remaining stent fiber portions underwent elastic bending. Cross-sections revealed only the outside surface layer of the coiled fiber underwent plastic yielding. The interior elastic fiber was supported by this plastic shell. The analysis suggests that during balloon-induced expansion, local plastic yielding in torsion "sets" the stent fibers, imparting high radial collapse resistance. The results further suggest that the stent exerts non-uniform mechanical forces on the vessel wall during expansion.

Perineural Resiniferatoxin Selectively Inhibits Inflammatory Hyperalgesia

Resiniferatoxin (RTX) is an ultrapotent capsaicin analog that binds to the transient receptor potential channel, vanilloid subfamily member 1 (TRPV1). There is a large body of evidence supporting a role for TRPV1 in noxious-mediated and inflammatory hyperalgesic responses. In this study, we evaluated low, graded, doses of perineural RTX as a method for regional pain control. We hypothesized that this approach can provide long-term, but reversible, blockade of a portion of nociceptive afferent fibers within peripheral nerves when given at a site remote from the neuronal perikarya in the dorsal root ganglia. Following perineural RTX application to the sciatic nerve, we demonstrated a significant inhibition of inflammatory nociception that was dose- and time-dependent. At the same time, treated animals maintained normal proprioceptive sensations and motor control, and other nociceptive responses were largely unaffected. Using a range of mechanical and thermal algesic tests, we found that the most sensitive measure following perineural RTX administration was inhibition of inflammatory hyperalgesia. Recovery studies showed that physiologic sensory function could return as early as two weeks post-RTX treatment, however, immunohistochemical examination of the DRG revealed a partial, but significant reduction in the number of the TRPV1-positive neurons. We propose that this method could represent a beneficial treatment for a range of chronic pain problems, including neuropathic and inflammatory pain not responding to other therapies.

Evaluation of Asbestos Exposures during Firewood-Harvesting Simulations in Libby, MT, USA—Preliminary Data

Research was conducted in order to assess potential exposure to asbestos while harvesting firewood from amphibole-contaminated trees near Libby, MT, USA. Three firewood-harvesting simulations took place in the summer and fall of 2006 in the Kootenai Forest inside the US Environmental Protection Agency (EPA) restricted zone surrounding the former W.R. Grace vermiculite mine. Another simulation was conducted near Missoula, MT, USA, which served as the control. The work practices following each simulation were consistent throughout each trial. Personal breathing zone (PBZ) asbestos concentrations were measured by phase contrast microscopy (PCM) and transmission electron microscopy (TEM). Surface wipe samples of personal protective clothing were measured by TEM. The mean (n = 12) PBZ PCM sample time-weighted average (TWA) concentration was 0.29 fibers per milliliter, standard deviation (SD = 0.54). A substantial portion (more than five fibers per sample) of non-asbestos fibers (cellulose) was reported on all PBZ samples (excluding field blanks) when analyzed by TEM. The mean (n = 12) PBZ TEM sample TWA concentration for amphibole fibers <5-microm long was 0.15 fibers per milliliter (SD = 0.21) and the mean (n = 12) PBZ TEM concentration for amphibole fibers >5-microm long was 0.07 fibers per milliliter (SD = 0.08). Substantial amphibole fiber concentrations were revealed on Tyvek clothing wipe samples. The mean concentration (n = 12) was 29 826 fibers per square centimeter (SD = 37 555), with 91% (27 192 fibers per square centimeter) comprised fibers <5-microm long. There were no significant differences in PBZ and wipe sample concentrations among the tasks performed by four investigators. Each of these three simulations were consistent in demonstrating that amphibole fibers are released from tree reservoirs during firewood-harvesting activities in asbestos-contaminated areas and that the potential for exposure exists during such activities.

The Resonant Bandwidth Enhancement in a Mechanically Induced Long Period Fiber Grating Formed over a Twisted Fiber

A mechanically induced grating formed over a twisted fiber can increase the resonant bandwidth. The tunability and control of the resonant bandwidth is found to be dependent on the induced twist. The effective group indices of cladding modes increase with the twist-induced birefringence. The difference in group indices between the LP 01 and the cladding modes LP 11 , LP 12 , and LP 13 decreases as the fiber twist rate increases above 0.5 turns/cm. This results in bandwidth enhancement of the grating. This broadband mode converter, which has a wide tunability, is cost effective and insensitive to pressure-induced birefringence. The resonant bandwidth can be increased and tuned further by forming two gratings in series with a twist-free and twisted fiber portions. A coupling bandwidth of around 100 nm (< 3 db) is achieved in this dual grating technique.

Detection of antinuclear antibodies by a colloidal gold modified optical fiber: comparison with ELISA

A fiberoptic evanescent-wave sensor has been developed for the measurement of antinuclear antibodies in sera from patients and healthy individuals. The sensor was constructed on the basis of modification of the unclad portion of an optical fiber with self-assembled gold colloids, where the colloidal gold surface was further functionalized with extractable nuclear antigens. Results show that detection of antinuclear antibodies by this sensor agrees quantitatively with the clinically accepted enzyme-linked immunosorbent assay (ELISA) method. This sensing platform has the following advantages: label-free and real-time detection capability, simple to construct and use, highly sensitive, and does not require a secondary antibody. The sensitivity of this platform is at least an order of magnitude higher than that of the ELISA method and thus may lead to a new direction in recognition of immune response.

Non-synaptic transmission at autonomic neuroeffector junctions

Non-synaptic transmission is characteristic of autonomic neuroeffector junctions. The structure of the autonomic neuromuscular junction is described. The essential features are that: the terminal portions of autonomic nerve fibers are varicose and mobile, transmitters being released ‘en passage’ from varying distances from the effector cells; while there is no structural post-junctional specialization on effector cells, receptors for neurotransmitters accumulate on cell membranes at close junctions; muscle effectors are bundles rather than single smooth muscle cells, that are connected by gap junctions which allow electrotonic spread of activity between cells. A multiplicity of transmitters are utilized by autonomic nerves, and cotransmission occurs often involving synergistic actions of the cotransmitters, although pre- and post-junctional neuromodulation of neurotransmitter release also take place. It is suggested that autonomic neural control of immune, epithelial and endothelial cells also involves non-synaptic transmission.

Primary face motor area as the motor representation of articulation

No clinical data have yet been presented to show that a lesion localized to the primary motor area (M1) can cause severe transient impairment of articulation, although a motor representation for articulation has been suggested to exist within M1. Here we describe three cases of patients who developed severe dysarthria, temporarily mimicking speech arrest or aphemia, due to a localized brain lesion near the left face representation of the human primary motor cortex (face-M1). Speech was slow, effortful, lacking normal prosody, and more affected than expected from the degree of facial or tongue palsy. There was a mild deficit in tongue movements in the sagittal plane that impaired palatolingual contact and rapid tongue movements. The speech disturbance was limited to verbal output, without aphasia or orofacial apraxia. Overlay of magnetic resonance images revealed a localized cortical region near face-M1, which displayed high intensity on diffusion weighted images, while the main portion of the corticobulbar fibers arising from the lower third of the motor cortex was preserved. The cases suggest the existence of a localized brain region specialized for articulation near face-M1. Cortico-cortical fibers connecting face-M1 with the lower premotor areas including Broca's area may also be important for articulatory control.

Repairing process in the transected muscle fibers of the mouse tibialis anterior.

Repairing process at the injury site in the transected muscle fibers of the mouse tibialis anterior was studied by light and electron microscopy. Immediately after the transection, the cut end (approximately 10 µm) was filled with dense network of disorganized myofilaments, in which disrupted membranous structures and degraded mitochondria were scattered. In the portion next to the portion exhibiting sudden necrotic changes, morphological features of the myofilaments, mitochondria and membranous structures appeared to be almost normal. The degradation of disorganized myofilaments at the cut end began within 1 hour after the transection, and at 1hour after the transection, the degenerating areas were noted in most of muscle fibers up to 150-250 µm from the cut end. Following the degradation, accumulation of mitochondria occurred between the necrotic and myofilament-predominant living portions, and several transverse tubules (T-tubules) and sarcoplasmic reticula were found between the mitochondria-accumulated and myofilament-predominant areas. In most cases, demarcation membrane formed between the mitochondria-accumulated and myofilament-predominant areas, and the fusion of T-tubules and sarcoplasmic reticula was encountered in these areas, suggesting that at least some parts of the demarcation membranes formed through fusion of T-tubules and sarcoplasmic reticula. This repairing process was completed in a number of muscle fibers within 6 hours after the transection. Macrophages were first found in the injured portions at 6 hours after the transection, increased in number with time, and several macrophages were distributed at 1 to 3 days after the transection. Some spindle-shaped cells were first found in the degenerating portions of the muscle fibers at 1 day after the transection. Since they were located along the basal lamina of the muscle fiber, and had a long oval pale nucleus and relatively abundant cytoplasm, they can be regarded as activated satellite cells. They gradually increased in number with time, and became larger and longer. On and after 5 days, thin regenerating muscle fibers exhibiting centrally located nuclei were observed, and they became gradually thicker with time. These findings indicate that the muscle regeneration was actively occurring during these periods. The repairing process is followed by the invasion of macrophages, and then the occurrence of muscle regeneration in the sequential order. These findings suggest that there might be close chronological relationship among these events.

A New Z-Epicanthoplasty and a Concomitant Double Eyelidplasty in Chinese Eyelids

Patients with no double eyelid folds and with a mild or moderate medial epicanthus are most typically Asians. After only receiving double eyelidplasty, they often complain that their eyes look round and their eyelid fissures are shorter because their medial epicanthi still exist. In this article, according to the authors' surgical findings, it is reasoned that the malpositioned portion of the orbicularis oculi muscle fibers is the main cause of congenital medial epicanthus. Several design principles for performing the Z-epicanthoplasty concomitant with a double eyelidplasty were advanced: (1) removal of the main deformity-formed cause, (2) correcting the pretarsal skin shortage in the medial upper eyelid, (3) preventing the prominent scarring in the medial canthal area, and (4) achieving other advantages (i.e., easy design and operation, precision of performance with a concomitant double eyelidplasty, and excellent and reproducible results). Epicanthoplasty only was performed in six patients. An epicanthoplasty concomitant with a double eyelidplasty was performed in 230 cases with congenital or traumatic medial epicanthi. Sixty-seven cases in this series were followed up for 4 to 23 months (average, 7 months). The contours of the double eyelids were natural. Mild scar proliferation was observed in all of the patients in the early postoperative period and then would diminish and become a gray-white line. Some skin wrinkles and skin shadow on the B flap could be seen. The indications for this procedure are all types of medial epicanthi but the inversus type. Older age is a relative contraindication.